Potrebić A, Dragasević N, Svetel M, Kostić V S
Institute of Psychiatry, Clinical Centre of Serbia, Belgrade.
Srp Arh Celok Lek. 2001 Sep-Oct;129(9-10):235-8.
Parkinson's disease (PD), that has usually been associated with movement disorders, is also associated with depression in about 40% of patients [9]. Transcranial magnetic stimulation (TMS) is a new non-invasive technique for direct stimulation of the cerebral cortical neurons [1]. Several open studies have shown that repetitive TMS (rTMS) at both rapid (rapid rTMSi: > 1 Hz) and low frequencies (slow rTMSi: < 1 Hz) may have antidepressant action [2-6]. The study included 8 patients diagnosed as PD fulfilling the DSM-IV criteria for major depression (5 patients) and dysthymia (3 patients). Magnetic stimulator, 200 Mag-Stim, total output 2 T and a circular coil of 90 mm, were used. For ten consecutive days, between noon and 1 p.m. the patients were stimulated with apprx. 80% of the output (1.6 T) at 0.5 Hz. The daily treatment implied stimulation of both sides of the head (first the right, then the left) at four sites (prefrontal, frontal, parietal and occipital regions) with 5 stimulations each site (20 stimulations per hemisphere). Before the beginning of the study, 2-3 hours after the last stimulation (day 10), 7 and 14 days after completion of the treatment, the patients were subjected to scoring on the Hamilton Depression Rating Scale [11] and Unified Parkinson's Disease Rating Scale (UPDRS) [12]. The HDRS values before initiation of rTMS were 19.2 +/- 3.1, with significant fall (p < 0.01) after 10 days of stimulation (14.9 +/- 3.2), 17 days (12.2 +/- 2.7) and 24 days (13.6 +/- 5.3) after the beginning of the study, suggesting that the antidepressive effect persisted even two weeks after discontinuation of stimulation. The UPDRS values were monitored concomitantly. The values on this scale failed to alter significantly. In conclusion, rTMS is a relatively safe and painless method associated with antidepressant action in PD patients. Treatment of depression in PD is of great importance, but the choice of medication is accompanied with numerous limitations [20]. Antidepressant action of rTMS and its maintenance for two weeks after discontinuation of stimulation enables usage of this method in PD in phases of exacerbation of depressive symptoms at least over the period required to reach the full effect of selected medication.
帕金森病（PD）通常与运动障碍相关，但约40%的患者也伴有抑郁[9]。经颅磁刺激（TMS）是一种直接刺激大脑皮质神经元的新型非侵入性技术[1]。多项开放性研究表明，快速（快速重复经颅磁刺激：>1Hz）和低频（慢速重复经颅磁刺激：<1Hz）重复经颅磁刺激（rTMS）可能具有抗抑郁作用[2-6]。该研究纳入了8例符合DSM-IV重度抑郁标准（5例）和恶劣心境标准（3例）的PD患者。使用的磁刺激仪为200 Mag-Stim，总输出2T，圆形线圈直径90mm。连续10天，在中午12点至下午1点之间，用约80%的输出（1.6T）以0.5Hz的频率对患者进行刺激。每日治疗包括在头部两侧（先右侧，后左侧）的四个部位（前额叶、额叶、顶叶和枕叶区域）进行刺激，每个部位刺激5次（每个半球20次）。在研究开始前、最后一次刺激后2 - 3小时（第10天）、治疗结束后7天和14天，对患者进行汉密尔顿抑郁评定量表[11]和统一帕金森病评定量表（UPDRS）[12]评分。rTMS开始前HDRS值为19.2±3.1，刺激10天后（14.9±3.2）、研究开始后17天（12.2±2.7）和24天（13.6±5.3）显著下降（p<0.01），表明即使在刺激停止两周后抗抑郁效果仍持续存在。同时监测UPDRS值，该量表上的值未发生显著变化。总之，rTMS是一种相对安全且无痛的方法，对PD患者具有抗抑郁作用。PD患者抑郁的治疗非常重要，但药物选择存在诸多限制[20]。rTMS的抗抑郁作用及其在刺激停止后持续两周，使得该方法至少在达到所选药物充分疗效所需的时间段内，可用于PD患者抑郁症状加重期。
