Original Title: Indicaciones, seguridad, efectividad y coste-efectividad de la estimulación cerebral no invasiva en el tratamiento de los trastornos mentales

Authors' objectives: To identifity, evaluate and syntetiseze the available scientific knowledge about the indications, safety, effectiveness and cost-effectiveness or rTMS and tDCS in the treatment of mental disorders where its therapeutic potential is investigated.

Authors' results and conclusions: RESULTS: A total of 1005 systematic reviews (SR) were found in the electronic databases, and 586 were considered after the elimination of duplicates. Finally, a total of 27 systematic reviews were included (24 in rTMS and 3 in tDCS): 14 in depression, 2 in schizophrenia, 2 in obsessive-compulsive disorder, 1 in posttraumatic stress disorder, 1 in panic disorder, 4 in addictions, 1 eating disorder, 1 in autism and 1 in tics. A total of 4105 random controlled trial (RTC) were found in the electronic databases, and 2105 were considered after the elimination of duplicates. Finally, a total of 64 random controlled triawere included (52 in TMSr and 12 in tDCS): 16 in depression, 1 in bipolar disorder, 21 in schizophrenia, 2 in obsessive-compulsive disorder, 2 in posttraumatic stress disorder, 1 in panic disorder, 14 in addictions, 1 in borderline personality disorder, 3 in autism, 1 in attention-deficit hyperactivity disorder, and 2 in tics. CONCLUSIONS: In relation to security, in no case we observed no significant differences in adverse effects or dropout rates. In all cases the effects observed were mainly mild, transient headache for rTMS and tingling or itching for tDCS. In terms of effectiveness in the reduction of psychiatric symptoms, the number of studies is quite higher in the case of the rTMS, because interest in the tDCS has appeared recently. Is have made recommendations favorable to the rTMS in depression, obsessive-compulsive disorder and post-traumatic stress disorder, although in all those cases have been recommendations conditional, because the level of evidence according to the system GRADE has been valued as low. Also will have found results promising of the rTMS in panic disorder, addiction to tobacco and to cocaine, or autism, but are necessary new studies that confirm these results. In the case of the tDCS evidence is less numerous and its recommendation in any case has not been possible. Predictors or moderators that significantly explain the effect observed has not been identified, so it is still far from a standardized application protocol regarding the stimulation parameters for each disorder. From the NHS perspective, it is unclear that rTMS is an alternative cost-effective versus pharmacotherapy, rTMS is less effective and more costly than the electroconvulsive therapy (ECT), and rTMS followed by ECT, if necessary, is not an option cost-effective versus only choose the ECT.

Authors' methods: The following electronic databases were consulted: MEDLINE y PreMedline (1950-february 2016), EMBASE (1980- february 2016), PsycInfo (1887- february 2016), CINAHL (1982- february 2016), Cochrane Library (1982- february 2016), DARE (1973- february 2016). Two reviewers performed the entire selection process of studies and in case of doubt or disagreement between them a third reviewer was consulted, who revised the protocol criteria and tried to reach a consensus with the other two reviewers. We selected systematic reviews with and whitout meta-analysis of randomized controlled trials examining the efficacy of rTMS and/or tDCS versus placebo (sham EMTr), pharmacotherapy, psychological treatment, other noninvasive brain treatments or electroconvulsive therapy, for any mental disorder. The study selection was limited to those published in English and Spanish. The data extraction of the studies was carried out on specific sheet. The methodological quality of included reviews was assessed using the AMSTAR scale.

Project Status: Completed

Year Published: 2016

URL for published report: https://sescs.es/estimulacion-cerebral-no-invasiva-en-el-tratamiento-de-los-trastornos-mentales/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es