TY - JOUR
T1 - Effects of repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex on symptom domains in neuropsychiatric disorders
T2 - a systematic review and cross-diagnostic meta-analysis
AU - Kan, Rebecca L.D.
AU - Padberg, Frank
AU - Giron, Cristian G.
AU - Lin, Tim T.Z.
AU - Zhang, Bella B.B.
AU - Brunoni, Andre R.
AU - Kranz, Georg S.
N1 - Funding Information:
This study was funded by the General Research Fund under the University Grants Committee of the Hong Kong Special Administrative Region (numbers 15100120 and 25100219) and the Mental Health Research Center, The Hong Kong Polytechnic University.
Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/4
Y1 - 2023/4
N2 - Background: The left dorsolateral prefrontal cortex is a prime target for repetitive transcranial magnetic stimulation (TMS) to treat neuropsychiatric disorders; thus, abundant efficacy data from controlled trials are available. A cross-diagnostic meta-analysis was conducted to identify the symptom domains susceptible to repetitive TMS to the left dorsolateral prefrontal cortex. Methods: This systematic review and meta-analysis investigated the effects of repetitive TMS to the left dorsolateral prefrontal cortex on neuropsychiatric symptoms presenting across diagnoses. We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for randomised and sham controlled trials published from inception to Aug 17, 2022. Included studies assessed symptoms using clinical measures and reported sufficient data to calculate effect sizes pooled with a random effects model. Two independent reviewers conducted screening and used the Cochrane risk-of-bias tool for quality assessment. Summary data were extracted from published reports. The main outcome was the therapeutic effects of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains. This study is registered with PROSPERO (CRD42021278458). Findings: Of 9056 studies identified (6704 from databases and 2352 from registers), 174 were included in the analysis including 7905 patients. 163 of 174 studies reported gender data; 3908 (52·35%) of 7465 patients were male individuals, and 3557 (47·65%) were female individuals. Mean age was 44·63 years (range 19·79–72·80). Ethnicity data were mostly not available. Effect size was large for craving (Hedges' g –0·803 [95% CI –1·099 to –0·507], p<0·0001; I2=82·40%), medium for depressive symptoms (–0·725 [–0·889 to –0·561], p<0·0001; I2=85·66%), small for anxiety, obsessions or compulsions, pain, global cognition, declarative memory, working memory, cognitive control, and motor coordination (Hedges' g –0·198 to –0·491), and non-significant for attention, suicidal ideation, language, walking ability, fatigue, and sleep. Interpretation: The cross-diagnostic meta-analysis shows the efficacy of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains, providing a novel framework for assessing target or efficacy interactions of repetitive TMS, and informing personalised applications for conditions for which regular trials are uninformative. Funding: The University Grants Committee of Hong Kong and the Mental Health Research Center, The Hong Kong Polytechnic University.
AB - Background: The left dorsolateral prefrontal cortex is a prime target for repetitive transcranial magnetic stimulation (TMS) to treat neuropsychiatric disorders; thus, abundant efficacy data from controlled trials are available. A cross-diagnostic meta-analysis was conducted to identify the symptom domains susceptible to repetitive TMS to the left dorsolateral prefrontal cortex. Methods: This systematic review and meta-analysis investigated the effects of repetitive TMS to the left dorsolateral prefrontal cortex on neuropsychiatric symptoms presenting across diagnoses. We searched PubMed, MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for randomised and sham controlled trials published from inception to Aug 17, 2022. Included studies assessed symptoms using clinical measures and reported sufficient data to calculate effect sizes pooled with a random effects model. Two independent reviewers conducted screening and used the Cochrane risk-of-bias tool for quality assessment. Summary data were extracted from published reports. The main outcome was the therapeutic effects of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains. This study is registered with PROSPERO (CRD42021278458). Findings: Of 9056 studies identified (6704 from databases and 2352 from registers), 174 were included in the analysis including 7905 patients. 163 of 174 studies reported gender data; 3908 (52·35%) of 7465 patients were male individuals, and 3557 (47·65%) were female individuals. Mean age was 44·63 years (range 19·79–72·80). Ethnicity data were mostly not available. Effect size was large for craving (Hedges' g –0·803 [95% CI –1·099 to –0·507], p<0·0001; I2=82·40%), medium for depressive symptoms (–0·725 [–0·889 to –0·561], p<0·0001; I2=85·66%), small for anxiety, obsessions or compulsions, pain, global cognition, declarative memory, working memory, cognitive control, and motor coordination (Hedges' g –0·198 to –0·491), and non-significant for attention, suicidal ideation, language, walking ability, fatigue, and sleep. Interpretation: The cross-diagnostic meta-analysis shows the efficacy of repetitive TMS of the left dorsolateral prefrontal cortex on distinct symptom domains, providing a novel framework for assessing target or efficacy interactions of repetitive TMS, and informing personalised applications for conditions for which regular trials are uninformative. Funding: The University Grants Committee of Hong Kong and the Mental Health Research Center, The Hong Kong Polytechnic University.
UR - http://www.scopus.com/inward/record.url?scp=85150214608&partnerID=8YFLogxK
U2 - 10.1016/S2215-0366(23)00026-3
DO - 10.1016/S2215-0366(23)00026-3
M3 - Journal article
C2 - 36898403
AN - SCOPUS:85150214608
SN - 2215-0366
VL - 10
SP - 252
EP - 259
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 4
ER -