A preliminary study of fMRI-Guided rTMS in the treatment of generalized anxiety disorder
A preliminary study of fMRI-Guided rTMS in the treatment of generalized anxiety disorder
复制标题
DOI：
10.4088/jcp.v69n0708
复制
发表时间：
2008-07-01
影响因子：
5.3
通讯作者：
Iacoboni, Marco
中科院分区：
文献类型：
--
作者：
Bystritsky, Alexander;Kaplan, Jonas T.;Iacoboni, Marco
背景：重复经颅磁刺激（rTMS）是一种非侵入性的方法，有望治疗几种精神疾病。然而，最有效的治疗部位和参数需要更多的探索。此外，rTMS是否是一种有效的治疗与广泛性焦虑症（GAD）的DSM-IV诊断的个人尚未进行实证检验。这项试点研究的目标是评估功能性磁共振成像（fMRI）引导的rTMS是否有效地减少GAD.Method的症状：10名参与者与DSM-IV诊断广泛性焦虑症，从加州大学洛杉矶分校的焦虑症计划招募，年龄在18岁至56岁之间，从2006年8月至2007年3月参加了这项研究。预处理症状激发fMRI实验被用来确定最活跃的位置在前额叶皮层的参与者。10名参与者在3周的时间内完成了6次rTMS，立体定向到先前确定的前额叶位置。主要疗效指标为汉密尔顿焦虑量表（HAM-A）和临床疗效总评量表-疾病改善（CGI-I）量表。对治疗的反应被定义为HAM-A和CGI-I评分为I或2（分别为“非常改善”或“显著改善”）的50%或更多的降低。结果：总体而言，rTMS与HAM-A评分的显著降低（t = 6.044，p = .001）相关，表明GAD症状的临床改善。在终点，6（60%）的10名参与者谁完成了研究显示减少50%或更多的HAM-A和CGI-I评分为I或2;这6名受试者也有一个终点HAM-A评分< 8，因此满足标准的remission.Conclusion：目前的研究结果表明，fMRI引导的rTMS治疗可能是一种有益的技术，用于治疗焦虑症。局限性包括样本量小和开放标签设计，其技术可能与较大的安慰剂反应相关。这些局限性需要进一步的研究来确定rTMS是否确实有效治疗焦虑症。clinicaltrials.gov
Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that holds promise for treating several psychiatric disorders. Yet the most effective location and parameters for treatment need more exploration. Also, whether rTMS is an effective treatment for individuals with a DSM-IV diagnosis of generalized anxiety disorder (GAD) has not been empirically tested. The goal of this pilot study was to evaluate whether functional magnetic resonance imaging (fMRI)-guided rTMS is effective in reducing symptoms of GAD.Method: Ten participants with a DSM-IV diagnosis of GAD, recruited from the UCLA Anxiety Disorders Program, and between the ages of 18 and 56 years were enrolled in the study from August 2006 to March 2007. A pretreatment symptom provocation fMRI experiment was used to determine the most active location in the prefrontal cortex of the participants. Ten participants completed 6 sessions of rTMS over the course of 3 weeks, stereotactically directed to the previously determined prefrontal location. The primary efficacy measures were the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions-Improvement of Illness (CGI-I) scale. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of I or 2 ("very much improved" or "much improved," respectively).Results: Overall, rTMS was associated with significant decreases in HAM-A scores (t = 6.044, p = .001) indicative of clinical improvement in GAD symptoms. At endpoint, 6 (60%) of the 10 participants who completed the study showed reductions of 50% or more on the HAM-A and a CGI-I score of I or 2; those 6 subjects also had an endpoint HAM-A score < 8, therefore meeting criteria for remission.Conclusion: Results of the current study suggest that fMRI-guided rTMS treatment may be a beneficial technique for the treatment of anxiety disorders. Limitations include a small sample size and open-label design with a technology that may be associated with a large placebo response. These limitations necessitate further research to determine whether rTMS is indeed effective in treating anxiety disorders.Trial Registration: clinicaltrials.gov Identifier: NCT00539357.