Schizophrenia sufferers’ functional outcomes and quality of life can be negatively impacted by negative symptoms. However, there are currently few treatment approaches thought to be successful for this symptomatic dimension. A number of studies have shown that noninvasive brain stimulation (NIBS) therapies can have a positive effect on reducing undesirable symptoms. However, it is yet unknown how effectively various NIBS methods work to alleviate undesirable symptoms. The purpose of this study was to evaluate and contrast the efficacy and acceptability of various NIBS therapies for alleviating adverse symptoms. From their inception until December 7th, 2021, the electronic databases of ClinicalKey, Cochrane Central, Embase, ProQuest, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science were searched thoroughly. The effects of repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation, transcranial random noise stimulation, transcutaneous vagus nerve stimulation, and transcranial direct current stimulation on negative symptoms in schizophrenia were analyzed using a frequentist model network meta-analysis. Included were randomized clinical trials (RCTs) examining NIBS therapies for people with schizophrenia. Synthesizing and extracting data was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Multiple researchers extracted the data separately from each other. A random-effects model was used for the pair-wise meta-analytic techniques. Core Metrics and Results Alterations in the severities of adverse symptoms and acceptance served as the coprimary outcomes (i.e., dropout rates owing to any reason). Positive and depressive symptom shifts were secondary outcomes. Findings were 2,211 people (mean [range] age, 38.7 [24.0-57.0] years; mean [range] proportion of female patients, 30.6% [0%-70.0%]) participated in 48 randomized controlled trials. Excitatory NIBS approaches (standardized mean difference [SMD]: high-definition transcranial random noise stimulation, -2.19 [95% CI, -3.36 to -1.02]; intermittent theta-burst stimulation, -1.32 [95% CI, -1.88 to -0.76]; anodal transcranial direct current stimulation, -1.28 [95% CI, -2.55 to -0.02]; high There was little to no difference in the groups’ acceptance. In this network meta-analysis, excitatory NIBS protocols applied to the left dorsolateral prefrontal cortex were linked to substantial reductions in the severity of negative symptoms. Due to the small number of studies that met the inclusion criteria, further high-quality, large-scale RCTs are needed.

Source: jamanetwork.com/journals/jamapsychiatry/article-abstract/2793707