Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Brain Stimul. 2012 Oct;5(4):547-53. doi: 10.1016/j.brs.2011.09.004. Epub 2011 Oct 3.
There is growing evidence that high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex is effective in the treatment of depression. Brain imaging studies have shown that rTMS alters regional brain activity with improvement of depression. However, a predictor of treatment response to rTMS has not yet been identified.
The aim of this study was to estimate regional cerebral blood flow in the frontal regions and investigate the correlation with treatment response to high-frequency rTMS over the left dorsolateral prefrontal cortex in depression.
Twenty-four patients with depression received high-frequency rTMS over the left dorsolateral prefrontal cortex and were assessed with the Hamilton Depression Rating Scale. Brain scans were acquired before rTMS using (99m)Tc-ethyl cysteinate dimer single photon emission computed tomography (SPECT), and cerebral blood flow in 16 brain regions was estimated using a fully automated region of interest (ROI) analysis software. Two principal components were extracted from cerebral blood flow in 16 brain regions by factor analysis with maximum likelihood method and Promax rotation with Kaiser normalization.
Sixteen brain regions were divided into two groups: dorsolateral prefrontal cortex (superior frontal, medial frontal, middle frontal, and inferior frontal regions); ventromedial prefrontal cortex (anterior cingulate, subcallosal, orbital, and rectal regions). Treatment response to rTMS was correlated with cerebral blood flow ratio of the dorsolateral prefrontal cortex to the ventromedial prefrontal cortex (DLPFC/VMPFC CBF ratio, r = -0.60, P = 0.002).
The findings of this study suggest that depressed patients with a lower DLPFC/VMPFC CBF ratio may show a better response to high-frequency rTMS over the left dorsolateral prefrontal cortex.
越来越多的证据表明，高频重复经颅磁刺激（rTMS）对左背外侧前额叶有效治疗抑郁症。脑成像研究表明，rTMS 通过改善抑郁症来改变局部脑活动。然而，尚未确定 rTMS 治疗反应的预测因子。
本研究旨在估计前额区域的局部脑血流，并探讨其与左背外侧前额叶高频 rTMS 治疗抑郁症反应的相关性。
24 例抑郁症患者接受左背外侧前额叶高频 rTMS 治疗，并采用汉密尔顿抑郁量表进行评估。rTMS 治疗前使用（99m）Tc-乙基半胱氨酸二聚体单光子发射计算机断层扫描（SPECT）进行脑部扫描，并使用全自动感兴趣区（ROI）分析软件估算 16 个脑区的脑血流。采用最大似然法和 Kaiser 标准化的 Promax 旋转进行因子分析，从 16 个脑区的脑血流中提取两个主成分。
16 个脑区分为两组：背外侧前额叶（额上、额中、额下和中前额叶区）；腹内侧前额叶（前扣带、胼胝体下、眶额和直回区）。rTMS 治疗反应与背外侧前额叶与腹内侧前额叶的脑血流比率（DLPFC/VMPFC CBF 比率）相关（r = -0.60，P = 0.002）。
本研究结果表明，背外侧前额叶与腹内侧前额叶脑血流比率较低的抑郁症患者可能对左背外侧前额叶高频 rTMS 反应更好。
