Laryngeal mask use was effective for protecting against further cervical spine cord injury in patients with cervical spondylosis during electroconvulsive therapy: two case reports.
Laryngeal mask use was effective for protecting against further cervical spine cord injury in patients with cervical spondylosis during electroconvulsive therapy: two case reports.
复制标题
颈椎病患者在电休克治疗期间使用喉罩可有效防止颈椎进一步损伤：两例病例报告。
DOI：
10.1097/yct.0000000000000757
复制
发表时间：
2021
期刊：
影响因子：
2.5
通讯作者：
Sameshima T.
中科院分区：
文献类型：
--
作者：
kadoi Y;Ota J;Saito S;Sameshima T.
最近的一项研究评估了惯用手是否对重度抑郁症（MDD）患者重复经颅磁刺激（rTMS）的临床反应有影响（n= 310）。作者发现，左手型重度抑郁症患者（n= 23）对rTMS的反应程度高于右手型患者，尤其是高频左侧治疗。尽管他们的研究具有回顾性的局限性，而且关于偏手性的数据有限，比如没有使用爱丁堡偏手性量表2，但作者得出结论，传统的rTMS治疗似乎对左撇子重度抑郁症患者有效，因此，在这些患者中修改治疗应用的偏侧性是不合理的。尽管如此，他们主张未来的试验研究这个问题，以进一步证实他们的结论。这一点很重要，因为目前还没有研究表明是否所有左撇子受试者的反应都与右撇子受试者相同。影像学和电生理研究显示，左撇子和右撇子的利手性和大脑情绪偏侧可能与抑郁症有关，而重度抑郁症病理生理的半球变异可能影响rTMS治疗的临床反应。我描述了一名39岁的左撇子（爱丁堡量表得分为- 100分，即完全左撇子）妇女，根据《精神疾病诊断和统计手册》第五版，自青春期前和边缘性人格障碍以来，患有复发性重度抑郁症，4有2年的严重重度抑郁症发作史，对沃替西汀10mg /d和氟西汀40mg /d耐药。她表现出抑郁和焦虑情绪、自杀念头、快感缺乏、疲劳、绝望、嗜睡、嗜食和注意力不集中。她有抑郁症的家族史。患者为电影制作人，无其他精神病史、重大医学问题或药物滥用或依赖史；她没有性虐待或身体虐待史。详细的医学和神经学评估没有显示rTMS的任何禁忌症。在整个rTMS治疗期间，患者继续服用相同剂量的抗抑郁药。在患者签署知情同意书后，她使用MagPro R30磁刺激器（magi - venture, Farum, Denmark）进行了3次10 Hz的rTMS，并在左侧背外侧前额叶皮层进行了一个水冷的数字8型70毫米线圈，但在几天内，她抱怨抑郁、焦虑和疲劳加剧，在4次1 Hz的rTMS中，她在右侧背外侧前额叶皮层进行了同样的反应。因为她是左撇子，我决定逆转刺激参数用1hz的rTMS对她的左背外侧前额皮质进行治疗。她最初在Montgomery-Asberg抑郁评定量表上得分为30分，但在每日rTMS治疗7周后，她的Montgomery-Asberg抑郁评定量表得分为6分（缓解）。然后她接受了维持性经颅磁刺激，她的缓解持续了6个多月。她没有经颅磁刺激的副作用。这个病例说明需要谨慎对待左撇子患者，并考虑患者的反向参数，特别是谁是
To the Editor Arecent study1 assessed whether handed-ness has an effect on clinical response to repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD)(n= 310). The authors found that left-handed patients with MDD (n= 23) responded to a greater degree than righthanded patients to rTMS particularly with high-frequency left-sided treatment. Despite the limitations pertaining to the retrospective nature of their study and the limited data on handedness, such as not using the Edinburgh Handedness Inventory, 2 the authors concluded that conventional rTMS treatment seems to be effective in patients with MDD who are left-handed and therefore, modifying the laterality of treatment application in these patients is not justified. Nonetheless, they advocated that future trials investigate this question to further confirm their conclusion. This is important because no research has been performed on whether all left-handed subjects respond in the same way as right-handed subjects. Handedness and cerebral lateralization of emotion in leftversus right-handed individuals might be relevant to depression according to imaging and electrophysiological studies, and hemispheric variation in the pathophysiology of MDD may influence clinical response to rTMS treatment. 3I describe the case of a 39-year-old left-handed (score on the Edinburgh inventory of− 100, ie, full left-handed) woman suffering from recurrent major depressive disorder since preadolescence and borderline personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 4 with a 2-year history of a severe major depressive episode resistant to vortioxetine 10 mg/d and fluoxetine 40 mg/d. She endorsed a depressive andanxious mood, suicidal thoughts, anhedonia, fatigue, hopelessness, hypersomnia, and hyperphagia, and poor concentration. She had a family history of depression. The patient is a filmmaker with no history of other psychiatric, major medical problems or of substance abuse or dependence; she had no history of sexual or physical abuse. Detailed medical and neurological assessments did not reveal any contraindications to rTMS. Throughout the entire rTMS treatment period, the patient was continued on the same doses of the antidepressants she had been taking. After the patient signed an informed consent, she underwent 3 sessions of 10 Hz rTMS with a MagPro R30 magnetic stimulator (Mag-Venture, Farum, Denmark) with a liquid-cooled figure-eight 70-mm coil to the left dorsolateral prefrontal cortex but within a few days she complained of worsening depression, anxiety and fatigue, and she had the same reaction within four sessions of 1 Hz rTMS to the right dorsolateral prefrontal cortex. Because she was lefthanded, I decided to reverse the stimulus parameters and treated her with 1 Hz rTMS to the left dorsolateral prefrontal cortex. She initially scored 30 on the Montgomery-Asberg depression rating scale5 but after 7 weeks of daily rTMS treatments, her Montgomery-Asberg depression rating scale score was 6 (remission). She then underwent maintenance rTMS, and her remission has been sustained for more than 6 months. She had no side effect associated with rTMS. This case illustrates the need to treat with caution patients who are left-handed and consider reversed parameters for patients particularly who are