Department of Psychiatry and Psychology, Mayo Clinic , Rochester, MN , USA ; Division of Child and Adolescent Psychiatry, Mayo Clinic , Rochester, MN , USA.
Neurocognitive Research Laboratory, Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA ; Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, TX , USA.
Front Psychiatry. 2013 Dec 12;4:165. doi: 10.3389/fpsyt.2013.00165. eCollection 2013.
It is estimated that 30-40% of adolescents with major depressive disorder (MDD) do not receive full benefit from current antidepressant therapies. Repetitive transcranial magnetic stimulation (rTMS) is a novel therapy approved by the US Food and Drug Administration to treat adults with MDD. Research suggests rTMS is not associated with adverse neurocognitive effects in adult populations; however, there is no documentation of its neurocognitive effects in adolescents. This is a secondary post hoc analysis of neurocognitive outcome in adolescents who were treated with open-label rTMS in two separate studies.
Eighteen patients (mean age, 16.2 ± 1.1 years; 11 females, 7 males) with MDD who failed to adequately respond to at least one antidepressant agent were enrolled in the study. Fourteen patients completed all 30 rTMS treatments (5 days/week, 120% of motor threshold, 10 Hz, 3,000 stimulations per session) applied to the left dorsolateral prefrontal cortex. Depression was rated using the Children's Depression Rating Scale-Revised. Neurocognitive evaluation was performed at baseline and after completion of 30 rTMS treatments with the Children's Auditory Verbal Learning Test (CAVLT) and Delis-Kaplan Executive Function System Trail Making Test.
Over the course of 30 rTMS treatments, adolescents showed a substantial decrease in depression severity. Commensurate with improvement in depressive symptoms was a statistically significant improvement in memory and delayed verbal recall. Other learning and memory indices and executive function remained intact. Neither participants nor their family members reported clinically meaningful changes in neurocognitive function.
These preliminary findings suggest rTMS does not adversely impact neurocognitive functioning in adolescents and may provide subtle enhancement of verbal memory as measured by the CAVLT. Further controlled investigations with larger sample sizes and rigorous trial designs are warranted to confirm and extend these findings.
据估计，30-40%的青少年重度抑郁症（MDD）患者未从当前的抗抑郁治疗中充分获益。重复经颅磁刺激（rTMS）是一种新的治疗方法，已获得美国食品和药物管理局批准，用于治疗成年人 MDD。研究表明 rTMS 不会对成年人群产生不良神经认知影响；然而，尚未有其在青少年人群中的神经认知影响的相关记录。这是两项独立研究中接受开放标签 rTMS 治疗的青少年神经认知结果的二次事后分析。
18 名（平均年龄 16.2±1.1 岁；11 名女性，7 名男性）患有 MDD 的青少年患者，他们对至少一种抗抑郁药物反应不足，被纳入研究。14 名患者完成了所有 30 次 rTMS 治疗（5 天/周，120%运动阈值，10Hz，每次 3000 次刺激），应用于左侧背外侧前额叶皮层。使用儿童抑郁评定量表修订版（Children's Depression Rating Scale-Revised）评估抑郁程度。在完成 30 次 rTMS 治疗后，使用儿童听觉言语学习测试（Children's Auditory Verbal Learning Test，CAVLT）和 Delis-Kaplan 执行功能系统连线测试（Delis-Kaplan Executive Function System Trail Making Test）进行神经认知评估。
在 30 次 rTMS 治疗过程中，青少年的抑郁严重程度显著下降。与抑郁症状改善相一致的是，记忆和延迟言语回忆方面的显著改善。其他学习和记忆指标以及执行功能保持完好。参与者及其家属均未报告神经认知功能出现有临床意义的变化。
这些初步发现表明 rTMS 不会对青少年的神经认知功能产生不利影响，并且可能通过 CAVLT 测量提供对言语记忆的微妙增强。需要进一步进行更大样本量和严格试验设计的对照研究，以确认和扩展这些发现。
