rTMS treatment for depression in Parkinson's disease increases BOLD responses in the left prefrontal cortex
rTMS treatment for depression in Parkinson's disease increases BOLD responses in the left prefrontal cortex
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DOI：
10.1017/s1461145707007961
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发表时间：
2008-03-01
影响因子：
4.8
通讯作者：
Arnaro, Edson, Jr.
中科院分区：
文献类型：
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作者：
Cardoso, Ellison Fernando;Fregni, Felipe;Arnaro, Edson, Jr.
帕金森氏病(PD)患者接受抗抑郁治疗的机制尚不清楚。通过神经成像方法研究治疗成功后的神经变化，可以深入了解与特定治疗选择相关的作用机制。为探讨重复经颅磁刺激(RTMS)和氟西汀的神经调制机制，将21例帕金森病患者随机分为两组：左侧前额叶背外侧(5 HzrTMS；120%运动阈值)活动rTMS+安慰剂组和假rTMS+氟西汀20 mg/d组，治疗前后分别进行事件相关功能磁共振成像(FMRI)检查。两组患者的情绪均有显著改善，且效果相似。RTMS治疗后，左侧梭形回、小脑和右侧DLPFC的脑活动较治疗前降低，左侧DLPFC和扣带回前部的脑活动增加。相比之下，氟西汀治疗后，右侧运动前皮质和右侧前额叶内侧皮质的脑活动增加。在左侧前额叶皮质，两组间存在显著的交互作用，提示两个治疗组在这一区域的活动变化不同。我们的发现表明，rTMS和氟西汀对帕金森病的抗抑郁作用与抑郁相关神经网络不同区域的变化有关。
The mechanisms underlying the effects of antidepressant treatment in patients with Parkinson's disease (PD) are unclear. The neural changes after successful therapy investigated by neuroimaging methods can give insights into the mechanisms of action related to a specific treatment choice. To study the mechanisms of neural modulation of repetitive transcranial magnetic Stimulation (rTMS) and fluoxetine, 21 PD depressed patients were randomized into only two active treatment groups for 4 wk: active rTMS over left dorsolateral prefrontal cortex (DLPFC) (5 Hz rTMS; 120% motor threshold) with placebo pill and sham rTMS with fluoxetine 20mg/d. Event-related functional magnetic resonance imaging (fMRI) with emotional stimuli was performed before and after treatment - in two sessions (test and re-test) at each time-point. The two groups of treatment had a significant, similar mood improvement. After rTMS treatment, there were brain activity decreases in left fusiform gyrus, cerebellum and right DLPFC and brain activity increases in left DLPFC and anterior cingulate gyrus compared to baseline. In contrast, after fluoxetine treatment, there were brain activity increases in right premotor and right medial prefrontal cortex. There was a significant interaction effect between groups vs. time in the left medial prefrontal cortex, suggesting that the activity in this area changed differently in the two treatment groups. Our findings show that antidepressant effects of rTMS and fluoxetine in PD are associated with changes in different areas of the depression-related neural network.