Dilkov Dancho, Hawken Emily R, Kaludiev Emil, Milev Roumen
Department of Psychiatry, Military Medical Academy, Sofia, Bulgaria.
Department of Psychiatry, Queen's University, Kingston, ON, Canada.; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
Prog Neuropsychopharmacol Biol Psychiatry. 2017 Aug 1;78:61-65. doi: 10.1016/j.pnpbp.2017.05.018. Epub 2017 May 19.
Up to 50% of people with GAD fail to respond to first-line pharmacotherapies for generalized anxiety disorder (GAD), partly due to poor treatment compliance rates and partly due to the complex physiology underlying GAD. Thus, new non-invasive techniques, like repetitive transcranial magnetic stimulation (rTMS) are being investigated.
Participants were recruited from two different mood disorder sites: Kingston, Ontario, Canada and Sofia, Bulgaria. Hamilton Anxiety Rating Scale (HARS) scores were reported from patients diagnosed with GAD following treatment with high-frequency (20Hz) rTMS applied to the right dorsal lateral prefrontal cortex (DLPFC).
By the end of 25 rTMS treatments, the ACTIVE (n=15) treatment group showed a clinically significant reduction in the HARS scores compared to the SHAM (n=25) group. Hedge's g at visit 4 (following 25 rTMS treatments) was 2.1 between ACTIVE and SHAM treatments. Furthermore, at 2 and 4weeks follow-up (after the end of treatment) HARS scores of the ACTIVE group remained stable and even slightly improved, demonstrating a sustained effect of the response.
Relatively small sample size of the ACTIVE group as well as the SHAM procedure may limit the generalizability of the results.
Thus, participants receiving rTMS treatment showed a clinically significant decrease in reported anxiety symptoms as measured by the HARS. rTMS may be a treatment options for patients treatment refractory to pharmacotherapies. www.clinicaltrials.gov: NCT00616447.
高达50%的广泛性焦虑症（GAD）患者对广泛性焦虑症的一线药物治疗无反应，部分原因是治疗依从率低，部分原因是GAD潜在的复杂生理学机制。因此，正在研究诸如重复经颅磁刺激（rTMS）等新的非侵入性技术。
参与者从两个不同的情绪障碍研究地点招募：加拿大安大略省金斯顿和保加利亚索非亚。报告了被诊断为GAD的患者在接受高频（20Hz）rTMS治疗右侧背外侧前额叶皮质（DLPFC）后的汉密尔顿焦虑量表（HARS）评分。
在25次rTMS治疗结束时，与假手术组（n = 25）相比，活性治疗组（n = 15）的HARS评分在临床上有显著降低。在第4次随访（25次rTMS治疗后）时，活性治疗组与假手术组之间的Hedge's g为2.1。此外，在治疗结束后的2周和第4周随访时，活性治疗组的HARS评分保持稳定，甚至略有改善，表明反应具有持续效应。
活性治疗组相对较小的样本量以及假手术程序可能会限制结果的普遍性。
因此，接受rTMS治疗的参与者在HARS测量中报告的焦虑症状有临床上的显著减轻。rTMS可能是对药物治疗难治的患者的一种治疗选择。www.clinicaltrials.gov：NCT00616447。
