Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2015-0072
Trends in Psychiatry and Psychotherapy
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Transcranial magnetic stimulation for posttraumatic stress disorder: an updated systematic review and meta-analysis

Estimulação magnética transcraniana para transtorno de estresse pós-traumático: revisão sistemática de literatura e metanálise

Alisson Paulino Trevizol; Mirna Duarte Barros; Paula Oliveira Silva; Elizabeth Osuch; Quirino Cordeiro; Pedro Shiozawa

http://dx.doi.org/10.1590/2237-6089-2015-0072 Trends Psychiatry Psychother, vol.38, n1, p.50-55, 2016
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Abstract

Introduction Transcranial magnetic stimulation (TMS) is a promising non-pharmacological intervention for posttraumatic stress disorder (PTSD). However, randomized controlled trials (RCTs) and meta-analyses have reported mixed results. Objective To review articles that assess the efficacy of TMS in PTSD treatment. Methods A systematic review using MEDLINE and other databases to identify studies from the first RCT available up to September 2015. The primary outcome was based on PTSD scores (continuous variable). The main outcome was Hedges' g. We used a random-effects model using the statistical packages for meta-analysis available in Stata 13 for Mac OSX. Heterogeneity was evaluated with I2 (> 35% for heterogeneity) and the χ2 test (p < 0.10 for heterogeneity). Publication bias was evaluated using a funnel plot. Meta-regression was performed using the random-effects model. Results Five RCTs (n = 118) were included. Active TMS was significantly superior to sham TMS for PTSD symptoms (Hedges' g = 0.74; 95% confidence interval = 0.06-1.42). Heterogeneity was significant in our analysis (I2 = 71.4% and p = 0.01 for the χ2 test). The funnel plot shows that studies were evenly distributed, with just one study located marginally at the edge of the funnel and one study located out of the funnel. We found that exclusion of either study did not have a significant impact on the results. Meta-regression found no particular influence of any variable on the results. Conclusion Active TMS was superior to sham stimulation for amelioration of PTSD symptoms. Further RCTs with larger sample sizes are fundamental to clarify the precise impact of TMS in PTSD.

Keywords

Meta-analysis, posttraumatic stress disorder, transcranial magnetic stimulation, non-pharmacological therapies, systematic review

Resumo

Introdução A estimulação magnética transcraniana (EMT) é uma intervenção não farmacológica promissora no tratamento de transtorno de estresse pós-traumático (TEPT). No entanto, estudos controlados e metanálises apresentaram resultados conflitantes até o momento. Objetivo Revisar os artigos sobre a eficácia da EMT para o tratamento de TEPT. Métodos Conduzimos uma revisão sistemática da literatura no MEDLINE para identificar estudos controlados e randomizados publicados até setembro de 2015. O desfecho primeiro foi baseado nas escalas de gravidade de TEPT como variáreis contínuas. O desfecho principal foi o g de Hedges. Utilizamos o modelo de efeito randômico com as análises estatísticas para metanálise do Stata 13 para Mac OSX. A heterogeneidade foi avaliada com o I2 (> 35% para heterogeneidade) e o teste do χ2 (p < 0,01 para heterogeneidade). Viés de publicação foi avaliado utilizando-se o gráfico do funil. Realizamos metarregressões com modelo de efeito randômico. Resultados Cinco estudos foram incluídos. A EMT ativa foi superior ao placebo para o tratamento de TEPT (g de Hedges = 0,74; intervalo de confiança 95% = 0,06-1,42). A heterogeneidade entre os estudos foi significativa em nossa análise (I2 = 71,4% e p = 0,01 para o teste do χ2). O gráfico do funil nos mostrou estudos simetricamente distribuídos, com apenas um estudo localizado marginalmente ao gráfico e um estudo localizado fora do funil. Encontramos que a exclusão de cada estudo não alterou significativamente o resultado final. A metarregressão não mostrou influência de nenhuma variável no resultado. Conclusões A estimulação ativa de EMT foi superior à estimulação simulada para melhora dos sintomas de TEPT. Novos estudos randomizados e controlados por simulação são necessários para esclarecer com melhor precisão o impacto da EMT no TEPT.

Palavras-chave

Metanálise, transtorno de estresse pós-traumático, estimulação magnética transcraniana, terapias não farmacológicas, revisão sistemática

References

Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048-60.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC. Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 2000;61:60-6.

Pagani M, Hogberg G, Salmaso D, Tarnell B, Sanchez-Crespo A, Soares J. Regional cerebral blood flow during auditory recall in 47 subjects exposed to assaultive and non-assaultive trauma and developing or not posttraumatic stress disorder. Eur Arch Psychiatry Clin Neurosci. 2005;255:359-65.

Karsen EF, Watts BV, Holtzheimer PE. Review of the effectiveness of transcranial magnetic stimulation for post-traumatic stress disorder. Brain Stimul. 2014;7:151-7.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.

Boggio PS, Rocha M, Oliveira MO, Fecteau S, Cohen RB, Campanha C. Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder. J Clin Psychiatry. 2010;71:992-9.

Cohen H, Kaplan Z, Kotler M, Kouperman I, Moisa R, Grisaru N. Repetitive transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in posttraumatic stress disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2004;161:515-24.

Isserles M, Shalev AY, Roth Y, Peri T, Kutz I, Zlotnick E. Effectiveness of deep transcranial magnetic stimulation combined with a brief exposure procedure in post-traumatic stress disorder--a pilot study. Brain Stimul. 2013;6:377-83.

Osuch EA, Benson BE, Luckenbaugh DA, Geraci M, Post RM, McCann U. Repetitive TMS combined with exposure therapy for PTSD: a preliminary study. J Anxiety Disord. 2009;23:54-9.

Knapp G, Hartung J. Improved tests for a random effects meta-regression with a single covariate. Stat Med. 2003;22:2693-710.

Watts BV, Landon B, Groft A, Young-Xu Y. A sham controlled study of repetitive transcranial magnetic stimulation for posttraumatic stress disorder. Brain Stimul. 2012;5:38-43.

Tillman GD, Kimbrell TA, Calley CS, Kraut MA, Freeman TW, Hart Jr J. Repetitive transcranial magnetic stimulation and threat memory: selective reduction of combat threat memory p300 response after right frontal-lobe stimulation. J Neuropsychiatry Clin Neurosci. 2011;23:40-7.

Rabe S, Beauducel A, Zollner T, Maercker A, Karl A. Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident. J Abnorm Psychol. 2006;115:687-98.

Morey RA, Dolcos F, Petty CM, Cooper DA, Hayes JP, LaBar KS. The role of trauma-related distractors on neural systems for working memory and emotion processing in posttraumatic stress disorder. J Psychiatr Res. 2009;43:809-17.

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