scholarly journals tDCS and tinnitus A meta analytic exploration into efficacy and optimization

2020 ◽  
Author(s):  
Alexander Cates ◽  
Evan Davies
Keyword(s):  
Brain Stimulation ◽  
Meta Analysis ◽  
Future Research ◽  
Controlled Trials ◽  
Subjective Outcome ◽  
New Approach ◽  
Causal Treatment ◽  
Underlying Causes ◽  
The Brain ◽  
Efficacy Of Treatment

Millions of Americans suffer from tinnitus, or ringing of the ears. Despite its prevalence, treatment for tinnitus is limited, with most approaches focusing on making the symptoms tolerable, instead of treating the underlying neurological causes. Recently however, brain stimulation techniques, such as transcranial direct current stimulation (tDCS), have emerged offering a new method to interact with the brain and offering hope as a new approach to treating the underlying causes of tinnitus, not just making the symptoms tolerable. In the present meta-analysis, we analyzed the results from 17 controlled trials and 5 uncontrolled case studies to determine the efficacy of tDCS for treating tinnitus. Additionally, we performed sub-analyses to test how different tDCS parameters may alter the efficacy of treatment. Overall, we found a small but significant effect (Overall Hedges g of 0.17 (95% CI 0.09-0.25)) of tDCS on tinnitus symptoms. However, mechanistically we found that targeting the DLPFC improved symptoms significantly more than other targets, including targeting the auditory cortex directly. This along with the subjective outcome measures currently available, suggest that while tDCS does offer a benefit to treating the symptoms, it does not appear to treat any underlying causes. It is the opinion of the authors therefore that tDCS should be used in addition to traditional interventions to make the symptoms more tolerable. As covered in the discussion, future research should explore more objective measures of tinnitus in order to better assess the efficacy of tDCS and other brain stimulation methods, with the hope of developing a causal treatment of tinnitus.

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

scholarly journals Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

2018 ◽  
Author(s):  
Julian Mutz ◽  
Daniel R. Edgcumbe ◽  
Andre R. Brunoni ◽  
Cynthia H.Y. Fu
Keyword(s):  
Brain Stimulation ◽  
High Frequency ◽  
Bipolar Depression ◽  
Meta Analysis ◽  
Low Frequency ◽  
Controlled Trials ◽  
Female Response ◽  
Non Invasive ◽  
Left Dlpfc ◽  
Severity Scores

AbstractWe examined the efficacy and acceptability of non-invasive brain stimulation in adult unipolar and bipolar depression. Randomised sham-controlled trials of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS), without co-initiation of another treatment, were included. We analysed response, remission and all-cause discontinuation rates, and depression severity scores. Fifty-four studies were included (N = 2,959, mean age = 44.94 years, 61.98% female). Response rates demonstrated efficacy of high-frequency rTMS over the left DLPFC (OR = 3.94, 95% CI [2.52; 6.15]), right-sided low-frequency rTMS (OR = 7.44, 95% CI [2.06; 26.83]) bilateral rTMS (OR = 3.68, 95% CI [1.66; 8.13]), deep TMS (OR = 1.69, 95% CI [1.003; 2.85]), intermittent TBS (OR = 4.70, 95% CI [1.14; 19.38]) and tDCS (OR = 4.32, 95% CI [2.02; 9.29]); but not for continuous TBS, bilateral TBS or synchronised TMS. There were no differences in all-cause discontinuation rates. The strongest evidence was for high-frequency rTMS over the left DLPFC. Intermittent TBS provides an advance in terms of reduced treatment duration. tDCS is a potential treatment for non-resistant depression.

scholarly journals Rates of Attrition and Dropout in App-Based Interventions for Chronic Disease: Systematic Review and Meta-Analysis (Preprint)

2020 ◽  
Author(s):  
Gideon Meyerowitz-Katz ◽  
Sumathy Ravi ◽  
Leonard Arnolda ◽  
Xiaoqi Feng ◽  
Glen Maberly ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Meta Analysis ◽  
Dropout Rate ◽  
Dropout Rates ◽  
Dropping Out ◽  
Future Research ◽  
Controlled Trials ◽  
Qualitative Synthesis ◽  
Attrition Rates ◽  
Central Register

BACKGROUND Chronic disease represents a large and growing burden to the health care system worldwide. One method of managing this burden is the use of app-based interventions; however attrition, defined as lack of patient use of the intervention, is an issue for these interventions. While many apps have been developed, there is some evidence that they have significant issues with sustained use, with up to 98% of people only using the app for a short time before dropping out and/or dropping use down to the point where the app is no longer effective at helping to manage disease. OBJECTIVE Our objectives are to systematically appraise and perform a meta-analysis on dropout rates in apps for chronic disease and to qualitatively synthesize possible reasons for these dropout rates that could be addressed in future interventions. METHODS MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, Cochrane CENTRAL (Central Register of Controlled Trials), and Embase were searched from 2003 to the present to look at mobile health (mHealth) and attrition or dropout. Studies, either randomized controlled trials (RCTs) or observational trials, looking at chronic disease with measures of dropout were included. Meta-analysis of attrition rates was conducted in Stata, version 15.1 (StataCorp LLC). Included studies were also qualitatively synthesized to examine reasons for dropout and avenues for future research. RESULTS Of 833 studies identified in the literature search, 17 were included in the review and meta-analysis. Out of 17 studies, 9 (53%) were RCTs and 8 (47%) were observational trials, with both types covering a range of chronic diseases. The pooled dropout rate was 43% (95% CI 29-57), with observational studies having a higher dropout rate (49%, 95% CI 27-70) than RCTs in more controlled scenarios, which only had a 40% dropout rate (95% CI 16-63). The studies were extremely varied, which is represented statistically in the high degree of heterogeneity (I<sup>2</sup>&gt;99%). Qualitative synthesis revealed a range of reasons relating to attrition from app-based interventions, including social, demographic, and behavioral factors that could be addressed. CONCLUSIONS Dropout rates in mHealth interventions are high, but possible areas to minimize attrition exist. Reducing dropout rates will make these apps more effective for disease management in the long term. CLINICALTRIAL International Prospective Register of Systematic Reviews (PROSPERO) CRD42019128737; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128737

scholarly journals Effective maNagement of Depression among Patients witH cANCEr (ENHANCE): A Protocol for a Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms.

2021 ◽  
Author(s):  
Maria Margareta Pertl ◽  
Perez ◽  
Sonya Collier ◽  
Emer Guinan ◽  
Garret Monahan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Meta Analysis ◽  
Relative Effectiveness ◽  
Future Research ◽  
Controlled Trials ◽  
Systematic Review Methodology ◽  
Patients With Cancer

Abstract Background: Depression is common among patients with cancer and is associated with lower treatment participation, lower satisfaction with care, poorer quality of life, greater symptom burden, and higher healthcare costs. Various types of interventions (e.g., pharmacological, psychotherapy) are used for the treatment of depression. However, evidence for these among patients with cancer is limited. Furthermore, the relative effectiveness and acceptability of different approaches is unknown because a direct comparison between all available treatments has not been carried out. We will address this by conducting a network meta-analysis (NMA) of interventions for depression among people with cancer using a hybrid overview of reviews and systematic review methodology. Methods: We will search for and extract data from systematic reviews of randomised controlled trials (RCTs) of depression interventions for patients with cancer from inception, before performing a supplemental search for more recent RCTs. We will include RCTs comparing pharmacological, psychotherapy, exercise, combination therapy, collaborative care, or complementary and alternative medicine interventions with pill placebo, no treatment, waitlist, treatment as usual, or minimal treatment control groups, or directly in head-to-head trials, among adults who have a current or previous diagnosis of cancer and elevated depressive symptoms (scores above a cut-off on validated scales or meeting diagnostic criteria). Our primary outcomes will be change in depressive symptoms (standardised mean difference) and intervention acceptability (% who withdrew). Our secondary outcomes will be 6-month change in depressive symptoms, health-related quality of life, adverse events and mortality. We will independently screen for eligibility, extract data, and assess risk of bias using the RoB2 tool. We will use frequentist random-effects multivariate NMA in Stata, Rankograms and surface under the cumulative ranking curves to synthesize evidence and obtain a ranking of intervention groups. We will explore heterogeneity and inconsistency using local and global measures and evaluate the credibility of results using the Confidence in NEtwork Meta-Analysis (CINeMA) framework.Discussion: Our findings will provide the best available evidence for managing depression among patients with cancer. Such information will help to inform clinical guidelines, evidence-based treatment decisions and future research by identifying gaps in the current literature. Systematic review registration: Submitted to PROSPERO (record number: 290145), awaiting registration

Volumetric and connectivity changes in brain networks associated with reward sensitivity, cognitive control, and negative affect in binge eating disorder and bulimia nervosa

2020 ◽  
Author(s):  
Bart Hartogsveld ◽  
Conny W.E.M. Quaedflieg ◽  
Peter van Ruitenbeek ◽  
Tom Smeets
Keyword(s):  
Cognitive Control ◽  
Negative Affect ◽  
Inferior Frontal Gyrus ◽  
Treatment Options ◽  
Reward Sensitivity ◽  
Future Research ◽  
Environmental Cues ◽  
Underlying Causes ◽  
Brain Changes ◽  
The Brain

Binging disorders are characterized by episodes of eating large amounts of food whilst experiencing a loss of control. Recent studies suggest that the underlying causes of these binging disorders consist of a complex system of environmental cues, different processing of food stimuli, altered behavioral responding, and brain changes. We propose that task-independent volumetric and connectivity changes in the brain are highly related to altered functioning in reward sensitivity, cognitive control, and negative affect, which in turn promotes and conserves binging behavior. We here review imaging studies and show that volume and connectivity changes in the orbitofrontal cortex, inferior frontal gyrus, medial prefrontal cortex, striatum, insula and amygdala overlap with distorted brain activation associated with increased reward sensitivity, decreased cognitive control, and distorted responses to negative affect or stress seen in binging disorder. Future research integrating both task-based and task-independent neuroimaging approaches therefore shows considerable promise in clarifying binging behavior. We provide suggestions for how this integration may guide future research and inform novel brain-based treatment options in binging disorders.

Deep brain stimulation in Parkinson’s disease: meta-analysis of randomized controlled trials

2014 ◽  
Vol 261 (11) ◽  
pp. 2051-2060 ◽  
Author(s):  
L. Perestelo-Pérez ◽  
A. Rivero-Santana ◽  
J. Pérez-Ramos ◽  
P. Serrano-Pérez ◽  
J. Panetta ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Deep Brain
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