Bakker Nathan, Shahab Saba, Giacobbe Peter, Blumberger Daniel M, Daskalakis Zafiris J, Kennedy Sidney H, Downar Jonathan
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8.
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Faculty of Arts and Sciences, University of Toronto, 100 St. George Street, Toronto, Ontario, Canada M5S 3G3.
Brain Stimul. 2015 Mar-Apr;8(2):208-15. doi: 10.1016/j.brs.2014.11.002. Epub 2014 Nov 6.
Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS).
To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series.
A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014.
Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure.
Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted.
用于重度抑郁症的传统重复经颅磁刺激（rTMS）方案通常采用持续时间超过30分钟的刺激疗程。然而，最近的研究试图通过采用更简短的方案，如theta爆发刺激（iTBS），来提高成本、治疗能力和治疗效果。
在一个大型、自然主义的回顾性病例系列中，比较10赫兹（30分钟）与iTBS（6分钟）方案的背内侧前额叶皮质rTMS的安全性、有效性和疗效预测因素。
通过病历回顾，确定了185例患有难治性重度抑郁发作的患者，他们于2011年至2014年在加拿大一家诊所接受了20 - 30次背内侧前额叶皮质rTMS治疗（10赫兹，n = 98；iTBS，n = 87）。
10赫兹组和iTBS组患者在治疗前的临床特征无差异，只是iTBS组患者年龄显著更高。共进行了7912次背内侧前额叶皮质rTMS治疗（10赫兹，4274次；iTBS，3638次），未发生任何癫痫发作或其他严重不良事件，两组间提前终止治疗的发生率也无显著差异。两组间二分法结局无显著差异（反应/缓解率：贝克抑郁量表第二版：10赫兹组，40.6%/29.2%；iTBS组，43.0%/31.0%。17项汉密尔顿抑郁评定量表：10赫兹组，50.6%/38.5%；iTBS组，48.5%/27.9%）。在连续结局方面，两组在治疗前或治疗后的评分，或任何一项指标的改善百分比上均无显著差异。混合效应模型显示，两组在任何一项指标上均无显著的组×时间交互作用。
10赫兹和iTBS的背内侧前额叶皮质rTMS在静息运动阈值的120%时似乎都是安全且可耐受的。6分钟iTBS方案和30分钟10赫兹方案的有效性似乎相当。比较10赫兹与iTBS的随机试验可能是有必要的。
