The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia.
Psychol Med. 2011 Jun;41(6):1187-96. doi: 10.1017/S0033291710001923. Epub 2010 Oct 7.
Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres.
A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions. Outcomes were assessed with standard rating scales.
Overall, slightly more than 50% of the patients achieved clinical response criteria. There was no substantial difference in response between the unilateral and bilateral treatment groups. Successful response to rTMS was predicted by a greater degree of baseline depression severity.
There is no substantial difference in efficacy between unilateral right-sided rTMS and the two forms of bilateral rTMS assessed in the study. Furthermore, our results call into question the specificity between frequency and laterality and rTMS response.
尽管几项研究报告称，重复经颅磁刺激（rTMS）治疗对抑郁症患者具有明显疗效，但仍不清楚优化治疗效果所需的参数。为此，我们确定了低频右 rTMS 对背外侧前额叶皮层（DLPFC）的疗效，与两种双侧 rTMS 形式相比：（1）右低频顺序后左高频顺序 rTMS，（2）双侧低频 rTMS 顺序。
共有 219 名治疗抵抗性抑郁症（TRD）患者随机分为接受为期 4 周的 rTMS 治疗的三组。使用标准评定量表评估结果。
总体而言，略多于 50%的患者达到了临床反应标准。单侧和双侧治疗组之间的反应没有实质性差异。rTMS 反应的成功预测与基线抑郁严重程度的更大程度有关。
在本研究中评估的单侧右 rTMS 和两种双侧 rTMS 形式之间没有明显的疗效差异。此外，我们的结果质疑频率和偏侧性与 rTMS 反应之间的特异性。
