Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder.
Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder.
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DOI：
10.4088/jcp.08m04638blu
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发表时间：
2010-08
期刊：
影响因子：
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通讯作者：
Fregni F
中科院分区：
文献类型：
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作者：
Boggio PS;Rocha M;Oliveira MO;Fecteau S;Cohen RB;Campanhã C;Ferreira-Santos E;Meleiro A;Corchs F;Zaghi S;Pascual-Leone A;Fregni F
我们的目的是调查20 Hz重复经颅磁刺激（rTMS）的右或左背外侧前额叶皮层（DLPFC）相比，假rTMS缓解创伤后应激障碍（PTSD）相关症状的疗效。在这项于2005年10月至2008年7月进行的双盲、安慰剂对照的II期试验中，30名DSM-IV诊断为PTSD的患者被随机分配接受以下治疗之一：右侧DLPFC的主动20 Hz rTMS，左侧DLPFC的主动20 Hz rTMS或假rTMS。在2周内每天进行10次治疗。在治疗方案完成之前、期间和之后，由盲法评估者评估核心PTSD症状、抑郁和焦虑的严重程度。此外，治疗前后还进行了一系列神经心理学测试。结果表明，两个活跃的条件-20 Hz rTMS的左和右DLPFC-诱导的PTSD症状的PTSD清单和治疗结果PTSD量表指数显着减少;然而，右rTMS诱导更大的效果相比，左rTMS。此外，左rTMS后情绪有显着改善，右rTMS后焦虑显着减少。PTSD症状的改善是持久的;在3个月的随访中效果仍然显著。最后，神经心理学评估表明，主动20 Hz rTMS与认知恶化无关，并且用于PTSD患者是安全的。这些结果支持了前额叶皮质的调节可以减轻PTSD的核心症状的观点，并表明右侧DLPFC的高频rTMS可能是最佳的治疗策略。
We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)–associated symptoms. In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV–diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment. Results show that both active conditions—20 Hz rTMS of left and right DLPFC—induced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD. These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy.