Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: A systematic meta-review

Matheson, S.L.; Green, M.J.; Loo, C.; Carr, V.J.

doi:10.1016/j.schres.2010.01.002

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Volume 118, Issue 1 , Pages 201-210, May 2010

Quality assessment and comparison of evidence for electroconvulsive therapy and repetitive transcranial magnetic stimulation for schizophrenia: A systematic meta-review

S.L. Matheson
- Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia
- Corresponding author. c/- CRUfAD UNSW at St Vincent's Hospital, 299 Forbes St, Darlinghurst NSW 2010, Australia. Tel.: +61 2 8382 1878, +61 413 340 307 (Mob); fax: +61 2 8382 1721.
M.J. Green
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia
- Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW 2031, Australia
C. Loo
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia
- Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW 2031, Australia
- St George Hospital, Kogarah, NSW 2217, Australia
V.J. Carr
- Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, NSW 2031, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia

Received 28 July 2009; received in revised form 11 January 2010; accepted 13 January 2010. published online 01 February 2010.

Abstract

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.

Keywords: Electroconvulsive therapy, ECT, Repetitive transcranial magnetic stimulation, rTMS, Schizophrenia, Meta-analysis