Indicators for Remission of Suicidal Ideation Following Magnetic Seizure Therapy in Patients With Treatment-Resistant Depression.
Indicators for Remission of Suicidal Ideation Following Magnetic Seizure Therapy in Patients With Treatment-Resistant Depression.
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DOI：
10.1001/jamapsychiatry.2015.3097
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发表时间：
2016-04
期刊：
影响因子：
25.8
通讯作者：
Yinming Sun;F. Farzan;B. Mulsant;T. Rajji;P. Fitzgerald;M. Barr;J. Downar;W. Wong;D. Blumberger-D.-Blumb
中科院分区：
文献类型：
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作者：
Yinming Sun;F. Farzan;B. Mulsant;T. Rajji;P. Fitzgerald;M. Barr;J. Downar;W. Wong;D. Blumberger-D.-Blumb
磁发作治疗（MST）是治疗难治性抑郁症（TRD）的一种新的治疗选择。自杀意念通常与TRD相关，并导致该疾病的死亡率和发病率增加。目的：通过交叉经颅磁刺激和脑电图（TMS-EEG）皮质抑制测量，确定一种生物标志物，可作为MST治疗后自杀意念缓解的指标。设计、环境和参与者33名TRD患者参加了MST治疗的开放标签临床试验。来自27例患者（82%）的数据可用于本研究的分析。在MST治疗开始前1周内，使用TMS-EEG测量左背外侧前额叶皮层和左运动皮层的皮质抑制（即N100和长间隔皮质抑制[LICI]）来评估基线TMS-EEG测量，后者作为对照部位。MST治疗在全身麻醉下进行，使用一个由2个单独的锥形线圈组成的刺激线圈。在MST开始前和完成后，使用自杀意念量表（SSI）评估自杀意念。选择左背外侧前额皮质皮质抑制指标（即N100和LICI）。N100被量化为单次经颅磁刺激诱发电位（TEP）在100毫秒左右的负峰幅度。LICI被量化为双脉冲TEP相对于单脉冲TEP的抑制量。结果在纳入分析的27例患者中，15例（56%）为女性；样本的平均（SD）年龄为46.0（15.3）岁。在基线时，患者的平均SSI评分为9.0(6.8)，27例患者中有8例（30%）评分为0。MST完成后，患者的平均SSI评分为4.2(6.3)（治疗前后平均差值为4.8[6.7]；配对t26 = 3.72; P = .001）， 27例患者中有18例（67%）得分为0，缓解率为53%。额叶皮层的N100和LICI是自杀意念缓解的指标，但运动皮层没有，准确率为89%，灵敏度为90%，特异性为89%（曲线下面积，0.90;P = 0.003）。结论和相关性这些结果表明，皮质抑制可用于识别最有可能在MST疗程后经历自杀意念缓解的TRD患者。基线时更强的抑制性神经传递可能反映了跨突触网络的完整性，这是MST针对的最佳治疗反应。
IMPORTANCE Magnetic seizure therapy (MST) is a novel therapeutic option for treatment-resistant depression (TRD). Suicidal ideation is often associated with TRD and contributes to the increased mortality and morbidity of the disorder. OBJECTIVE To identify a biomarker that may serve as an indicator of remission of suicidal ideation following a course of MST by using cortical inhibition measures from interleaved transcranial magnetic stimulation and electroencephalography (TMS-EEG). DESIGN, SETTING, AND PARTICIPANTS Thirty-three patients with TRD were part of an open-label clinical trial of MST treatment. Data from 27 patients (82%) were available for analysis in this study. Baseline TMS-EEG measures were assessed within 1 week before the initiation of MST treatment using the TMS-EEG measures of cortical inhibition (ie, N100 and long-interval cortical inhibition [LICI]) from the left dorsolateral prefrontal cortex and the left motor cortex, with the latter acting as a control site. INTERVENTIONS The MST treatments were administered under general anesthesia, and a stimulator coil consisting of 2 individual cone-shaped coils was used. MAIN OUTCOMES AND MEASURES Suicidal ideation was evaluated before initiation and after completion of MST using the Scale for Suicide Ideation (SSI). Measures of cortical inhibition (ie, N100 and LICI) from the left dorsolateral prefrontal cortex were selected. N100 was quantified as the amplitude of the negative peak around 100 milliseconds in the TMS-evoked potential (TEP) after a single TMS pulse. LICI was quantified as the amount of suppression in the double-pulse TEP relative to the single-pulse TEP. RESULTS Of the 27 patients included in the analyses, 15 (56%) were women; mean (SD) age of the sample was 46.0 (15.3) years. At baseline, patients had a mean SSI score of 9.0 (6.8), with 8 of 27 patients (30%) having a score of 0. After completion of MST, patients had a mean SSI score of 4.2 (6.3) (pre-post treatment mean difference, 4.8 [6.7]; paired t26 = 3.72; P = .001), and 18 of 27 individuals (67%) had a score of 0 for a remission rate of 53%. The N100 and LICI in the frontal cortex-but not in the motor cortex-were indicators of remission of suicidal ideation with 89% accuracy, 90% sensitivity, and 89% specificity (area under the curve, 0.90; P = .003). CONCLUSIONS AND RELEVANCE These results suggest that cortical inhibition may be used to identify patients with TRD who are most likely to experience remission of suicidal ideation following a course of MST. Stronger inhibitory neurotransmission at baseline may reflect the integrity of transsynaptic networks that are targeted by MST for optimal therapeutic response.