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Meta-Analysis
. 2009 Mar;108(1-3):11-24.
doi: 10.1016/j.schres.2008.11.027. Epub 2009 Jan 11.

Meta-analysis of the effects of repetitive transcranial magnetic stimulation (rTMS) on negative and positive symptoms in schizophrenia

Catarina Freitas  1 , Felipe Fregni, Alvaro Pascual-Leone
Affiliations
Meta-Analysis

Meta-analysis of the effects of repetitive transcranial magnetic stimulation (rTMS) on negative and positive symptoms in schizophrenia

Catarina Freitas et al. Schizophr Res. 2009 Mar.

Abstract

Background: A growing body of evidence suggests that repetitive transcranial magnetic stimulation (rTMS) can alleviate negative and positive symptoms of refractory schizophrenia. However, trials to date have been small and results are mixed.

Methods: We performed meta-analyses of all prospective studies of the therapeutic application of rTMS in refractory schizophrenia assessing the effects of high-frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) to treat negative symptoms, and low-frequency rTMS to the left temporo-parietal cortex (TPC) to treat auditory hallucinations (AH) and overall positive symptoms.

Results: When analyzing controlled (active arms) and uncontrolled studies together, the effect sizes showed significant and moderate effects of rTMS on negative and positive symptoms (based on PANSS-N or SANS, and PANSS-P or SAPS, respectively). However, the analysis for the sham-controlled studies revealed a small non-significant effect size for negative (0.27, p=0.417) and for positive symptoms (0.17, p=0.129). When specifically analyzing AH (based on AHRS, HCS or SAH), the effect size for the sham-controlled studies was large and significant (1.04; p=0.002).

Conclusions: These meta-analyses support the need for further controlled, larger trials to assess the clinical efficacy of rTMS on negative and positive symptoms of schizophrenia, while suggesting the need for exploration for alternative stimulation protocols.

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Conflict of interest statement

Conflicts of interest

We disclose no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of the selection process of peer-reviewed articles for main analyses (negative and positive symptoms) and additional analysis (auditory hallucinations).
Figure 2
Figure 2
Pooled effect size (before versus after treatment) for studies of rTMS effects on negative symptoms (random effect model).
Figure 3
Figure 3
Estimates of the random effect model omitting one study at a time (rTMS effects on negative symptoms).
Figure 4
Figure 4
Begg’s funnel plot (95% CI) (rTMS effects on negative symptoms).
Figure 5
Figure 5
Pooled effect size (placebo versus active treatment) for studies of rTMS effects on negative symptoms (random effect model).
Figure 6
Figure 6
Pooled effect size (before versus after treatment) for studies of rRMS effects on positive symptoms (random effect model).
Figure 7
Figure 7
Estimates of the random effect model omitting one study at a time (rTMS effects on positive symptoms).
Figure 8
Figure 8
Begg’s funnel plot (95% CI) (rTMS effects on overall positive symptoms).
Figure 9
Figure 9
Pooled effect size (placebo versus active treatment) for studies of rTMS effect on overall positive symptoms (random effect model).
Figure 10
Figure 10
Pooled effect size (before versus after treatment) for studies of rTMS effects on auditory hallucinations (random effect model).
Figure 11
Figure 11
Pooled effect size (placebo versus active treatment) for studies of rTMS effects on auditory hallucinations (random effect model).
See this image and copyright information in PMC

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