Three randomized, controlled trials were identified that met inclusion criteria. The report noted that analysis of cost-effectiveness acceptability curves demonstrated that rTMS has very low probability of being more cost-effective than ECT.
Limited data are available from the Brainsway device trial that assessed outcomes at 4 and 16 weeks. Electro-convulsive therapy was superior to rTMS in the treatment of depression mean weighted effect size Studies were included according to the following criteria: Raw data of patients were extracted from 5 1 parallel, 4 cross-over selected from articles RCTs.
These investigators evaluated the optimal parameters of rTMS for neuropathic pain NPincluding the rTMS sessions needed for inducing acute as well as long-term analgesic effects.
Available RCTs were screened. The authors concluded that rTMS is a non-invasive brain stimulation that may be considered a valuable and promising technique for cognitive enhancement in TRD.
An Agency for Healthcare Research and Quality's review Gaynes et al, reported that there is insufficient evidence to evaluate whether non-pharmacological treatments are effective for TRD.
No significant impact was found for other clinical outcomes. Nine of 23 studies were included; brain stimulation sites comprised either the primary motor cortex M1 or the dorso-lateral pre-frontal cortex DLPFC. The authors concluded that the findings of this study showed that rTMS improves QoL of patients with fibromyalgia.
The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0. In a randomized, double-blind, sham-controlled study, Benninger and colleagues examined the safety and effectiveness of intermittent theta-burst stimulation iTBS in the treatment of motor symptoms in Parkinson disease PD ; iTBS of the motor and DLPFC was investigated in 8 sessions over 2 weeks.
The authors concluded that TMS was effective in treating major depression with minimal side effects reported. Managed care According to Wikipedia, managed care offers a variety of techniques that help with unnecessary cost of healthcare through the different mechanisms and economic incentives such as lower costly select….
A total of 16 patients with chronic drug resistant neuropathic orofacial pain participated in this randomized, placebo controlled, cross-over study. These investigators conducted a systematic review of RCTs to evaluate therapies for central post-stroke pain. Chronic Pain Syndromes There is also a lack of scientific evidence in the use of TMS as a diagnostic tool for psychiatric disorders, and treatment for chronic pain.
The major drawbacks of this study were: Two independent reviewers evaluated the abstracts for inclusion, reviewed full texts of eligible studies, and abstracted data. There was significant variability between study effect sizes. A total of 10 Besides differing by year of publication and available studies, the meta-analyses applied different selection criteria and analytic approaches.
The authors concluded that there is moderate evidence that rTMS is not more effective than sham in reducing the severity of pain in fibromyalgia patients, questioning the routine recommendation of this method for fibromyalgia treatment.
Other important gaps in current knowledge include whether TMS is effective as an adjunctive treatment to second-line drug therapy, the durability of TMS treatment, and the effectiveness of retreatment". However, it is too early to conclude that rTMS improves net health outcomes for patients with treatment resistant depression, much less that it is as effective as current alternatives such as augmentation, new drugs, or ECT.
They identified 1, studies; 31 were suitable for inclusion, with a cumulative sample of active and sham TMS courses. One group maintenance -- M group received additional maintenance dTMS sessions weekly or twice-weekly.
A random-effects meta-analysis was carried out with a test for heterogeneity using the I and pooled estimate as a non-standardized mean of difference in change in pain severity measures by a numeric rating scale. Using data from the AHRQ report, the Institute for Clinical and Economic Review ICER, conducted a cost-effectiveness modeling study, assuming that transcranial electrical stimulation and electroconvulsive therapy have equivalent efficacy.
Improvement of QoL involved mainly affective, emotional, and social dimensions. Data were obtained from randomized, sham-controlled studies of rTMS treatment for depression 34 studiesauditory verbal hallucinations AVH, 7 studiesnegative symptoms in schizophrenia 7 studiesand obsessive-compulsive disorder OCD, 3 studies.
Most studies required patients to have 1 or more, and most typically two or more, previously failed trials of antidepressant medication. Risk ratios for remission and response were 2. This procedure entails placement of an electromagnetic coil on the scalp; high-intensity electrical current is rapidly turned on and off in the coil through the discharge of capacitors.
The assessment stated that it is "still open to question" whether or not rTMS has the potential to reduce tremors. Hayes reported on a metaanalysis of controlled trials of TMS with sham stimulation.
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