Repetitive transcranial magnetic stimulation as treatment of poststroke depression: A preliminary study
Repetitive transcranial magnetic stimulation as treatment of poststroke depression: A preliminary study
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DOI：
10.1016/j.biopsych.2003.08.017
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发表时间：
2004-02-15
影响因子：
10.6
通讯作者：
Chemerinski, E
中科院分区：
文献类型：
--
作者：
Jorge, RE;Robinson, RG;Chemerinski, E
背景：抑郁症对卒中后康复和死亡率有重要影响。有一定比例的中风后抑郁(PSD)患者对抗抑郁药物没有反应。重复经颅磁刺激(RTMS)在这些难治性PSD患者中可能是一种安全有效的替代方案。方法：我们对难治性PSD患者进行了一项随机、平行、双盲研究，比较活动和假左侧前额叶rTMS。在停用抗抑郁药物后，患者被随机分配接受10次活动(10赫兹，运动阈值的110%，持续5秒的20次训练)或假左侧额叶rTMS。疗效测量包括汉密尔顿抑郁量表评分、有效率和缓解率。患者在基线和完成方案后完成一组神经心理测试。结果：与假刺激相比，10次左侧背外侧前额叶皮质活跃的rTMS与抑郁症状的显著减轻相关。这种减少不受患者年龄、中风类型或部位、左额叶白质疏松体积或刺激线圈到前额叶皮质距离的影响。然而，HAM-D评分减分率与额叶灰质和白质体积呈显著正相关。在积极刺激组和假刺激组之间，认知功能没有显著变化。结论：综合这些初步研究结果，rTMS可能是治疗难治性抑郁症和卒中的一种有效且安全的替代疗法。
Background: Depression has a significant impact on poststroke recovery and mortality. There are a proportion of Patients with poststroke depression (PSD) who do not respond to antidepressants. Repetitive Transcranial Magnetic Stimulation (rTMS) might be a safe and effective alternative in these refractory cases.Methods: We conducted a randomized, parallel, double-blind study of active versus sham left prefrontal rTMS in patients with refractory PSD. After discontinuing antidepressants, patients were randomly assigned to receive 10 sessions of active (10 Hz, 110% of the motor threshold, 20 trains of 5 seconds duration) or sham left prefrontal rTMS. Efficacy measures included HAM-D scores, response and remission rates. Patients completed a neuropsychological battery at baseline and after completing the protocol.Results: When compared with sham stimulation, 10 sessions of active rTMS of the left dorsolateral prefrontal cortex were associated with a significant reduction of depressive symptoms. This reduction was not influenced by patient's age, type or location of stroke, volume of left frontal leukoaraiosis or by the distance of the stimulating coil to the prefrontal cortex. However, there was a significant positive correlation between the percentage of reduction of Ham-D scores and frontal gray and white matter volumes. There were no significant changes in cognitive functioning between the active and the sham stimulation groups. In addition, there were few and mild adverse effects that were equally distributed among groups.Conclusions: Taken together, these preliminary,findings suggest that rTMS may be an effective and safe treatment alternative for patients with refractory depression and stroke.