rTMS of the Dorsomedial Prefrontal Cortex for Major Depression: Safety, Tolerability, Effectiveness, and Outcome Predictors for 10 Hz Versus Intermittent Theta-burst Stimulation
rTMS of the Dorsomedial Prefrontal Cortex for Major Depression: Safety, Tolerability, Effectiveness, and Outcome Predictors for 10 Hz Versus Intermittent Theta-burst Stimulation
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DOI：
10.1016/j.brs.2014.11.002
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发表时间：
2015-03-01
影响因子：
7.7
通讯作者：
Downar, Jonathan
中科院分区：
文献类型：
--
作者：
Bakker, Nathan;Shahab, Saba;Downar, Jonathan
背景资料：传统的经颅磁刺激（rTMS）治疗抑郁症的方案通常采用持续时间>30分钟的刺激疗程。然而，最近的研究试图通过采用更简短的方案（如θ波爆发刺激（iTBS））来改善成本、容量和结果。目的：在一项大型、自然的研究中，比较10 Hz（30分钟）与iTBS（6分钟）方案的DMPFC-rTMS的安全性、有效性和结局预测因素，方法：通过病历回顾确定了185例药物抵抗性抑郁发作患者，他们接受了20-30次DMPFC-rTMS治疗（10 Hz，n = 98; iTBS，n = 87）。结果：10 Hz和iTBS患者的临床特征在治疗前没有差异，除了iTBS患者的年龄显著更高。总共进行了7912次DMPFC-rTMS（10 Hz，4274; iTBS，3638）运行，没有任何癫痫发作或其他严重不良事件，两组之间提前停药的比率没有显著差异。两组间的二分结局无显著差异（应答/缓解率：贝克抑郁量表-II：10 Hz，40.6%/29.2%; iTBS，43.0%/31.0%。17-项目汉密尔顿抑郁量表：10 Hz，50.6%/38.5%; iTBS，48.5%/27.9%）。在连续结果方面，两组之间在治疗前或治疗后评分或两项指标的改善百分比方面没有显著差异。混合效应模型显示，没有显着的组由时间相互作用，无论是measure.Conclusions：10 Hz和iTBS DMPFC-rTMS出现安全和耐受在120%的静息运动阈值。6分钟iTBS和30分钟10 Hz方案的有效性似乎相当。比较10 Hz与iTBS的随机试验可能是必要的。(C)2015年，作者。爱思唯尔公司出版
Background: Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS).Objective: To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series.Methods: A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014.Results: Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure.Conclusions: Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted. (C) 2015 The Authors. Published by Elsevier Inc.