NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
Gen Hosp Psychiatry. 2015 May-Jun;37(3):274.e7-9. doi: 10.1016/j.genhosppsych.2015.03.002. Epub 2015 Mar 13.
Mitochondrial myopathies (MMs) often present with leukoencephalopathy and psychiatric symptoms, which do not respond to or worsen with psychiatric drugs.
A 67-year-old woman with a 10-year history of probable chronic progressive external ophthalmoplegia, an MM, had drug-resistant, anxious-depressive symptoms. Since she had never had seizures, we proposed 20 sessions of deep transcranial magnetic stimulation (dTMS) for her depression. Surprisingly, besides the expected improvement of depression, we observed marked improvement of movement disorder that lasted as long as the patient was undergoing dTMS. She also improved her performance on neuropsychological tests of executive function and cognitive speed. Depressive symptom improvement was persistent, while anxiety symptoms recurred after the end of the sessions.
dTMS may be an alternative antidepressant strategy in patients with MMs, provided that they are free from seizures. The mechanism of improvement of motor disturbance may relate to dorsolateral prefrontal cortex stimulation and improved executive function and needs further investigation.
线粒体肌病（MMs）常伴有脑白质病和精神症状，这些症状对精神药物无反应或恶化。
一位 67 岁女性，患有可能的慢性进行性眼外肌麻痹症（一种 MMs）10 年，伴有药物抵抗性焦虑抑郁症状。由于她从未有过癫痫发作，我们提议为她的抑郁症进行 20 次深部经颅磁刺激（dTMS）治疗。令人惊讶的是，除了预期的抑郁改善外，我们还观察到运动障碍有明显改善，并且这种改善持续到 dTMS 治疗结束。她还在执行功能和认知速度的神经心理学测试中表现更好。抑郁症状的改善是持久的，而焦虑症状在疗程结束后再次出现。
如果患者没有癫痫发作，dTMS 可能是 MMs 患者的一种替代抗抑郁策略。运动障碍改善的机制可能与背外侧前额叶皮层刺激以及执行功能的改善有关，需要进一步研究。
