Non-invasive brain stimulation augmentation therapy for treatment-resistant schizophrenia: a systematic review and network meta-analysis

作者：Yaohui Wei, Carolin Lorenz, Spyridon Siafis, Johannes Schneider‐Thoma, David D. Kim, Hui Wu, Nobuyuki Nomura, Shimeng Dong, Yuki Furukawa, Yikang Zhu, Irene Bighelli, Wulf‐Peter Hansen, Ulrike Vogelmann, Wolfgang Strube, Chunbo Li, John M. Davis, Robert C. Smith, Georgia Salanti, Frank Padberg, Stefan Leucht · 发表于：EClinicalMedicine · 年份：2025 · DOI：10.1016/j.eclinm.2025.103583 · 被引用次数：6 · 研究领域：Transcranial Magnetic Stimulation Studies、Neurological disorders and treatments、Electroconvulsive Therapy Studies

Background: Non-invasive brain stimulation (NIBS) provides adjunctive therapeutic options for individuals with schizophrenia if medications are insufficient to produce clinical response, but guidelines remain controversial on whether NIBS is effective, and which NIBS methods and targets are preferred. We aimed to compare the efficacy and safety of NIBS for treatment-resistant schizophrenia (TRS). Methods: This systematic review and network meta-analysis of randomised controlled trials investigated NIBS interventions, including electroconvulsive therapy, magnetic seizure therapy (MST), repetitive transcranial magnetic stimulation (rTMS), and transcranial electric stimulation (tES), as adjunctive treatment for TRS. We searched the Cochrane Schizophrenia Group's specialised register from inception to 2025.07.13, and three Chinese databases from inception to 2024.10.30. The primary outcome was overall symptoms, and adverse events were analysed as secondary outcomes. We synthesized the data using random-effects network meta-analysis. Sensitivity analyses examined the robustness of the findings and the effects of the detailed NIBS protocols. The protocol was pre-registered with PROSPERO (CRD42023410645) and published in a scientific journal. Findings: We identified 21710 references and included 78 trials with a total of 3416 participants (1216 women, 1733 men; mean age 37.06 years, range 25.55-48.38; ethnicity data were not recorded). Compared with sham stimulation, rTMS (SMD -0.47...