Xia Guohua, Gajwani Prashant, Muzina David J, Kemp David E, Gao Keming, Ganocy Stephen J, Calabrese Joseph R
Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106, USA.
Int J Neuropsychopharmacol. 2008 Feb;11(1):119-30. doi: 10.1017/S1461145707007699. Epub 2007 Mar 5.
This review focused on the treatment-emergent mania/hypomania (TEM) associated with repetitive transcranial magnetic stimulation (rTMS) treatment of depression. English-language literature published from 1966-2006 and indexed in Medline was searched. Ten of 53 randomized controlled trials on rTMS treatment of depression specifically addressed TEM. The pooled TEM rate is 0.84% for the active treatment group and 0.73% for the sham group. The difference is not statistically significant. Along with case reports, a total of 13 cases of TEM associated with rTMS treatment of depression have been published. Most of these patients were diagnosed with bipolar disorder and the majority of patients experiencing TEM took medication concurrent with rTMS. The parameters of rTMS used in these cases were scattered over the spectrum of major parameters explored in previous studies. Most train durations and intervals were within the published safety guidelines of the field. Reducing the frequency of sessions from two per day to one per day might be associated with a lower likelihood of TEM recurrence. The severity of manic symptoms varied significantly, but all cases responded to treatment that included a decrease or discontinuation of antidepressant and/or rTMS treatment and/or use of anti-manic medication. Current data suggests that rTMS treatment carries a slight risk of TEM that is not statistically higher than that associated with sham treatment. More systematic studies are needed to better understand TEM associated with rTMS. Special precautions and measures should be adopted to prevent, monitor, and manage TEM in research and practice.
本综述聚焦于与重复经颅磁刺激（rTMS）治疗抑郁症相关的治疗中出现的躁狂/轻躁狂（TEM）。检索了1966年至2006年发表并被Medline收录的英文文献。53项关于rTMS治疗抑郁症的随机对照试验中有10项专门涉及TEM。活性治疗组的合并TEM发生率为0.84%，假手术组为0.73%。差异无统计学意义。连同病例报告在内，共有13例与rTMS治疗抑郁症相关的TEM病例已发表。这些患者大多被诊断为双相情感障碍，且大多数经历TEM的患者在接受rTMS治疗时同时服用药物。这些病例中使用的rTMS参数分布在先前研究探索的主要参数范围内。大多数脉冲串持续时间和间隔在该领域已发表的安全指南范围内。将治疗频率从每天两次降至每天一次可能与TEM复发的可能性降低有关。躁狂症状的严重程度差异很大，但所有病例对包括减少或停用抗抑郁药和/或rTMS治疗和/或使用抗躁狂药物在内的治疗均有反应。目前的数据表明，rTMS治疗存在轻微的TEM风险，在统计学上并不高于与假手术治疗相关的风险。需要进行更系统的研究，以更好地了解与rTMS相关的TEM。在研究和实践中应采取特殊的预防措施和措施来预防、监测和管理TEM。
