Speer A M, Benson B E, Kimbrell T K, Wassermann E M, Willis M W, Herscovitch P, Post R M
Biological Psychiatry Branch, NIMH, NIH, Bethesda, Maryland, United States.
J Affect Disord. 2009 Jun;115(3):386-94. doi: 10.1016/j.jad.2008.10.006. Epub 2008 Nov 22.
Optimal parameters of rTMS for antidepressant efficacy in general, or within patients, have not been adequately delineated.
Using a double-blind, sham-controlled, cross-over design, 22 adult patients with treatment refractory major depression (n=9; bipolar disorder, depressed phase) were randomized to active rTMS (20-Hz or 1-Hz) or sham rTMS conditions and given 5 rTMS treatments per week for two weeks. Repetitive TMS was administered at 100% of motor threshold for 1600 pulses over the left prefrontal cortex using a figure-eight coil. Patients initially randomized to sham rTMS were then exposed to two weeks of active rTMS with each frequency under blinded conditions. Those who received active 20-Hz and 1-Hz rTMS were crossed over to the opposite frequency for two weeks. Improvement in Hamilton Depression ratings were assessed after each two-week treatment phase. PET imaging was used to evaluate the patient's baseline absolute regional cerebral activity (blood flow and metabolism) as potential predictor of clinical response.
Changes in depression severity on 1-Hz and 20-Hz rTMS were inversely correlated. PET scans with baseline hypoperfusion (but not hypometabolism) were associated with better improvement on 20-Hz rTMS as predicted.
The magnitude of the clinical change with either frequency at 100% motor threshold was not robust, and larger studies with higher intensities of rTMS for longer durations of time should be explored.
High and low frequency rTMS exerts differential effects on depressed mood within individual subjects. The brain activity predictors and correlates of an optimal antidepressant response to rTMS remain to be better defined.
一般情况下，或在患者个体中，重复经颅磁刺激（rTMS）治疗抑郁症疗效的最佳参数尚未得到充分界定。
采用双盲、假刺激对照、交叉设计，将22例难治性重度抑郁症成年患者（n = 9；双相情感障碍，抑郁相）随机分为rTMS治疗组（20赫兹或1赫兹）或假rTMS组，每周进行5次rTMS治疗，共两周。使用八字形线圈，在左侧前额叶皮质以运动阈值的100%给予1600个脉冲的重复经颅磁刺激。最初随机分配到假rTMS组的患者随后在盲法条件下接受两周的不同频率的主动rTMS治疗。接受20赫兹和1赫兹主动rTMS治疗的患者交叉接受相反频率的治疗两周。在每两周的治疗阶段后评估汉密尔顿抑郁量表评分的改善情况。使用正电子发射断层扫描（PET）成像评估患者的基线绝对局部脑活动（血流和代谢），作为临床反应的潜在预测指标。
1赫兹和20赫兹rTMS治疗后抑郁严重程度的变化呈负相关。如预期的那样，基线灌注不足（而非代谢减退）的PET扫描与20赫兹rTMS治疗的更好改善相关。
在运动阈值100%的任一频率下，临床变化的幅度都不显著，应开展更大规模、更高强度、更长疗程的rTMS研究。
高频和低频rTMS对个体受试者的抑郁情绪有不同影响。rTMS最佳抗抑郁反应的脑活动预测指标及相关因素仍有待进一步明确。
