The Effects of Non-invasive Brain Stimulation on Impulsivity in People with Mental Disorders: a Systematic Review and Ex
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REVIEW
The Effects of Non-invasive Brain Stimulation on Impulsivity in People with Mental Disorders: a Systematic Review and Explanatory Meta-Analysis Cheng-Chang Yang 1,2
&
Laura Mauer 3 & Birgit Völlm 4 & Najat Khalifa 5
Received: 2 February 2020 / Accepted: 20 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), have been used to modulate impulsivity. To date, no reviews have systematically examined their effects on modulating impulsivity in people with mental health disorders. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline and PsycINFO databases on the use of rTMS and tDCS to modulate impulsivity in people with mental health disorders. Results from 11 tDCS and 18 rTMS studies indicate that tDCS has a significant, albeit small, effect on modulating impulsivity (g = 0.29; 95% CI, 0.09 to 0.48; p = .004) whereas rTMS has no significant effect on impulsivity (g = −0.08; 95% Cl, −0.35 to 0.19; p = .550). Subgroup analyses identified the key parameters required to enhance the effects of tDCS and rTMS on impulsivity. Gender and stimulation intensity acted as significant moderators for effects of rTMS on impulsivity. There is insufficient evidence to support the use of tDCS or rTMS in clinical practice to reduce impulsivity in people with mental health disorders. The use of standardized non-invasive brain stimulation protocols and outcome measures in patients with the same diagnosis is advised to minimize methodological heterogeneity. Keywords Impulsivity . Brain stimulation . Response inhibition . Delay discounting . Theta burst stimulation
Introduction Impulsivity Impulsivity is a multi-dimensional construct that reflects a tendency to act without planning ahead. It encompasses
behaviors like having difficulty in inhibiting a prepotent motor response, preferring smaller immediate over larger delayed rewards, and making premature decisions (Evenden, 1999). These behaviors reflect the key facets of impulsivity including motor, temporal and cognitive impulsivity. Motor impulsivity is underpinned by failure to inhibit a prepotent behavioral
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11065-020-09456-2) contains supplementary material, which is available to authorized users. * Cheng-Chang Yang [email protected]
1
Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No 291 ZhongZheng Road, Zhonghe District, New Taipei City, Taiwan
Laura Mauer [email protected]
2
Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, T
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