ارزیابی کیفیت و مقایسه شواهد برای الکتروشوک درمانی و تحریک مغناطیسی ترانس کرانیال تکراری برای اسکیزوفرنی:متابررسی سیستماتیک

Background Randomized studies directly comparing the effects of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) for depression generally favour ECT. ECT and rTMS have also been investigated for chronic symptoms of schizophrenia although there are no direct comparisons available. Aims We sought to determine the relative benefits and adverse outcomes of ECT and rTMS by comparing effect sizes reported in systematic reviews and to quality assess this evidence using GRADE and QUOROM guidelines. Method Included are systematic reviews with meta-analysis published since 2000, reporting results for people with a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder or first episode schizophrenia. Medline, Embase, CINAHL, Current Contents, PsycINFO and the Cochrane library were searched and hand searching was conducted. Data extraction and quality assessment were completed by two independent reviewers. Results Fifty-three of 58 reviews were excluded as they did not meet inclusion criteria. The remaining five have a low probability of reporting bias and show that high quality evidence suggests a short-term, medium to large treatment effect of rTMS for auditory hallucinations (d = 0.88) but not other symptoms, for people treated with concurrent antipsychotics. For ECT, high quality evidence suggests a short-term small, significant effect for improvement in global symptoms, for people with or without concurrent antipsychotics (RR = 0.76). There is no evidence for longer-term therapeutic or adverse effects of either treatment. Conclusions It is worthwhile considering rTMS in cases where auditory hallucinations have not responded to antipsychotic medications and ECT where overall symptoms have not responded to antipsychotic medications. Gadget timed out while loading

Many people with schizophrenia do not respond adequately to antipsychotic medication for which recourse to adjunctive treatments is a common clinical practice. Two somatic treatments used mainly for depression are electroconvulsive therapy (ECT) and, more recently, repetitive transcranial magnetic stimulation (rTMS). Randomized studies directly comparing the two treatments generally favour ECT for depression (Malhi et al., 2006) and psychotic depression (Rodriguez-Martin et al., 2001). ECT and rTMS have also been investigated for treating chronic symptoms of schizophrenia although there are no direct comparisons between these treatments in this context. In the absence of direct comparisons, the aim of this meta-review is to quality assess the available evidence from systematic reviews with meta-analyses and to compare treatment effect sizes of both benefits and adverse outcomes of ECT and rTMS for schizophrenia.