Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada.
380154Vancouver General Hospital, British Columbia, Canada.
Can J Psychiatry. 2020 Nov;65(11):770-778. doi: 10.1177/0706743720923064. Epub 2020 May 7.
Despite effective psychological and pharmacological treatments, there is a large unmet burden of illness in post-traumatic stress disorder (PTSD). Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive intervention and a putative treatment strategy for PTSD. The evidence base to date suggests that rTMS targeting the dorsolateral prefrontal cortex (DLPFC), in particular the right DLPFC, leads to improvements in PTSD symptoms. However, optimal stimulation parameters have yet to be determined. In this study, we examine the efficacy of high- and low-frequency rTMS of the right DLPFC using a randomized, double-blind, sham-controlled design in civilian PTSD.
We conducted a 2-week single-site randomized sham-controlled trial of rTMS targeting the right DLPFC. We recruited civilians aged 19 to 70 with PTSD and randomized subjects with allocation concealment to daily 1-Hz rTMS, 10-Hz rTMS, or sham rTMS. The primary outcome was improvement in Clinician Administered PTSD Scale-IV (CAPS-IV). Secondary outcomes included change in depressive and anxiety symptoms.
We recruited 31 civilians with PTSD. One 1-Hz-treated patient developed transient suicidal ideation. Analyses revealed significant improvement in CAPS-IV symptoms in the 1-Hz group relative to sham (Hedges' = -1.07) but not in the 10-Hz group. This was not attributable to changes in anxious or depressive symptomatology. Ten-Hz stimulation appeared to improve depressive symptoms compared to sham.
Low-frequency rTMS is efficacious in the treatment of civilian PTSD. Our data suggest that high-frequency rTMS of the right DLPFC is worthy of additional investigation for the treatment of depressive symptoms comorbid with PTSD.
尽管有有效的心理和药物治疗，但创伤后应激障碍（PTSD）仍存在大量未满足的疾病负担。重复经颅磁刺激（rTMS）是一种非侵入性干预措施，也是 PTSD 的一种潜在治疗策略。迄今为止的证据表明，针对背外侧前额叶皮层（DLPFC），特别是右侧 DLPFC 的 rTMS 可改善 PTSD 症状。然而，最佳刺激参数尚未确定。在这项研究中，我们使用随机、双盲、假对照设计，在平民 PTSD 中检查右侧 DLPFC 的高低频 rTMS 的疗效。
我们进行了一项为期 2 周的、单站点、随机、假对照 rTMS 试验，针对右侧 DLPFC。我们招募了年龄在 19 至 70 岁之间的 PTSD 平民，并通过分配隐匿将受试者随机分配至每日 1Hz rTMS、10Hz rTMS 或假 rTMS。主要结局是改善临床医生管理的 PTSD 量表-IV（CAPS-IV）。次要结局包括抑郁和焦虑症状的变化。
我们招募了 31 名 PTSD 平民。1 名接受 1Hz 治疗的患者出现短暂的自杀意念。分析显示，1Hz 组相对于假刺激组，CAPS-IV 症状有显著改善（Hedges'= -1.07），但 10Hz 组无显著改善。这不是由于焦虑或抑郁症状的变化所致。10Hz 刺激似乎比假刺激改善了抑郁症状。
低频 rTMS 对治疗平民 PTSD 有效。我们的数据表明，右侧 DLPFC 的高频 rTMS 值得进一步研究，以治疗 PTSD 共病的抑郁症状。
