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Abstract：
Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects.
We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson\'s disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction.
Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies.
Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson\'s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy).
All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson\'s disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction.
Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies.
Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson\'s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy).
All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
摘要：
经颅直流电刺激已显示出有希望的临床结果，导致对其临床效果进行循证审查的需求增加。
我们召集了一组经颅直流电刺激专家，对超过1次刺激测试的临床试验进行系统回顾：疼痛，帕金森病运动功能与认知,中风运动功能和语言，癫痫,重度抑郁症,强迫症,Tourette综合征,精神分裂症,和毒瘾。
专家被要求根据PRISMA指南的搜索方法进行系统评价。关于疗效的建议分为A级(绝对有效)，B（可能有效），C（可能有效）或者没有推荐。我们评估了所有纳入研究的偏倚风险，以确认结果是否由潜在偏倚研究驱动。
虽然大多数临床试验被设计为概念验证试验，本综述中分析的一些适应症可以被认为是绝对有效的(A级)，比如抑郁症，并且可能有效（B级），比如神经性疼痛，纤维肌痛,偏头痛,术后患者自控镇痛和疼痛，帕金森病（运动和认知），行程(马达),癫痫,精神分裂症,酒精成瘾。偏倚评估表明，大多数研究的偏倚风险较低，偏倚的敏感性分析并未改变这些结果.效应大小从0.01到0.70不等，在大约8个条件下是显著的，效果最大的是术后急性疼痛，而中风运动恢复较小（与机器人疗法联合使用时无意义）。
此处列出的所有建议均基于当前发布的PubMed索引数据。尽管在某些情况下有大量证据，必须强调的是，效果的大小和持续时间通常是有限的；因此，不同的研究设计需要进一步确定真正的临床影响.
我们召集了一组经颅直流电刺激专家，对超过1次刺激测试的临床试验进行系统回顾：疼痛，帕金森病运动功能与认知,中风运动功能和语言，癫痫,重度抑郁症,强迫症,Tourette综合征,精神分裂症,和毒瘾。
专家被要求根据PRISMA指南的搜索方法进行系统评价。关于疗效的建议分为A级(绝对有效)，B（可能有效），C（可能有效）或者没有推荐。我们评估了所有纳入研究的偏倚风险，以确认结果是否由潜在偏倚研究驱动。
虽然大多数临床试验被设计为概念验证试验，本综述中分析的一些适应症可以被认为是绝对有效的(A级)，比如抑郁症，并且可能有效（B级），比如神经性疼痛，纤维肌痛,偏头痛,术后患者自控镇痛和疼痛，帕金森病（运动和认知），行程(马达),癫痫,精神分裂症,酒精成瘾。偏倚评估表明，大多数研究的偏倚风险较低，偏倚的敏感性分析并未改变这些结果.效应大小从0.01到0.70不等，在大约8个条件下是显著的，效果最大的是术后急性疼痛，而中风运动恢复较小（与机器人疗法联合使用时无意义）。
此处列出的所有建议均基于当前发布的PubMed索引数据。尽管在某些情况下有大量证据，必须强调的是，效果的大小和持续时间通常是有限的；因此，不同的研究设计需要进一步确定真正的临床影响.
