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采用双侧 theta 爆发刺激治疗重度抑郁症:一项随机、双盲、安慰剂对照的多中心试验(TBS-D)研究方案。

Treatment of major depressive disorder with bilateral theta burst stimulation: study protocol for a randomized, double-blind, placebo-controlled multicenter trial (TBS-D).

机构信息

Department of Psychiatry and Psychotherapy, Brain Stimulation Center, Tübingen Center for Mental Health (TüCMH), Neurophysiology and Interventional Neuropsychiatry, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany.

Institute of Clinical Epidemiology and Applied Biostatistics (IKEaB), University of Tübingen, Tübingen, Germany.

出版信息

Eur Arch Psychiatry Clin Neurosci. 2021 Oct;271(7):1231-1243. doi: 10.1007/s00406-021-01280-w. Epub 2021 Jun 19.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (dlPFC) is currently evolving as an effective and safe therapeutic tool in the treatment of major depressive disorder (MDD). However, already established rTMS treatment paradigms are rather time-consuming. With theta burst stimulation (TBS), a patterned form of rTMS, treatment time can be substantially reduced. Pilot studies and a randomized controlled trial (RCT) demonstrate non-inferiority of TBS to 10 Hz rTMS and support a wider use in MDD. Still, data from placebo-controlled multicenter RCTs are lacking. In this placebo-controlled multicenter study, 236 patients with MDD will be randomized to either intermittent TBS (iTBS) to the left and continuous TBS (cTBS) to the right dlPFC or bilateral sham stimulation (1:1 ratio). The treatment will be performed with 80% resting motor threshold intensity over six consecutive weeks (30 sessions). The primary outcome is the treatment response rate (Montgomery-Asberg Depression Rating Scale reduction ≥ 50%). The aim of the study is to confirm the superiority of active bilateral TBS compared to placebo treatment. In two satellite studies, we intend to identify possible MRI-based and (epi-)genetic predictors of responsiveness to TBS therapy. Positive results will support the clinical use of bilateral TBS as an advantageous, efficient, and well-tolerated treatment and pave the way for further individualization of MDD therapy.Trial registration: ClinicalTrials.gov (NCT04392947).

摘要

重复经颅磁刺激(rTMS)于背外侧前额叶皮层(dlPFC)的应用,目前正发展为治疗重度抑郁症(MDD)的一种有效且安全的治疗手段。然而,既定的 rTMS 治疗方案耗时较长。通过采用经颅磁刺激的模式θ爆发刺激(TBS),可大幅缩短治疗时间。初步研究和一项随机对照试验(RCT)证实,TBS 与 10 Hz rTMS 相比非劣效,并支持其在 MDD 中的更广泛应用。但目前仍缺乏安慰剂对照的多中心 RCT 数据。在这项安慰剂对照的多中心研究中,236 名 MDD 患者将被随机分配至左侧间歇性 TBS(iTBS)和右侧连续 TBS(cTBS)或双侧假刺激(1:1 比例)。治疗将采用 80%静息运动阈值强度进行,持续 6 周(30 次)。主要结局是治疗反应率(蒙哥马利-阿斯伯格抑郁评定量表评分降低≥50%)。本研究旨在证实与安慰剂治疗相比,双侧 TBS 治疗的优越性。在两项卫星研究中,我们旨在确定 TBS 治疗反应的可能的 MRI 基础和(外显)遗传预测因子。阳性结果将支持双侧 TBS 作为一种有利、高效且耐受良好的治疗方法在临床上的应用,并为 MDD 治疗的进一步个体化铺平道路。

试验注册

ClinicalTrials.gov(NCT04392947)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3d26/8429166/d1fdaf8673c9/406_2021_1280_Fig1_HTML.jpg

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