Chistyakov Andrei V, Kaplan Boris, Rubichek Odil, Kreinin Isabella, Koren Dany, Feinsod Moshe, Klein Ehud
Laboratory of Clinical Neurosciences, Department of Neurosurgery, Rambam Medical Center, B. Rappaport Faculty of Medicine, The Technion, Israel Institute of Technology, Haifa, Israel.
Int J Neuropsychopharmacol. 2005 Jun;8(2):223-33. doi: 10.1017/S1461145704004912. Epub 2004 Nov 30.
The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) that have been demonstrated in recent studies could be related to its ability to modulate cortical excitability. Yet, the relationship between stimulus location and frequency and treatment outcome has not been established. The aim of the present study was to compare efficacy of rTMS in various configurations and clomipramine treatment in patients with major depression (MD) and to evaluate the relationship between clinical outcome and changes in cortical excitability. Fifty-nine MD patients were randomized to receive (1) left (n = 12) or right (n = 12) 3 Hz rTMS with placebo medication; (2) left (n = 10) or right (n = 9) 10 Hz rTMS with placebo medication; (3) active medication (clomipramine) with sham rTMS (n = 16). Both 3 Hz and 10 Hz rTMS were administered to the prefrontal cortex by a circular coil at an intensity of 110% and 100% of the resting motor threshold (rMT) respectively. Measurements of cortical excitability were performed prior to and 24 h after completion of 2 wk of daily rTMS or pharmacological treatments. These included the rMT, silent period threshold (SPT), inter-threshold difference (ITD), MEP/M-wave amplitude ratio and silent period duration (SPD). Severity of depression was blindly assessed by the Hamilton Depression Rating Scale (HDRS). The best improvement scores were seen in patients who received left 3 Hz rTMS. The 10 Hz rTMS treatment was less tolerated resulting in a significantly higher dropout rate. A significant increase of the MEP/M wave amplitude ratio accompanied by a shortening of the SPD was evidenced in patients who showed marked clinical improvement (reduction in HDRS by 50% or more) following left rTMS regardless of stimulation frequency. Our results suggest that 3 Hz left rTMS has a higher therapeutic efficacy and tolerability in patients with MD. The enhancement of cortical excitability may be related to the antidepressant action of rTMS.
近期研究已证实，重复经颅磁刺激（rTMS）的抗抑郁作用可能与其调节皮质兴奋性的能力有关。然而，刺激部位、频率与治疗效果之间的关系尚未明确。本研究旨在比较不同参数配置的rTMS与氯米帕明治疗重度抑郁症（MD）患者的疗效，并评估临床疗效与皮质兴奋性变化之间的关系。59例MD患者被随机分为三组：（1）接受左侧（n = 12）或右侧（n = 12）3Hz rTMS并服用安慰剂；（2）接受左侧（n = 10）或右侧（n = 9）10Hz rTMS并服用安慰剂；（3）服用活性药物（氯米帕明）并接受伪rTMS（n = 16）。3Hz和10Hz rTMS均通过圆形线圈分别以静息运动阈值（rMT）的110%和100%的强度刺激前额叶皮质。在每日进行2周的rTMS或药物治疗前后，分别测量皮质兴奋性。测量指标包括rMT、静息期阈值（SPT）、阈间差值（ITD）、运动诱发电位/肌肉动作电位（MEP/M波）幅度比以及静息期时长（SPD）。采用汉密尔顿抑郁量表（HDRS）对抑郁严重程度进行盲法评估。接受左侧3Hz rTMS治疗的患者改善得分最佳。10Hz rTMS治疗的耐受性较差，导致脱落率显著更高。无论刺激频率如何，接受左侧rTMS治疗后临床显著改善（HDRS降低50%或更多）的患者，其MEP/M波幅度比显著增加，同时SPD缩短。我们的结果表明，3Hz左侧rTMS对MD患者具有更高的治疗效果和耐受性。皮质兴奋性的增强可能与rTMS的抗抑郁作用有关。
