Does Therapeutic Repetitive Transcranial Magnetic Stimulation Cause Cognitive Enhancing Effects in Patients with Neuropsychiatric Conditions? A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Donel M Martin, Shawn M McClintock, Jane Forster, Colleen K Loo, Donel M Martin, Shawn M McClintock, Jane Forster, Colleen K Loo

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as a therapeutic intervention for neuropsychiatric illnesses and has demonstrated efficacy for treatment of major depression. However, an unresolved question is whether a course of rTMS treatment results in effects on cognitive functioning. In this systematic review and meta-analysis we aimed to quantitatively determine whether a course of rTMS has cognitive enhancing effects. We examined cognitive outcomes from randomised, sham-controlled studies conducted in patients with neuropsychiatric conditions where rTMS was administered to the dorsolateral prefrontal cortex (DLPFC) across repeated sessions, searched from PubMed/MEDLINE and other databases up until October 2015. Thirty studies met our inclusion criteria. Cognitive outcomes were pooled and examined across the following domains: Global cognitive function, executive function, attention, working memory, processing speed, visual memory, verbal memory and visuospatial ability. Active rTMS treatment was unassociated with generalised gains across the majority of domains of cognitive functioning examined. Secondary analyses revealed a moderate sized positive effect for improved working memory in a small number of studies in patients with schizophrenia (k = 3, g = 0.507, 95 % CI = [0.183-0.831], p < .01). Therapeutic rTMS when administered to the DLPFC in patients with neuropsychiatric conditions does not result in robust cognitive enhancing effects.

Keywords: Cognition; Depression; Neuropsychiatric; Repetitive transcranial magnetic stimulation; Schizophrenia; Working memory.

Conflict of interest statement

Conflict of Interest: Author Martin declares that he has no conflict of interest. Author McClintock has received research support from the NIH/NIMH (K23 MH087739) and has received honoraria for teaching from TMS Health Solutions. Author Forster declares that she has no conflict of interest. Author Loo has received equipment on loan from the Neuronetics company.

Figures

Fig. 1. Flowchart of search and study…
Fig. 1. Flowchart of search and study selection process
Fig.2. Summary plot showing assessment of risk…
Fig.2. Summary plot showing assessment of risk of bias
Fig.3. Forest plots for effects of rTMS…
Fig.3. Forest plots for effects of rTMS on global cognitive function, executive function and attention
Fig.4. Forest plots for effects of rTMS…
Fig.4. Forest plots for effects of rTMS on processing speed, visual memory, verbal memory and visuospatial ability
Fig.5. Forest plots of effects of rTMS…
Fig.5. Forest plots of effects of rTMS on working memory
Fig.6. Funnel plot for working memory outcomes
Fig.6. Funnel plot for working memory outcomes

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