Department of Neurology, University of Pecs, Pecs, Hungary.
Mov Disord. 2010 Oct 30;25(14):2311-7. doi: 10.1002/mds.23270.
Based on several open-label and case studies, repetitive transcranial magnetic stimulation (rTMS) seems to have an antidepressive effect on patients with Parkinson's disease (PD). However, this hypothesis requires further confirmation. We conducted a randomized, double-blind placebo-controlled study to evaluate the effect of rTMS over the left dorsolateral prefrontal cortex (DLPFC) on depression and various motor and nonmotor features of PD. Twenty-two PD patients with mild or moderate depressive episodes were assigned into two groups, one receiving real-rTMS (90% of resting motor threshold, 5 Hz, 600 pulses-a-day for 10 days) over the left DLPFC, and another group receiving sham-rTMS. An investigator blinded to the treatment performed three video-taped examinations on each patient: before stimulation (baseline), 1 day (short term), and 30 days after treatment session ended (long-term effect). Mini-Mental State Examination, Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr, Epworth Sleepiness, Visual Analog and Montgomery-Asberg Depression Rating Scales (MADRS), Beck Depression Inventory (BDI), and Trail making and Stroop tests were applied. In the actively treated group, not only depression rating scales showed significant improvement 30 days after treatment ended (BDI by 44.4% and MADRS by 26.1%), but also the accuracy of Stroop test (by 16%). We could also demonstrate an insignificant improvement in UPDRS-III by 7.5 points (31.9%, P = 0.06). In the sham-treated group none of the examined tests and scales improved significantly after sham stimulation. Our study demonstrated the beneficial effect of the left DLPFC rTMS on depression in PD lasting at least 30 days after treatment. However, this result should be confirmed in patients with severe depression by further clinical trials.
基于几项开放标签和案例研究，重复经颅磁刺激（rTMS）似乎对帕金森病（PD）患者具有抗抑郁作用。然而，这一假设需要进一步证实。我们进行了一项随机、双盲、安慰剂对照研究，以评估 rTMS 对左侧背外侧前额叶皮层（DLPFC）对抑郁症和 PD 的各种运动和非运动特征的影响。22 例伴有轻度或中度抑郁发作的 PD 患者被分为两组，一组接受左侧 DLPFC 的真实 rTMS（静息运动阈值的 90%，5Hz，每天 600 个脉冲，持续 10 天），另一组接受假 rTMS。一名对治疗不知情的研究者对每位患者进行了三次录像检查：刺激前（基线）、1 天（短期）和治疗结束后 30 天（长期效果）。使用简易精神状态检查、统一帕金森病评定量表（UPDRS）、Hoehn-Yahr、Epworth 嗜睡量表、视觉模拟量表和蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、贝克抑郁量表（BDI）以及连线和斯特鲁普测验进行评估。在积极治疗组中，不仅抑郁评分量表在治疗结束后 30 天显示出显著改善（BDI 改善 44.4%，MADRS 改善 26.1%），而且斯特鲁普测验的准确性也提高了 16%。我们还可以证明 UPDRS-III 改善了 7.5 分（31.9%，P = 0.06）。在假刺激组中，所有检查和量表在假刺激后均无显著改善。我们的研究表明，左侧 DLPFC rTMS 对 PD 患者的抑郁具有有益作用，这种作用至少可以持续 30 天。然而，这一结果需要通过进一步的临床试验在重度抑郁症患者中得到证实。
