Burhan Amer M, Patience James A, Teselink Johannes G P, Marlatt Nicole M, Babapoor-Farrokhran Sahand, Palaniyappan Lena
Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada.
J Psychiatr Res. 2020 Nov;130:342-346. doi: 10.1016/j.jpsychires.2020.08.009. Epub 2020 Aug 22.
Depression is a significant health issue with treatment resistance reported in about one third of patients. Treatment resistance results in significant disability, impaired quality of life, and increased healthcare costs. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for treatment resistant depression (TRD) with response and remission rates in open-label studies being as high as 58% and 37% respectively. Theta-burst is a faster and novel rTMS paradigm that has shown promise as a treatment for TRD in some preliminary studies. In a naturalistic design, we evaluated the response, remission and tolerability of bilateral sequential (right then left) prefrontal theta-burst rTMS (bsTBS) in 50 patients with TRD (600 pulses/session, 20 sessions, 100% of resting motor threshold (80% if intolerant to 100%, n = 2), F4/F3 of 10-20-20 EEG localization). Data was collected over 36 months from a specialized academic TMS clinic. Patients had multiple-treatment resistance with at least two failed trials of different antidepressants with 20% also having failed electroconvulsive therapy and 66% having received professional therapy. We found a 28% remission rate (HAMD-17 score of ≤7) and a 52% response rate (≥50% reduction in HAMD-17) with a 42% reduction in average HAMD-17 score. The treatment was well tolerated, with muscle contractions, mild pain or discomfort, headache, scalp irritation, and changes to vitals being captured as occasional adverse events with two instances of syncope (0.22% of treatments). This naturalistic study shows that bsTBS is a promising paradigm for a multiple-TRD patient population with approximately one-third of treatments achieving remission and over half achieving significant response.
抑郁症是一个重大的健康问题，约三分之一的患者存在治疗抵抗。治疗抵抗会导致严重残疾、生活质量受损以及医疗成本增加。重复经颅磁刺激（rTMS）是治疗抵抗性抑郁症（TRD）的一种治疗选择，在开放标签研究中的缓解率和有效率分别高达58%和37%。theta爆发刺激是一种更快且新颖的rTMS模式，在一些初步研究中已显示出作为TRD治疗方法的前景。在一项自然主义设计中，我们评估了50例TRD患者双侧序贯（先右后左）前额叶theta爆发刺激（bsTBS）的有效率、缓解率和耐受性（600脉冲/疗程，20个疗程，静息运动阈值的100%（若不耐受100%则为80%，n = 2），10 - 20 - 20脑电图定位的F4/F3）。数据是在36个月内从一家专业学术性TMS诊所收集的。患者存在多重治疗抵抗，至少有两种不同抗抑郁药试验失败，20%的患者电休克治疗也失败，66%的患者接受过专业治疗。我们发现缓解率为28%（汉密尔顿抑郁量表-17得分≤7），有效率为52%（汉密尔顿抑郁量表-17得分降低≥50%），汉密尔顿抑郁量表-17平均得分降低42%。该治疗耐受性良好，肌肉收缩、轻度疼痛或不适、头痛、头皮刺激以及生命体征变化被记录为偶尔的不良事件，有两例晕厥（占治疗的0.22%）。这项自然主义研究表明，bsTBS对于多重TRD患者群体是一种有前景的模式，约三分之一的治疗达到缓解，超过一半的治疗有显著效果。
