Valiulis Vladas, Gerulskis Giedrius, Dapšys Kastytis, Valavičiūtė Karolina, Šiurkutė Aldona, Mačiulis Valentinas
Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania;
Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania.
Acta Neurobiol Exp (Wars). 2018;78(3):271-280.
Repetitive transcranial magnetic stimulation (rTMS) is a popular and effective treatment for drug resistant depression. However, there is considerable variability in clinical outcomes, in previous studies and between patients. Because of high requirements for the use of fMRI based neuronavigation, many practitioners of rTMS still choose to use a standard 5 cm rule for rTMS coil placement which leads to large variations in which brain regions are being stimulated. We decided to test the possibilities of a MNI based MR‑less neuronavigation system in rTMS depression treatment, by comparing the physiological effects and clinical outcomes of 3 distinct stimulation targets. Forty‑six patients (thirty‑three female, thirteen male) from the Republican Vilnius psychiatric hospital, all with drug resistant depressive disorder, participated in the study. All patients received high frequency (10 Hz) stimulation for 10 to 15 daily rTMS sessions. However, before the treatment they were randomly sorted into 3 groups according to stimulation target in MNI map: Group 1 received rTMS at point ‑40; 48; 35; Group 2 received rTMS at point ‑46; 45; 38; Group 3 received rTMS at point ‑38; 44; 26. Electroencephalography (EEG) recordings and clinical tests were obtained the day before the rTMS course and after the last session. There were some notable differences in physiological changes between the groups, with the largest EEG band spectral power increases found in Group 1 patients and the lowest in Group 2 patients. There was a significantly larger decrease of the Hamilton Depression Rating Scale (HAM-D) scores in the Group 3 (66.94%) compared to Group 1 (57.52%) and Group 2 (56.02%). This suggests it is possible to achieve higher clinical efficacy and less physiological impact on the brain when using different targets in a neuronavigated MNI based MR‑less rTMS system.
重复经颅磁刺激（rTMS）是一种治疗耐药性抑郁症的常用且有效的方法。然而，在以往的研究以及患者之间，临床疗效存在相当大的差异。由于基于功能磁共振成像（fMRI）的神经导航使用要求较高，许多rTMS从业者仍选择使用标准的5厘米规则来放置rTMS线圈，这导致所刺激的脑区存在很大差异。我们决定通过比较3个不同刺激靶点的生理效应和临床疗效，来测试基于蒙特利尔神经研究所（MNI）图谱的无磁共振神经导航系统在rTMS治疗抑郁症中的可能性。来自维尔纽斯共和国精神病医院的46名患者（33名女性，13名男性），均患有耐药性抑郁症，参与了该研究。所有患者均接受高频（10赫兹）刺激，每天进行10至15次rTMS治疗。然而，在治疗前，他们根据MNI图谱中的刺激靶点被随机分为3组：第1组在点-40；48；35接受rTMS治疗；第2组在点-46；45；38接受rTMS治疗；第3组在点-38；44；26接受rTMS治疗。在rTMS疗程开始前一天和最后一次治疗后，进行了脑电图（EEG）记录和临床测试。各组之间在生理变化方面存在一些显著差异，第1组患者的脑电图频段谱功率增加最大，第2组患者的增加最小。与第1组（57.52%）和第2组（56.02%）相比，第3组的汉密尔顿抑郁量表（HAM-D）评分下降幅度显著更大（66.94%）。这表明，在基于MNI图谱的无磁共振神经导航rTMS系统中使用不同靶点时，有可能实现更高的临床疗效并减少对大脑的生理影响。
