The effects of repetitive transcranial magnetic stimulation on empathy: a systematic review and meta-analysis

Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols.

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Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03600-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hyune June Lee ◽

Sung Min Kim ◽

Ji Yean Kwon

Keyword(s):

Systematic Review ◽

Transcranial Magnetic Stimulation ◽

Side Effects ◽

Electroconvulsive Therapy ◽

Effect Size ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Cochrane Library ◽

Peripartum Depression

Abstract Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

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Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211068788 ◽

2021 ◽

pp. 000486742110687

Author(s):

Paul B Fitzgerald ◽

Shane Gill ◽

Michael Breakspear ◽

Jayashri Kulkarni ◽

Leo Chen ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Public Funding ◽

Antidepressant Medication ◽

Cost Effective ◽

Cost Effective Treatment ◽

Economic Analyses ◽

Meta Analyses

Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression – it is a safe, effective and cost-effective treatment.

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A meta-analysis of the effects of repetitive transcranial magnetic stimulation on aphasia rehabilitation in stroke patients

Neurology Asia ◽

10.54029/2021xjx ◽

2021 ◽

Vol 26 (3) ◽

pp. 491-500

Author(s):

Mehrnaz Gholami ◽

Noushin Pourbaghi ◽

Samaneh Taghvatalab

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Speech Therapy ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Stroke Patients ◽

Standard Mean Difference ◽

Meta Analyses

Background & Objective: Aphasia—acquired loss of the ability to understand or express language—is a common and debilitating neurological consequence of stroke. Evidence suggests that transcranial magnetic stimulation (TMS) can signiﬁcantly improve language outcomes in patients with aphasia. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonﬂuent aphasia since 2005. Methods: We conducted a systematic review and meta-analyses of TMS treatment studies in patients with aphasia. Eight electronic databases (PubMed, Medline, Embase, Scopus, ScienceDirect, Cochrane Central Register of Controlled Trials, Journals@ Ovid, and clinicaltrials.gov) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed. We included studies if were: randomized controlled blinded clinical trials, meta-analyses or crossover designs of rTMS alone or with speech therapy or any other therapy tested with rTMS. Standard mean difference (SMD) for changes in picture naming accuracy was estimated. Results: The literature search yielded 423 studies. Fifty articles were further evaluated to be included. Eleven met all inclusion criteria and were chosen for review. Eleven eligible studies involving 301 stroke patients were identiﬁed in this meta-analysis. Further analyses demonstrated prominent effects for the naming subtest (SMD = 1.26, 95% CI = 0.80 to 1.71, P=0.01), with heterogeneity (I2 = 69.101%). The meta-analysis continued to show that there was a statistically signiﬁcant effect of rTMS compared with sham rTMS on the severity of aphasia. None of the patients from the 11 included articles reported adverse effects from rTMS. Conclusions: There are some strong studies evaluating the efﬁcacy of rTMS in stroke patients but further research is required to fully establish the usefulness of this treatment. This meta-analysis indicates a clinically positive effect of rTMS with or without speech and language therapy (SLT) for patients with aphasia following stroke in overall language function and expressive language, including naming, repetition, writing, and comprehension. Low-frequency (1 Hz) rTMS over the unaffected hemisphere is effective and compatible with the concept of interhemispheric inhibition. Moreover, the treatment of 1 Hz rTMS for patients with aphasia after stroke was safe.

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Repetitive Transcranial Magnetic Stimulation Treatment for Peripartum Depression: Systematic Review & Meta-Analysis

10.21203/rs.3.rs-108764/v1 ◽

2020 ◽

Author(s):

Hyunejune Lee ◽

Sungmin Kim ◽

Ji Yean Kwon

Keyword(s):

Systematic Review ◽

Transcranial Magnetic Stimulation ◽

Side Effects ◽

Electroconvulsive Therapy ◽

Effect Size ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Cochrane Library ◽

Peripartum Depression

Abstract BackgroundPeripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. MethodsWe performed a systematic review followed the PRISMA guidelines. We searched studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method.ResultsThe therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.920 – 1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.777 – 1.233), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346, (95% CI: 0.214 – 0.506), which was a meaningful result. There were no serious side effects to the mothers or fetuses.ConclusionsFrom a variety of perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid the exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

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Effects of Repetitive Transcranial Magnetic Stimulation in Patients With Mild Cognitive Impairment: A Meta-Analysis of Randomized Controlled Trials

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.723715 ◽

2021 ◽

Vol 15 ◽

Author(s):

Xinqi Zhang ◽

Xiaoyong Lan ◽

Chanjuan Chen ◽

Huixia Ren ◽

Yi Guo

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Transcranial Magnetic Stimulation ◽

High Frequency ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library

Background: Mild cognitive impairment (MCI) is an intermediary state between normal aging and dementia. It has a high risk of progression in patients with Alzheimer's disease (AD). Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique used to improve cognitive deficits in patients with MCI and AD. Although previous meta-analyses included studies carried on patients with MCI and AD, few studies have analyzed patients with MCI independently. This meta-analysis aimed to evaluate the effects and safety of rTMS on cognition function in patients with MCI and factors that may influence such effects.Methods: Data used in this study were searched and screened from different databases, including PubMed, Web of Science, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Technical Periodicals (VIP), Wanfang Database, and China BioMedical Literature Database (SinoMed). The retrieved studies were carefully reviewed, data were extracted, and the quality of data was assessed.Results: A total of 12 studies involving 329 patients with MCI were included in the present meta-analysis. The analyses results revealed that rTMS improved cognitive function [standardized mean difference (SMD) = 0.83, 95% confidence interval (CI) = 0.44–1.22, p = 0.0009] and memory function (SMD = 0.73, 95% CI = 0.48–0.97, p < 0.00001) in the MCI + rTMS active group when compared to the sham stimulation group. The showed that: (1) cognitive improvement was more pronounced under high-frequency rTMS stimulation of multiple sites, such as the bilateral dorsolateral prefrontal cortex and (2) more than 10 rTMS stimulation sessions produced higher improvement on cognition function in patients with MCI.Conclusions: This study shows that rTMS can improve cognitive function in patients with MCI, especially when applied at high frequency, multi-site, and for a prolonged period. However, further studies are required to validate these findings and explore more effective stimulation protocols and targets.Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO/], identifier: CRD 42021238708.

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The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis

Frontiers in Neuroscience ◽

10.3389/fnins.2021.769848 ◽

2021 ◽

Vol 15 ◽

Author(s):

Weiwei Yang ◽

Xiongbin Cao ◽

Xiaoyun Zhang ◽

Xuebing Wang ◽

Xiaowen Li ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Subgroup Analysis ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Low Frequency ◽

Training Group ◽

Cochrane Library ◽

Significant Difference ◽

The Cochrane Library

Objective: The primary purpose of our study is to systemically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of dysphagia after stroke.Search Methods: We searched randomized controlled trials (RCTs) and non-RCTs published by PubMed, the Cochrane Library, ScienceDirect, MEDLINE, and Web of Science from inception until April 24, 2021. Language is limited to English. After screening and extracting the data, and evaluating the quality of the selected literature, we carried out the meta-analysis with software RevMan 5.3 and summarized available evidence from non-RCTs.Results: Among 205 potentially relevant articles, 189 participants (from 10 RCTs) were recruited in the meta-analysis, and six non-RCTs were qualitatively described. The random-effects model analysis revealed a pooled effect size of SMD = 0.65 (95% CI = 0.04–1.26, p = 0.04), which indicated that rTMS therapy has a better effect than conventional therapy. However, the subgroup analysis showed that there was no significant difference between low-frequency and high-frequency groups. Even more surprisingly, there were no statistically significant differences between the two groups and the conventional training group in the subgroup analysis, but the combined effect was positive.Conclusion: Our study suggests that rTMS might be effective in treating patients with dysphagia after stroke.

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Effectiveness of repetitive transcranial magnetic stimulation (rTMS) for the treatment of obsessive-compulsive disorder (OCD): a meta-analysis

BJPsych Open ◽

10.1192/bjo.2021.118 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S24-S24

Author(s):

Kabir Garg ◽

Naomi Fineberg ◽

Luca Pellegrini ◽

Arun Enara ◽

Eduardo Cinosi

Keyword(s):

Transcranial Magnetic Stimulation ◽

Obsessive Compulsive Disorder ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Library ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Compulsive Disorder

AimsOCD is a chronic and debilitating psychiatric illness. Current first-line treatments include serotonin reuptake inhibitors and cognitive behavioural therapy, but a substantial minority of patients fail to respond adequately, requiring further forms of intervention usually provided in a sequenced algorithm. Repetitive Transcranial Magnetic Stimulation (rTMS) uses magnetic pulses passed through a coil placed on the scalp to stimulate the underlying brain region. Clinical trials of r-TMS in OCD have produced conflicting results, possibly related to the variability in the site of stimulation, protocols used, and variability in the selection of patients. We perform an updated systematic review and meta-analysis of the effectiveness of rTMS for the treatment of OCD aimed to determine whether certain rTMS parameters (i.e. site, duration, protocol etc.) or patients’ characteristics (i.e age, duration of illness, illness severity, treatment resistance etc), are associated with effectiveness. Our overarching aim is to determine the place of rTMS in the sequenced OCD care-pathway.MethodThe meta-analysis is pre-registered in PROSPERO (ID: 241381). Potentially relevant studies will be retrieved using the MEDLINE, PsycINFO, and Cochrane Library databases using the parameters [‘obsessive compulsive disorder’ or ‘OCD’ or ‘obsessions’ or ‘compulsions’] AND [‘transcranial magnetic stimulation’ or ‘TMS’]. The reference lists of retained articles will also be scrutinized for additional relevant publications. Only full text English language articles will be included in the review. The methodological quality of the studies will be assessed using CONSORT criteria. A summary of the study's quality as a randomized clinical trial will be produced.ResultOur preliminary analysis shows some efficacy for r-TMS in non-treatment resistant OCD than treatment resistant OCD. Detailed results will be presented in the poster at the event. Effect measure will be either categorical (e.g. relative risk (RR) or odds ratio (OR) or continuous (mean difference or standardized mean difference - Hedge's g or Cohen's d - when taking into consideration the severity of the disorder as a dimension). These outcomes will be measured through validated instruments, in the form of both self- rated scales and observer rated scales including semi-structured interviews.ConclusionThis meta-analysis will identify the patient, illness and protocol parameters that determine clinical outcomes, as guide to optimizing the role of rTMS in the care of patients with OCD.

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Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Language Recovery in Poststroke Survivors With Aphasia: An Updated Meta-analysis

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211011230 ◽

2021 ◽

pp. 154596832110112

Author(s):

Zhongqiu Hong ◽

Haiqing Zheng ◽

Jing Luo ◽

Mingyu Yin ◽

Yinan Ai ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Treatment Effects ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Low Frequency ◽

Language Function ◽

Language Performance ◽

Language Recovery ◽

Subgroup Analyses

The effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on treating poststroke aphasia (PSA) remain inconclusive. We aimed to evaluate the efficacy and safety of LF-rTMS on language function poststroke and determine potential factors that may affect treatment effects. Electronic databases, including MEDLINE, EMBASE, and Cochrane Library were searched to identify relevant randomized controlled trials (RCTs) concerning the effects of LF-rTMS on language performance poststroke. We adopted fixed- and random-effects models to estimate intervention effects, which were represented by the Hedges’ g and 95% CIs. Subgroup analyses regarding several factors potentially influencing the effects of LF-rTMS on language recovery were also conducted. A total of 14 RCTs involving 374 participants were included in the meta-analysis. The pooled analysis showed the positive and significant effects of LF-rTMS on language function, both short-term (Hedges’ g = 0.65; P < .05) and long-term (Hedges’ g = 0.46; P < .05). Subgroup analyses demonstrated that LF-rTMS for 20 minutes per day over 10 days yielded the largest effect size (Hedges’ g = 1.02; P < .05) and that LF-rTMS significantly improved language performance in the chronic stage after stroke (Hedges’ g = 0.55; P < .05). Patients with different native languages might have diverse responses to LF-rTMS treatment efficacy. Additionally, there were significant improvements in language subtests, including naming, repetition, comprehension, and writing. Overall, this updated meta-analysis demonstrated that LF-rTMS has significant positive effects on PSA, with moderate treatment effects. It provides additional evidence to support LF-rTMS as a promising complementary therapy to promote language recovery in PSA.

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