Shalvata Mental Health Care Center, Cognitive and Emotional Laboratory, Hod-Hasharon, Israel.
Brain Stimul. 2009 Oct;2(4):188-200. doi: 10.1016/j.brs.2009.08.002. Epub 2009 Sep 16.
Electroconvulsive therapy (ECT) is an effective alternative for pharmacotherapy in treatment-resistant depressive patients, but the side effects limit its use. Transcranial magnetic stimulation (TMS) has been proposed as a refined alternative, but most studies do not indicate that TMS is as effective as ECT for severe depression.
We propose that the limited effectiveness of standard TMS resides in its superficial effect on the cortex, although much of the pathophysiology of depression is associated with deeper and larger brain regions implicated in the reward system. Herein, we tested the effectiveness and safety of a novel TMS coil, the "H-coil," which enables direct stimulation of deeper brain regions, at the expense of focality.
We have studied the antidepressant and cognitive effects induced by 4 weeks of high-frequency (20 Hz) repeated deep TMS (DTMS) over the prefrontal cortex (PFC) of 65 medication-free depressive patients, who have failed to benefit from prior medications. Patients were randomly assigned to various treatment configurations, differing in stimulation intensity and laterality. Effects were assessed by the 24-item Hamilton depression rating scale (HDRS-24) and several secondary outcome measures.
A significant improvement in HDRS scores was found when high, but not low, stimulation intensity was used. Several cognitive improvements were evident, and no treatment-related serious adverse events were observed.
DTMS over the PFC was found safe and effective in alleviating depression. The results accentuate the significance of deep, high-intensity stimulation over low, and serve as the first study to indicate the potential of DTMS in psychiatric and neurologic disorders.
电抽搐疗法（ECT）是治疗抵抗性抑郁患者的药物治疗的有效替代方法，但副作用限制了其使用。经颅磁刺激（TMS）已被提议作为一种改良的替代方法，但大多数研究表明 TMS 不如 ECT 对重度抑郁症有效。
我们提出，标准 TMS 的有限效果在于其对皮层的浅表作用，尽管抑郁症的许多病理生理学与更深和更大的与奖励系统相关的大脑区域有关。在此，我们测试了一种新型 TMS 线圈，即“H 线圈”的有效性和安全性，该线圈可以在牺牲焦点的情况下直接刺激更深的大脑区域。
我们研究了 65 名未服用药物的抑郁患者接受 4 周高频（20 Hz）重复经颅深部 TMS（DTMS）治疗后对前额叶皮层（PFC）的抗抑郁和认知作用，这些患者以前的药物治疗都没有受益。患者被随机分配到不同的治疗配置中，刺激强度和侧别不同。通过 24 项汉密尔顿抑郁评定量表（HDRS-24）和几项次要结局指标评估效果。
当使用高而非低刺激强度时，发现 HDRS 评分显著改善。认知方面也有明显改善，未观察到与治疗相关的严重不良事件。
PFC 上的 DTMS 被发现安全有效，可以缓解抑郁。结果强调了深部、高强度刺激的重要性，而不是低强度和低强度刺激，并首次表明 DTMS 在精神和神经障碍中的潜在应用。
