Filipčić Igor, Šimunović Filipčić Ivona, Sučić Strahimir, Milovac Željko, Gereš Natko, Matić Katarina, Čelić-Ružić Mirela, Zečević Penić Sandra, Orgulan Ivana, Požgaj Vladimir, Bajić Žarko
Psychiatric Hospital "Sveti Ivan", Jankomir 11, pp 68, 10 090, Zagreb, Croatia.
Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
Eur Arch Psychiatry Clin Neurosci. 2021 Feb;271(1):49-59. doi: 10.1007/s00406-020-01141-y. Epub 2020 May 24.
Accelerated repetitive transcranial magnetic stimulation (rTMS) protocols are being increasingly studied because of their potential to provide quicker and enhanced treatment efficacy. However, there is a lack of accelerated deep TMS with H1-coil (adTMS) treatment research. This randomized pilot study investigated the efficacy and safety of adTMS protocols. Twenty-eight TRD patients received 20-min sessions twice daily for 10 or 15 days. Primary outcomes were changes in Hamilton Depression Rating Scale (HDRS) scores and discontinuation because of adverse events (AE). Secondary outcomes were response, remission, daily changes in Beck Depression Inventory-II (BDI-II) scores, and AE incidence. HDRS scores decreased by 13 (95% CI 11-17; 59%, 95% CI 45-73%) and 13 (95% CI 11-14; 62%, 95% CI 54-69%) points in the 10- and 15-day protocols, respectively. The adjusted difference between the two protocols was not significant or clinically relevant. Remission was achieved by 38% and 42% after 10-day and 15-day protocols, respectively. The intervention was discontinued because of AEs in 3/33 (9%) patients. The BDI-II decreases were significant and clinically relevant during the first 8 days. Twice-daily adTMS for 10 days seems to be safe and effective, with rapid clinical benefits during the first week of treatment. These promising results warrant further investigation in larger randomized clinical trials comparing adTMS with the standard dTMS protocol.
由于加速重复经颅磁刺激（rTMS）方案有提供更快且更强治疗效果的潜力，因此对其研究日益增多。然而，缺乏关于H1线圈加速深部经颅磁刺激（adTMS）治疗的研究。这项随机试点研究调查了adTMS方案的疗效和安全性。28例难治性抑郁症（TRD）患者每天接受两次20分钟的治疗，持续10天或15天。主要结局是汉密尔顿抑郁量表（HDRS）评分的变化以及因不良事件（AE）导致的治疗中断。次要结局是缓解情况、症状减轻、贝克抑郁量表第二版（BDI-II）评分的每日变化以及AE发生率。在10天和15天的治疗方案中，HDRS评分分别降低了13分（95%可信区间11 - 17；59%，95%可信区间45 - 73%）和13分（95%可信区间11 - 14；62%，95%可信区间54 - 69%）。两种治疗方案之间的校正差异不显著，也无临床相关性。10天和15天治疗方案后分别有38%和42%的患者达到症状减轻。3/33（9%）的患者因AE而中断干预。在治疗的前8天，BDI-II评分的降低显著且具有临床相关性。每天两次、持续10天的adTMS似乎安全有效，在治疗的第一周即可迅速产生临床效益。这些有前景的结果值得在更大规模的随机临床试验中进一步研究，以比较adTMS与标准深部经颅磁刺激（dTMS）方案。
