对重度抑郁症、双相情感障碍I型以及伴有酒精使用障碍的重度抑郁症患者的抑郁发作期，附加高频深部经颅磁刺激（dTMS）至双侧前额叶皮质。
Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex in depressive episodes of patients with major depressive disorder, bipolar disorder I, and major depressive with alcohol use disorders.
作者信息
Rapinesi Chiara, Kotzalidis Georgios D, Ferracuti Stefano, Girardi Nicoletta, Zangen Abraham, Sani Gabriele, Raccah Ruggero N, Girardi Paolo, Pompili Maurizio, Del Casale Antonio
机构信息
Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy.
Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy.
出版信息
Neurosci Lett. 2018 Apr 3;671:128-132. doi: 10.1016/j.neulet.2018.02.029. Epub 2018 Feb 15.
BACKGROUND
Dorsolateral prefrontal cortex (DLPFC) is critically involved in mood and alcohol use disorders.
OBJECTIVE
We aimed to investigate the safety of intervention with add-on bilateral prefrontal high-frequency deep transcranial magnetic stimulation (dTMS) and between-group differences in treatment response in patients with different types of depressive episodes, including major depressive episodes in the course of major depressive disorder (MDD), bipolar disorder, type I (BD-I), and MDD with alcohol use disorder (MDAUD).
METHODS
We conducted a 6-month open-label study, involving 82 patients with DSM-5 Depressive Episode. Of these, 41 had diagnosis of MDD, 20 BD-I, and 21 MDAUD. All patients received standard drug treatment and add-on dTMS over the bilateral DLPFC with left prevalence for four weeks, with five sessions in each week. We rated mood state with the Hamilton Depression Rating Scale (HDRS) at baseline, one-month, and six-month follow-up visits.
RESULTS
Mean total HDRS scores dropped from 22.8 (SD = 5.9) at baseline to 10.4 (SD = 3.6) at 1 month, to 10.0 (SD = 4.5) at 6 months, while response/remission were 70.73% (N = 58) and 19.51% (N = 16) at 1 month and 76.83% (N = 63) and 32.93% (27) at 6 months, respectively, with no between-group differences. No patient experienced any side effects.
CONCLUSIONS
High-frequency DLPFC dTMS was well tolerated and did not significantly differ on improvement of depression in MDD, BD-I, and MDAUD.
背景
背外侧前额叶皮层（DLPFC）在情绪和酒精使用障碍中起关键作用。
目的
我们旨在研究附加双侧前额叶高频深部经颅磁刺激（dTMS）干预的安全性，以及不同类型抑郁发作患者（包括重度抑郁症（MDD）病程中的重度抑郁发作、双相情感障碍I型（BD-I）和伴有酒精使用障碍的MDD（MDAUD））在治疗反应上的组间差异。
方法
我们进行了一项为期6个月的开放标签研究，纳入82例符合DSM-5抑郁发作的患者。其中，41例诊断为MDD，20例为BD-I，21例为MDAUD。所有患者均接受标准药物治疗，并附加对双侧DLPFC进行dTMS治疗，以左侧为主，持续四周，每周五次。我们在基线、1个月和6个月随访时用汉密尔顿抑郁量表（HDRS）对情绪状态进行评分。
结果
HDRS总分均值从基线时的22.8（标准差=5.9）降至1个月时的10.4（标准差=3.6），再降至6个月时的10.0（标准差=4.5），而1个月时的反应/缓解率分别为70.73%（N=58）和19.51%（N=16），6个月时分别为76.83%（N=63）和32.93%（27），组间无差异。没有患者出现任何副作用。
结论
高频DLPFC dTMS耐受性良好，在改善MDD、BD-I和MDAUD的抑郁症状方面无显著差异。
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