Ventrolateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of depersonalization disorder: A consecutive case series.
Ventrolateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of depersonalization disorder: A consecutive case series.
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DOI：
10.1016/j.psychres.2016.04.027
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发表时间：
2016-06-30
影响因子：
11.3
通讯作者：
David AS
中科院分区：
文献类型：
--
作者：
Jay EL;Nestler S;Sierra M;McClelland J;Kekic M;David AS
病例报告和一项开放试验报告了对人格解体障碍（DPD）患者的前额和颞顶叶部位进行重复经颅磁刺激（rTMS）的有希望的反应。我们最近发现，对腹外侧前额叶皮层（VLPFC）进行单次rTMS与症状减轻和生理唤醒增加有关。7例药物耐药DSM-IV DPD患者接受了长达20次的VLPFC右侧rTMS治疗，持续10周。根据参与者的个体结构MRI，使用神经导航软件引导刺激，并以静息运动阈值的110%进行刺激。一次治疗包括15分钟的1 Hz重复TMS。主要结果测量是剑桥人格解体量表（CDS）上人格解体症状的减少。次要结局包括贝克抑郁量表（BDI）和贝克焦虑量表（BAI）评分。右侧VLPFC的20次rTMS治疗显著降低了CDS评分，平均降低44%（范围2-83.5%）。两名患者可被归类为“完全应答者”，四名为“部分应答者”，一名为无应答者。反应通常发生在前6个疗程内。未发生重大不良事件。VLPFC rTMS治疗DPD的随机对照临床试验是必要的。人格解体的特点是感觉的非现实化和分离。没有可靠有效的治疗方法可用于患有这种疾病的人。目前的rTMS治疗导致7例中6例症状改善。参与者报告很少有副作用。
Case reports and an open trial have reported promising responses to repetitive transcranial magnetic stimulation (rTMS) to prefrontal and temporo-parietal sites in patients with depersonalization disorder (DPD). We recently showed that a single session of rTMS to the ventrolateral prefrontal cortex (VLPFC) was associated with a reduction in symptoms and increase in physiological arousal. Seven patients with medication-resistant DSM-IV DPD received up to 20 sessions of right-sided rTMS to the VLPFC for 10 weeks. Stimulation was guided using neuronavigation software based on participants’ individual structural MRIs, and delivered at 110% of resting motor threshold. A session consisted of 1 Hz repetitive TMS for 15 min. The primary outcome measure was reduction in depersonalization symptoms on the Cambridge Depersonalization Scale (CDS). Secondary outcomes included scores on the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). 20 sessions of rTMS treatment to right VLPFC significantly reduced scores on the CDS by on average 44% (range 2–83.5%). Two patients could be classified as “full responders”, four as “partial” and one a non-responder. Response usually occurred within the first 6 sessions. There were no significant adverse events. A randomized controlled clinical trial of VLPFC rTMS for DPD is warranted. Depersonalization is characterized by feelings of derealisation and detachment. There are no reliably effective treatments available for people with the condition. The present rTMS treatment led to symptom improvement in 6 out of 7 cases. Participants reported few side-effects.