Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Limburg, Netherland.
Psychiatry Res. 2021 Apr;298:113790. doi: 10.1016/j.psychres.2021.113790. Epub 2021 Feb 7.
Although effective in major depressive disorder (MDD), repetitive transcranial magnetic stimulation (rTMS) is costly and complex, limiting accessibility. To address this, we tested the feasibility of novel rTMS techniques with cost-saving opportunities, such as an open-room setting, large non-focal parabolic coils, and custom-built coil arms. We employed a low-frequency (LF) 1 Hz stimulation protocol (360 pulses per session), delivered on the most affordable FDA-approved device. MDD participants received an initial accelerated rTMS course (arTMS) of 6 sessions/day over 5 days (30 total), followed by a tapering course of daily sessions (up to 25) to decrease the odds of relapse. The self-reported Beck Depression Inventory II (BDI-II) was used to measure severity of depression. Forty-eight (48) patients completed the arTMS course. No serious adverse events occurred, and all patients reported manageable pain levels. Response and remission rates were 35.4% and 27.1% on the BDI-II, respectively, at the end of the tapering course. Repeated measures ANOVA showed significant changes of BDI-II scores over time. Even though our protocol will require further improvements, some of the concepts we introduced here could help guide the design of future trials aiming at increasing accessibility to rTMS.
尽管重复经颅磁刺激（rTMS）在重度抑郁症（MDD）中有效，但它成本高昂且复杂，限制了其可及性。为了解决这个问题，我们测试了具有节省成本机会的新型 rTMS 技术的可行性，例如开放式设置、大型非焦点抛物线线圈和定制的线圈臂。我们采用了低频（LF）1 Hz 刺激方案（每个疗程 360 个脉冲），使用最实惠的经美国食品和药物管理局批准的设备进行。MDD 参与者接受了初始加速 rTMS 疗程（arTMS），每天 6 个疗程，持续 5 天（共 30 个疗程），然后进行每日疗程的逐渐减少（最多 25 个疗程），以降低复发的几率。使用贝克抑郁量表第二版（BDI-II）自我报告来衡量抑郁的严重程度。48 名患者完成了 arTMS 疗程。没有发生严重不良事件，所有患者报告的疼痛水平均可控制。在逐渐减少疗程结束时，BDI-II 的反应率和缓解率分别为 35.4%和 27.1%。重复测量方差分析显示 BDI-II 评分随时间的显著变化。尽管我们的方案还需要进一步改进，但我们在这里介绍的一些概念可以帮助指导未来旨在增加 rTMS 可及性的试验设计。
