Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: A systematic review and meta-analysis of randomized controlled clinical trials

Shen, Xinyi; Liu, MingYi; Cheng, Yu; Cui, Jia; Pan, XinYue; Gou, QingYun; Liu, Xinlian; Cao, Hui; Zhang, Lushun

doi:10.1016/j.jad.2016.12.058

“…After examination of the full text of the remaining 123 articles, 109 additional references were discarded. 14 meta-analyses (8 for neurological disorders [18][19][20][21][22][23][24][25] and 6 for psychiatric disorders [12,26-30]) were included in the analysis. A flowchart, detailing the study selection process and reasons for exclusion, is provided in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

Excess significance bias in repetitive transcranial magnetic stimulation literature for neuropsychiatric disorders

Amad

¹

,

Jardri²,

Rousseau

³

et al. 2019

Preprint

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IntroductionRepetitive transcranial magnetic stimulation (rTMS) has been widely tested and promoted for use in multiple neuropsychiatric conditions, but as for many other medical devices, some gaps may exist in the literature and the evidence base for rTMS clinical efficacy remains under debate. We aimed to empirically test for an excess number of statistically significant results in the literature on rTMS therapeutic efficacy across a wide range of meta-analyses and to characterize the power of studies included in these meta-analyses. MethodsBased on power calculations, we computed the expected number of "positive" datasets for a medium effect-size (standardized mean difference, SMD=0.30) and compared it with the number of observed "positive" datasets. Sensitivity analyses considered small (SMD=0.20), modest (SMD=0.50), and large (SMD=0.80) effect sizes. Results14 meta-analyses with 228 datasets (110 for neurological disorders and 118 for psychiatric disorders) were assessed. For SMD=0.3, the number of observed "positive" studies (n=94) was larger than expected (n=35). We found evidence for an excess of significant findings overall (p<0.0001) and in 8/14 meta-analyses. Evidence for an excess of significant findings was also observed for SMD=0.5 for neurological disorders. 0 (0 %), 0 (0 %), 3 (1 %), and 53 (23 %) of the 228 datasets had power >0.80, respectively for SMDs of 0.30, 0.20, 0.50, and 0.80. ConclusionMost studies in the rTMS literature are underpowered. This results in fragmentation and waste of research efforts. The somewhat high frequency of "positive" results seems spurious and may reflect bias.

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“…• Transcranial stimulation targets the distributed brain network responsible for depression and delivers magnetic stimulation in short time. Transcranial direct current stimulation along with cognitive control therapy as a combination is used to treat the post-stroke depression, and it showed a response rate of 25% and is beneficial in chronic stroke patients [60][61][62].…”

Section: Chandrasekar Et Almentioning

confidence: 99%

Post-Stroke Psychiatric Disorders: An Overview on Its Screening and Management

Chandrasekar

¹

,

Sai

²

,

John

³

et al. 2019

Asian J Pharm Clin Res

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Stroke is the third leading cause of death. Stroke occurs when an insufficient amount of blood is supplied to the brain due to a thrombus or an emboli leading to permanent tissue damage. Lesions in the brain can lead to psychiatric complications. The prevalence of psychiatric complications after stroke is very common. Psychiatric complications such as depression, anxiety, apathy, pseudobulbar effects (laughing and crying), mania, psychosis, and bipolar disorders are seen after stroke. In this review, various psychiatric disorders are reported among post-stroke survivors in which depression and anxiety are common. Consequently, apathy, pseudobulbar effects, catastrophic reactions, psychosis, bipolar disorder, and mania are also observed after stroke. Therefore, early detection and management of psychiatric disorders prevent further complications and improve the quality of life in post-stroke patients.

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“…Yoga aids to improve the muscle strength, aerobic capacity, and plasticity and used as an adjuvant therapy in post-stroke depression [53,54]. Transcranial direct current stimulation along with cognitive control therapy as a combination is used to treat the post-stroke depression, and it showed a response rate of 25% and is beneficial in chronic stroke patients [60][61][62].…”

Section: Review Articlementioning

confidence: 99%

Post-Stroke Psychiatric Disorders: An Overview on Its Screening and Management

Chandrasekar

¹

,

Sai

²

,

John

³

et al. 2019

Asian J Pharm Clin Res

0

View full text Add to dashboard Cite

Stroke is the third leading cause of death. Stroke occurs when an insufficient amount of blood is supplied to the brain due to a thrombus or an emboli leading to permanent tissue damage. Lesions in the brain can lead to psychiatric complications. The prevalence of psychiatric complications after stroke is very common. Psychiatric complications such as depression, anxiety, apathy, pseudobulbar effects (laughing and crying), mania, psychosis, and bipolar disorders are seen after stroke. In this review, various psychiatric disorders are reported among post-stroke survivors in which depression and anxiety are common. Consequently, apathy, pseudobulbar effects, catastrophic reactions, psychosis, bipolar disorder, and mania are also observed after stroke. Therefore, early detection and management of psychiatric disorders prevent further complications and improve the quality of life in post-stroke patients.

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Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: A systematic review and meta-analysis of randomized controlled clinical trials

Cited by 93 publications

References 26 publications

Excess significance bias in repetitive transcranial magnetic stimulation literature for neuropsychiatric disorders

Excess significance bias in repetitive transcranial magnetic stimulation literature for neuropsychiatric disorders

Post-Stroke Psychiatric Disorders: An Overview on Its Screening and Management

Post-Stroke Psychiatric Disorders: An Overview on Its Screening and Management

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