Repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex for treating posttraumatic stress disorder: an exploratory meta-analysis of randomized, double-blind and sham-controlled trials.

TitleRepetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex for treating posttraumatic stress disorder: an exploratory meta-analysis of randomized, double-blind and sham-controlled trials.
Publication TypeJournal Article
Year of Publication2014
AuthorsBerlim M, Van den Eynde F
JournalCan J Psychiatry
Volume59
Issue9
Pagination487-96
Date Published2014 Sep
ISSN0706-7437
KeywordsAdult, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prefrontal Cortex, Psychiatric Status Rating Scales, Randomized Controlled Trials as Topic, Stress Disorders, Post-Traumatic, Transcranial Magnetic Stimulation, Treatment Outcome
Abstract

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) has yielded promising results as a treatment for posttraumatic stress disorder (PTSD). However, to date, no quantitative review of its clinical utility has been published.METHOD: We searched for randomized and sham-controlled trials from 1995 to March 2013 using MEDLINE, Embase, PsycINFO, CENTRAL, and SCOPUS. We then performed an exploratory random effects meta-analysis.RESULTS: Studies on rTMS applied to the right DLPFC included 64 adults with PTSD. The pooled Hedges g effect size for pre and post changes in clinician-rated and self-reported PTSD symptoms were, respectively, 1.65 (P < 0.001) and 1.91 (P < 0.001), indicating significant and large-sized differences in outcome favouring active rTMS. Also, there were significant pre and post decreases with active rTMS in overall anxiety (Hedges g = 1.24; P = 0.02) and depressive (Hedges g = 0.85; P < 0.001) symptoms. Dropout rates at study end did not differ between active and sham rTMS groups. Regarding rTMS applied to the left DLPFC, there is only one study published to date (using a high frequency protocol), and its results showed that active rTMS seems to be superior overall to sham rTMS.CONCLUSIONS: Our exploratory meta-analysis shows that active rTMS applied to the DLPFC seems to be effective and acceptable for treating PTSD. However, the small number of subjects included in the analyses limits the generalizability of these findings. Future studies should include larger samples and deliver optimized stimulation parameters.

Alternate JournalCan J Psychiatry
PubMed ID25565694
PubMed Central IDPMC4168811

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