A meta-analysis of cortical inhibition and excitability using transcranial magnetic stimulation in psychiatric disorders

Clin Neurophysiol. 2013 Jul;124(7):1309-20. doi: 10.1016/j.clinph.2013.01.014. Epub 2013 Feb 26.


Objective: To evaluate transcranial magnetic stimulation (TMS) measures of inhibition and excitation in obsessive-compulsive disorder (OCD), major depressive disorder (MDD) and schizophrenia (SCZ).

Methods: Paradigms included: short-interval cortical inhibition (SICI), cortical silent period (CSP), resting motor threshold, intracortical facilitation, and motor evoked potential amplitude. A literature search was performed using PubMed, Ovid Medline, Embase Psychiatry and PsycINFO 1990 through April 2012.

Results: A significant Hedge's g was found for decreased SICI (g=0.572, 95% confidence interval [0.179, 0.966], p=0.004), enhanced intracortical facilitation (g=0.446, 95% confidence interval [0.042, 0.849], p=0.030) and decreased CSP (g=-0.466, 95% confidence interval [-0.881, -0.052], p=0.027) within the OCD population. For MDD, significant effect sizes were demonstrated for decreased SICI (g=0.641, 95% confidence interval [0.384, 0.898], p=0.000) and shortened CSP (g=-1.232, 95% confidence interval [-1.530, -0.933], p=0.000). In SCZ, a significant Hedge's g was shown for decreased SICI (g=0.476, 95% confidence interval [0.331, 0.620], p=0.000).

Conclusion: Inhibitory deficits are a ubiquitous finding across OCD, MDD, SCZ and enhancement of intracortical facilitation is specific to OCD.

Significance: Provides a clear platform from which diagnostic procedures can be developed.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Databases, Factual / statistics & numerical data
  • Depressive Disorder, Major / physiopathology
  • Evoked Potentials, Motor / physiology*
  • Female
  • Humans
  • Male
  • Mental Disorders / pathology*
  • Mental Disorders / physiopathology
  • Motor Cortex / physiopathology*
  • Neural Inhibition / physiology*
  • Obsessive-Compulsive Disorder
  • Reaction Time
  • Schizophrenia / physiopathology
  • Time Factors
  • Transcranial Magnetic Stimulation*