A型肉毒毒素预防性治疗偏头痛有效性及安全性的随机对照试验的meta分析

目的评价A型肉毒毒素预防性治疗偏头痛的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed (CBM)、中国知网、万方等数据库中相关随机对照试验(RCT),采用Review manager 5. 3软件对数据进行meta分析。结果共纳入12项RCT,纳入4131例患者。meta分析结果显示,与安慰剂组比较,A型肉毒毒素组在平均每月偏头痛发作频率减少方面无明显差异(MD=-0. 1,95%CI:0. 41-0. 21,P=0. 53)。按偏头痛类型进行亚组分析后结果显示,A型肉毒毒素组在亚组慢性偏头痛组平均每月偏头痛发作频率减少方面优于安慰剂组(MD=-0. 43,95%CI:-0. 70～-0. 17,P=0. 001);而在亚组发作性偏头痛组,A型肉毒毒素组和安慰剂组在每月平均偏头痛发作频率减少方面无明显差异(MD=0. 08,95%CI:-0. 16～0. 33; P=0. 51)。与安慰剂组相比,A型肉毒毒素组平均每月偏头痛天数减少、平均每月急性头痛用药日数减少、生活质量量表评分改善情况等方面均优于安慰剂组(P 0. 05);总不良事件发生率均高于安慰剂组(OR=1. 38,95%CI:1. 20～1. 58; P 0. 00 001),但无严重不良反应发生。结论 A型肉毒毒素能有效地减少慢性偏头痛每月偏头痛发作频率、偏头痛天数和急性头痛用药的时间及改善生活质量,但对发作性偏头痛效果不明显,不良反应可耐受。     

天舒胶囊治疗偏头痛疗效的Meta分析

目的评价天舒胶囊治疗偏头痛的疗效和安全性。方法检索公开发表关于天舒胶囊治疗偏头痛的随机对照试验的文献,通过Cochrane系统评价方法对所纳入文献进行质量评价,采用Revman 5.2软件进行统计分析。结果将对照组仅为氟桂利嗪、结局指标为总有效率的7篇文献进行Meta分析显示,天舒胶囊组疗效显著优于氟桂利嗪组(OR=2.92,95%CI:1.89~4.49,Z=4.87,P0.00001);选取其中3个剂量及疗程相同的研究做亚组分析发现,治疗组与对照组疗效差异有统计学意义(OR=4.21,95%CI:2.21~8.02,Z=4.37,P0.0001),与整体分析结果一致。对另4篇因对照组药物不同及结局指标无法合并的文献进行描述性分析发现,天舒胶囊治疗偏头痛的疗效优于奥卡西平(P=0.007),且奥卡西平更易发生肝功能异常;治疗前后头痛发作频率、头痛持续时间差异均有统计学意义(均P0.05)。8篇文献以胃部不适、女性月经过多为主要不良反应,未见严重不良反应。结论天舒胶囊治疗偏头痛的疗效优于氟桂利嗪、奥卡西平、传统中成药元胡止痛胶囊、丹参胶囊,且不良反应少。     

重复经颅磁刺激治疗偏头痛患者的临床研究

目的观察重复经颅磁刺激(rTMS)治疗偏头痛的疗效和安全性。方法入选的96例偏头痛患者分为rTMS组和假刺激组,每组48例,并记录患者一般资料。rTMS组患者接受经颅磁刺激治疗,隔日1次,15次为一疗程,并进行随访。假刺激组使用伪线圈,不产生治疗效应。记录头痛频率改善、视觉模拟评分量表(VAS)评分改善情况、临床疗效和不良反应等。结果与假刺激组相比,rTMS组患者在头痛发作频率和VAS改善以及临床疗效上均有所好转,差异有统计学意义(P<0.05)。随访过程中rTMS组3例患者出现头晕乏力,但均未发生严重不良反应。结论 tTMS治疗偏头痛是有效且相对安全的方法。     

大麻二酚对难治性癫痫疗效和安全性的Meta分析

目的 评价大麻二酚对难治性癫痫的疗效和安全性。方法 检索Pubmed、Embase、Cochrane library、Web of science、中国生物医学文献(CBM)、中国知网(CNKI)、万方医学网、维普期刊资源网数据库中关于大麻二酚治疗癫痫的随机对照试验(RCT),检索时间从建库至2022年5月。采用RevMan 5.4软件进行Meta分析。结果 共纳入4项RCT。大麻二酚组在治疗过程中癫痫完全不发作率(OR=4.69,95%CI:1.39～15.76,P=0.01)、癫痫发作频率减少≥50%的患者百分率(OR=2.63,95%CI:1.86～3.71,P<0.00001)及临床总体印象的变化评分(CGIC)评分(OR=2.58,95%CI:1.89～3.53,P<0.00001)显著高于安慰剂组。与安慰剂组比较,大麻二酚10 mg亚组(HR=2.64,95%CI:1.54～4.54,P=0.0004)与大麻二酚20 mg亚组(HR=2.75,95%CI:1.91～3.96,P<0.00001)癫痫发作频率减少≥50%的患者百分率差异均有统计学意义。大麻二...     

重复经颅磁刺激和θ节律刺激治疗卒中后忽视的Meta分析

目的系统评价重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)和θ节律刺激(theta burst stimulation,TBS)治疗卒中后忽视的疗效和安全性。方法通过计算机检索、手工检索方法,全面收集rTMS和TBS治疗卒中后忽视的随机对照试验(randomized controlled trial,RCT)和非随机对照试验,按Cochrane协作网系统评价的方法进行评价。结果共纳入3个试验(69例患者),包括2个随机双盲假刺激对照试验和1个非随机假刺激对照试验。3个试验采用不同的量表的评价治疗期末忽视改善,Meta分析结果显示:上述刺激对卒中后忽视的改善程度优于对照组,差异有统计学意义[SMD=-2.61,95%CI(-4.70,-0.52),P=0.01];其中2个试验采用TBS治疗卒中后忽视(42例),Meta分析结果显示:TBS组优于对照组,但差异无统计学意义[SMD=-2.53,95%CI(-5.96,0.90),P=0.15];纳入的所有试验中,均未报道治疗过程中的严重不良反应,1个试验报到了治疗过程中不良反应,主要是发生在治疗过程中的一过性头痛,2组差异无统计学意义[RR=5.0,95%CI(0.27,93.55),P=0.28];1个试验报道了治疗期末生活质量的改善,结果显示:治疗组优于对照组,差异有统计学意义[MD=12.50,95%CI(4.98,20.02),P=0.001]。无临床试验评价进行长期的随访结果。结论本系统评价结果提示rTMS和TBS能有效改善治疗前后的忽视状况和生活质量,且不良反应小,未见严重不良反应。但纳入文献的研究样本量较小,缺乏长期随访结果,有待进一步多中心大样本随机对照研究。     

重复经颅磁刺激治疗卒中后抑郁随机对照试验Meta分析

目的系统评价重复经颅磁刺激（repetitive transcranial magnetic stimulation ,rTMS）治疗卒中后抑郁的疗效和安全性。方法通过计算机检索、手工检索方法,全面收集重 rTMS治疗卒中后抑郁的随机对照试验（randomized controlled trial ,RCT）,按Cochrane协作网系统评价的方法进行Meta分析。结果共纳入9个试验（664例患者）,包括3个假刺激对照试验和6个空白对照试验。9个试验均采用汉密尔顿抑郁量表（Hamilton Depression Scale ,HAMD）评价治疗期末抑郁的改善,Meta分析结果显示,高频和低频rTMS对抑郁改善程度均优于对照组,差异有统计学意义（低频：MD＝－5.49,95％ CI－10.37～－1.50,P＝0.009;高频：M D＝－7.66,95％ C I －12.09～－3.24,P＝0.0007）;3个评价治疗期末神经功能缺损试验（172例）的Meta分析结果显示,rTMS组明显优于对照组（SMD＝－0.59,95％ CI －0.94～－0.25,P＝0.0007）;5个评价治疗前后生活质量改善的Meta分析结果显示,rTMS组治疗期末的生活质量改善优于对照组（SMD＝1.30,95％ CI 0.93～1.68,P＜0.00001）;5个试验报道了治疗过程中的不良反应,主要是一过性头痛和恶心,Meta分析结果显示,2组差异无统计学意义（RR＝2.93,95％ CI 0.87～9.93,P＝0.08）;仅1个试验（120例）进行长期的随访,结果显示,rTMS组治疗期末抑郁的改善优于对照组,差异有统计学意义（P＜0.05）。结论重复经颅磁刺激能有效改善治疗前后的抑郁状态和生活质量,且不良反应小,未见严重不良反应,但其治疗抑郁的长期效果有待进一步研究。     

偏头痛伴发脑微出血的相关危险因素分析

目的分析偏头痛患者伴发脑微出血(CMBs)的临床特点及影响因素。方法连续收集178例临床确诊的偏头痛患者,根据头颅MRI有无CMBs表现分为两组,收集患者一般资料,头痛特点并进行比较。结果 (1)178例偏头痛患者中CMBs患者56例,偏头痛合并CMBs发生率为31.5%,其中单发病灶17例(30.4%),多发病灶39例(69.6%),单纯脑叶病灶31例(55.4%);(2)与无CMBs的偏头痛患者比较,合并CMBs的偏头痛患者更容易合并高血压(P=0.028),头痛病程长(P=0.002)、头痛发作频率高(P=0.001)且容易伴发先兆(P=0.036);(3)多因素Logistic回归分析显示,在校正年龄、性别及其他危险因素后,头痛病程(OR=1.166,95%CI:1.044~1.303,P=0.007)、头痛发作频率(OR=1.353,95%CI:1.116~1.640,P=0.002)和先兆偏头痛(OR=10.080,95%CI:1.630~62.329,P=0.013)与偏头痛发生CMBs相关。结论偏头痛病程长、发作频率高及伴有先兆是偏头痛发生CMBs的危险因素。     

偏头痛慢性转化的临床危险因素分析

目的比较慢性偏头痛(CM)与发作性偏头痛(EM)的病史特征、临床特点等,探究偏头痛慢性转化的危险因素,为其防治提供依据和策略。方法共纳入在中南大学湘雅医院神经内科就诊的CM患者72例及EM患者109例进行回顾性分析。采集患者基本信息,先进行单因素分析,筛选有统计学意义的指标进行相关分析和非条件性多因素logistic回归分析。结果单因素分析发现两组的BMI(P=0.000)、病程(P=0.000)、基线头痛发作频率(P=0.000)、基线头痛持续时间(P=0.037)、匹兹堡睡眠质量指数量表(PSQI,P=0.000)、焦虑自评量表(SAS,P=0.000)及抑郁自评量表(SDS,P=0.001)差异有统计学意义。logistic回归分析显示BMI(OR=1.468,95%CI:1.148～1.876)、病程(OR=1.102,95%CI:1.022～1.188)、基线头痛发作频率(OR=1.461,95%CI:1.247～1.711)、睡眠质量(OR=1.494,95%CI:1.198～1.864)、焦虑状态(OR=1.201,95%CI:1.048～1.376)是偏头痛慢性转化的危险因素。结论控制体重、减少头痛发作频率、缩短病程、改善心境状态与睡眠质量,有可能延缓偏头痛的慢性进展。     

右侧额叶低频重复经颅磁刺激治疗抑郁症的meta分析

目的系统评价右侧额叶低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)治疗抑郁症的疗效。方法检索Pub Med、Web of Science、CBM、CNKI、VIP数据库中有关低频r TMS刺激右侧额叶背外侧皮质(dorsolateral prefrontal cortex,DLPFC)治疗抑郁症的临床随机对照研究(randomized controlled trials,RCT)。采用Rev Man 5.2软件,根据对照组刺激方法的不同,分别以无效刺激及高频r TMS为对照,对治疗应答率进行meta分析。结果纳入以无效刺激为对照的RCT研究9项,其中低频r TMS组156例抑郁症患者,无效刺激组162例,meta分析显示低频r TMS刺激右侧DLPFC治疗抑郁症,其治疗应答率相比无效刺激组,差异有统计学意义RR=2.15(95%CI:1.57~2.95,P0.01);纳入以高频r TMS刺激左侧DLPFC为对照的RCT研究11项,其中低频r TMS组178例患者,高频r TMS组200例,meta分析表明两组间应答率差异无统计学意义(RR=0.80,95%CI:0.63~1.02,P=0.07)。结论低频r TMS刺激右侧DLPFC治疗抑郁症有效,但相比高频r TMS刺激左侧DLPFC方法而言,不具有疗效优势。     

重复经颅磁刺激改善失眠患者主观睡眠质量的Meta分析

目的系统评价重复经颅磁刺激(rTMS)对失眠患者主观睡眠质量的疗效,为rTMS治疗失眠提供循证依据。方法系统检索PubMed、Embase、Cochrane Library、万方数据库、维普中文期刊数据库、中国生物医学文献数据库和中国期刊全文数据库,纳入关于rTMS治疗失眠或睡眠障碍的随机对照研究。由两名研究者独立筛选文献、提取数据,并对纳入文献的方法学质量进行评价。采用RevMan 5.2进行Meta分析,采用Stata 13.0分析发表偏倚。结果最终纳入13篇文献,共889例患者。Meta分析结果显示:rTMS治疗组睡眠质量改善的效果优于对照组(SMD=-1.11,95%CI:-1.46～-0.76,Z=6.22,P0.01)。亚组分析结果显示,针对原发性和继发性失眠患者,rTMS治疗组睡眠质量改善的效果均优于对照组(原发性:SMD=-1.22,95%CI:-1.72～-0.72,Z=4.77,P0.01;继发性:SMD=-1.04,95%CI:-1.55～-0.54,Z=4.04,P0.01)。高频和低频rTMS对患者睡眠质量评分的改善效果均优于对照组(高频:SMD=-0.44,95%CI:-0.76～-0.13,Z=2.73,P0.01;低频:SMD=-1.24,95%CI:-1.61～-0.86,Z=6.45,P0.01)。结论高频或低频rTMS联合常规治疗对失眠患者主观睡眠质量的改善效果更佳,对原发性和继发性失眠均有效。     

Meta-analysis of efficacy of topiramate in migraine prophylaxis

OBJECTIVE:To evaluate the treatment effects and safety of topiramate in migraine prophylaxis. DATA RETRIEVAL:We searched the Medline database,EMbase,Cochrane Library and China National Knowledge Infrastructure database for articles published between January 1995 and May 2011,using the key words"migraine","topiramate",and"prophylaxis". SELECTION CRITERIA:We selected randomized controlled trials of migraine patients,in which the experimental group was orally administered topiramate,and the control group was given placebo. Odds ratios(ORs)and mean differences(MDs)were calculated using a fixed effects model/random effects model.Quality evaluation and data extraction were performed independently by two researchers utilizing RevMan 5.0 software. MAIN OUTCOME MEASURES:Efficacy was recorded as the responder rate(response defined as at least a 50%reduction in average monthly migraine frequency)and change in mean monthly number of migraine days.Adverse events were recorded as the number of subjects exhibiting at least one adverse event. RESULTS:Eight randomized controlled trials were found to be appropriate,and had available data. The meta-analysis results revealed that topiramate(100 or 200 mg/d)was more effective than placebo in responder rate(OR=2.97,95%confidence interval(CI):2.17-4.08,P<0.01;OR=2.35, 95%CI:1.77-3.12,P<0.01).Topiramate(100 mg/d)was more effective than placebo in terms of the change in mean monthly migraine days(MD:-1.14,95%CI:-1.69 to-0.59,P<0.01).The total incidence rate of adverse events for topiramate was higher than in the placebo group(P<0.01),but most adverse events were mild to moderate. CONCLUSION:Overall,topiramate obtained good outcomes and safety in migraine prophylaxis.     

Huangqi Guizhi Wuwu Decoction for treating diabetic peripheral neuropathy:a meta-analysis of 16 randomized controlled trials

OBJECTIVE:This meta-analysis was performed to systematically assess the efficacy and safety of the Chinese herbal medicine Huangqi Guizhi Wuwu Decoction(HGWWD) for treating diabetic peripheral neuropathy.DATA SOURCES:Six electronic databases,including the Cochrane Library,MEDLINE database,Chinese Biomedical Database,Chinese National Knowledge Infrastructure Database,Chinese Science and Technique Journals Database,and the Wanfang Database,were search ed on the internet for randomized controlled trials published up until 1 December 2015.The search terms included "Chinese herbal medicine","diabetic peripheral neuropathy" and "randomized controlled trials" in Chinese and in English.DATA SELECTION:We included randomized controlled trials using HGWWD/modified HGWWD for the treatment group,without restriction for the control group.We assessed literature quality in accordance with the Cochrane Review Handbook.A random or a fixed effects model was used to analyze outcomes using Rev Man 5.2 software.OUTCOME MEASURES:The primary outcomes were changes in symptoms and nerve conduction velocities.The secondary outcomeswere fasting blood glucose and hemorheological indexes.RESULTS:Sixteen randomized controlled trials,with a total of 1,173 patients,were included.Meta-analysis revealed that the efficacy of HGWWD for diabetic peripheral neuropathy was significantly superior compared with the control treatment(i.e.,control group)(risk ratio = 0.36,95% confidence interval(CI):0.29–0.46,Z =8.33,P 0.00001) Compared with the control group,there was an increase in median motor nerve conduction velocity(mean difference(MD) = 3.46,95%CI:1.88–5.04,Z = 4.30,P 0.01) and median sensory nerve conduction velocity(MD = 3.30,95%CI:2.04–4.56,Z = 5.14,P 0.01).There was also an increase in peroneal motor nerve conduction velocity(MD = 3.22,95%CI:2.45–3.98,Z = 8.21,P 0.01) and peroneal sensory nerve conduction velocity(MD = 3.05,95%CI:2.01–4.09,Z = 5.75,P 0.01) in the treatment groups.No significant difference in fasting blood glucose was found between the treatment groups and the control groups(MD =-0.12,95%CI:-0.42–0.19,Z = 0.76,P = 0.45).Plasma viscosity was significantly decreased after treatment(MD =-0.11,95%CI:-0.21 to-0.02,Z = 2.30,P = 0.02).No significant difference in fibrinogen was detectable(MD =-0.53,95%CI:-1.28–0.22,Z = 1.38,P = 0.17).Four trials reported that treatment groups experienced no adverse reactions.Adverse events were not mentioned in the other 12 trials.No trial reported the incidence of complications,quality of life outcomes,or health economics.CONCLUSION:HGWWD treatment improves diabetic neurologic symptoms and ameliorates nerve conduction velocities.Our study suggests that HGWWD may have significant therapeutic efficacy for the treatment of diabetic peripheral neuropathy.However,the methodological quality of the randomized controlled trials was generally low.Larger and better-designed randomized controlled trials are required to more reliably assess the clinical effectiveness of HGWWD.     

rTMS of the prefrontal cortex in the treatment of chronic migraine: a pilot study

A recent fMRI study showed that dorsolateral prefrontal cortex (DLPFC) exerts an inhibitory control on pain pathways in humans. We investigated whether high-frequency rTMS over left DLPFC could ameliorate chronic migraine. Treatment consisted of 12 rTMS sessions, delivered in alternate days over left DLPFC. Sham rTMS was used as placebo. Eleven patients were randomly assigned to the rTMS (n=6) or to the placebo (n=5) treatment. Measures of attack frequency, headache index, number of abortive medications (outcome measures) were recorded in the month before, during and in the month after treatment. Subjects treated by rTMS showed a significant reduction of the outcome measures during and in the month after the treatment as compared to the month before treatment. No significant differences in the outcome measures were observed in the placebo group. High-frequency rTMS over left DLPFC was able to ameliorate chronic migraine. This is in agreement with the suggested role of DLPFC in pain control.     

High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: a randomized, placebo-controlled study

Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for pain but there is no class 1 study on its role in migraine prophylaxis. In this study we report the efficacy and safety of high-rate rTMS in migraine prophylaxis. Adult migraine patients having >4 attacks/month were randomized to high-rate rTMS or sham stimulation. Stimulation in the form of 10 Hz rTMS, 600 pulses in 10 trains were delivered to the hot spot of the right abductor digiti minimi in 412 s. Three sessions were delivered on alternate days. The outcome was defined at 1 month. The primary outcome measures were reduction in headache frequency and severity >50 % as assessed by the Visual Analogue Scale (VAS). The secondary outcome measures were functional disability, rescue medication and adverse events. Fifty patients each were randomized to rTMS or sham stimulation. The baseline characteristics of rTMS and sham stimulation groups were similar. At 1 month, headache frequency (78.7 vs. 33.3 %; P = 0.0001) and VAS score (76.6 vs. 27.1 %; P = 0.0001) improved significantly in the patients receiving rTMS compared to those in the sham stimulation group. Functional disability also improved significantly in rTMS group (P = 0.0001). Only one patient following rTMS developed transient drowsiness and was withdrawn from the study. This study provides evidence of the efficacy and safety of 10 Hz rTMS in migraine prophylaxis.     

重复经颅磁刺激对急性脊髓损伤大鼠运动功能的影响

目的 探讨重复经颅磁刺激对急性脊髓损伤大鼠运动功能的影响. 方法 24只SD大鼠按照随机数字表法分为正常组、脊髓损伤对照组(对照组)、脊髓损伤高频磁刺激组(高频组)、脊髓损伤低频磁刺激组(低频组),每组6只.利用重物撞击法制作T10脊髓损伤模型.磁刺激组于手术后24 h开始给予刺激,高频组频率为10Hz,低频组频率为1 Hz,均为阈值刺激.500个脉冲,每天1次,连续4周,脊髓损伤对照组给予假刺激.各组大鼠分别于术后1 d、3d、7d、11 d、14d、21 d、28 d进行BBB行为学评分,于14、28 d时检测运动诱发电位(MEP),应用HE染色观察脊髓组织形态学变化,并应用免疫组织化学法检测神经丝蛋白(NF-200)表达变化. 结果 高频组、低频组大鼠BBB评分明显高于对照组,高频组BBB评分明显高于低频组,差异均有统计学意义(P<0.05).高频组、低频组运动诱发电位潜伏期较短,与对照组、正常组相比差异均有统计学意义(P<0.05);其中高频组较低频组短,差异有统计学意义(P<0.05).高频组、低频组NF-200表达较对照组明显升高,差异均有统计学意义(P<0.05);其中高频组较低频组高,差异有统计学意义(P<0.05).结论 重复经颅磁刺激可以促进脊髓损伤大鼠运动功能的恢复,其机制可能与促进轴突再生有关.高频组较低频组效果明显可能与调节大脑皮层兴奋性有关.     

Pyridoxine,folate and cobalamin for migraine: A systematic review

There is a possible relationship between migraine and hypercoagulability inducing factors, such as hyperhomocysteinemia. In this context, homocysteine (Hcy)-lowering vitamins (B6-folate-B12) may prove beneficial in the management—prophylaxis of migraine. We performed a systematic literature search in order to retrieve studies assessing the supplementation of B6, folate and B12 (alone or as adjunctive therapies) to migraine patients, as well as patients suffering from other primary headache disorders. MEDLINE, EMBASE, CENTRAL, Google Scholar, trial registries and OpenGrey were searched. Twelve relevant articles were retrieved. The management of acute migraine attacks with Hcy-lowering vitamins has not provided promising results (one randomized controlled trial—RCT—and one prospective uncontrolled trial). On the contrary, significant benefits were registered for the use of B6 alone, in combination with folate and in combination with folate and B12 in the prophylaxis of migraine with aura (MA) in adults compared to placebo (five RCTs, only one did not obtain significant results). Folate supplementation alone was not more efficacious than placebo (one RCT). Limited data for the prophylaxis of migraine without aura (MO) in children (two prospective uncontrolled trials) and adults (two prospective uncontrolled trials involving both MA and MO participants) impede the extraction of safe conclusions. An overall attractive safety profile was exhibited with gastrointestinal adverse events being the most common. Overall, a potential beneficial effect regarding the administration of B6, folate and/or B12 in the prophylaxis of MA in adults was indicated. Additional high-quality RCTs that will investigate MO in adults as well as MO and MA in children are warranted.     

坦度螺酮治疗癫痫伴焦虑、抑郁效果的系统评价

目的 系统评价坦度螺酮治疗癫痫伴焦虑、抑郁的临床效果及安全性。方法 计算机检索PubMed、Cochrane、Science Direct、Embase、维普、万方和中国知网等数据库，检索时间为从建库至 2018年8月，收集坦度螺酮治疗癫痫合并焦虑抑郁的随机对照试验，应用Rev Man 5.3软件进行Meta分析。结果 共纳入6个随机对照试验，包含462例。Meta分析结果显示:坦度螺酮显著降低汉密尔顿焦虑 量表评分（SMD=-1.01；95% CI:-1.91~-0.11；P=0.03），显著降低汉密尔顿抑郁量表评分（SMD=-1.57；95% CI:-2.42~-0.72；P=0.001），显著降低副反应发生率（OR=0.43；95% CI:0.22~0.82； P=0.01），显著增加有效率（OR=3.31；95% CI:1.97~5.56；P<0.001）。结论 坦度螺酮治疗癫痫伴焦虑抑郁具有显著的临床效果及较好的药物安全性。