Jha Shailesh, Chadda Rakesh K, Kumar Nand, Bal C S
Department of Psychiatry, Institute of Human Behaviour & Allied Sciences, New Delhi 110095, India.
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
Asian J Psychiatr. 2016 Jun;21:1-6. doi: 10.1016/j.ajp.2016.02.003. Epub 2016 Feb 12.
Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential treatment in treatment resistant major depressive disorder (MDD). However, there is no consensus about the exact site of stimulation for rTMS. Single-photon emission computed tomography (SPECT) offers a potential technique in deciding the site of stimulation. The present study was conducted to assess the difference in outcome of brain SPECT assisted rTMS versus standard protocol of twenty sessions of high frequency rTMS as add on treatment in 20 patients with treatment resistant MDD, given over a period of 4 weeks. Thirteen subjects (group I) received high frequency rTMS over an area of hypoperfusion in the prefrontal cortex, as identified on SPECT, whereas 7 subjects (group II) were administered rTMS in the left dorsoslateral prefrontal cortex (DLPFC) area. Improvement was monitored using standardized instruments. Patients in the group I showed a significantly better response compared to those in the group II. In group I, 46% of the subjects were responders on MADRS, 38% on BDI and 77% on CGI. The parallel figures of responders in Group II were 0% on MADRS, 14% on BDI and 43% on CGI. There were no remitters in the study. No significant untoward side effects were noticed. The study had limitations of a small sample size and non-controlled design, and all the subjects were also receiving the standard antidepressant therapy. Administration of rTMS over brain SPECT specified area of hypoperfusion may have a better clinical outcome compared to the standard protocol.
重复经颅磁刺激（rTMS）已成为难治性重度抑郁症（MDD）的一种潜在治疗方法。然而，关于rTMS的确切刺激部位尚无共识。单光子发射计算机断层扫描（SPECT）为确定刺激部位提供了一种潜在技术。本研究旨在评估脑SPECT辅助rTMS与20次高频rTMS标准方案作为附加治疗在20例难治性MDD患者中4周内的治疗效果差异。13名受试者（I组）在SPECT确定的前额叶皮质灌注不足区域接受高频rTMS，而7名受试者（II组）在左侧背外侧前额叶皮质（DLPFC）区域接受rTMS。使用标准化工具监测改善情况。I组患者的反应明显优于II组。在I组中，46%的受试者在蒙哥马利-艾森伯格抑郁量表（MADRS）上有反应，38%在贝克抑郁量表（BDI）上有反应，77%在临床总体印象量表（CGI）上有反应。II组相应的反应率在MADRS上为0%，在BDI上为14%，在CGI上为43%。研究中无缓解者。未观察到明显的不良副作用。本研究存在样本量小和非对照设计的局限性且所有受试者也在接受标准抗抑郁治疗。与标准方案相比，在脑SPECT指定的灌注不足区域给予rTMS可能具有更好的临床效果。
