经 rTMS 治疗的耐药性抑郁症患者的临床反应预测因素。
Predictors of clinical response after rTMS treatment of patients suffering from drug-resistant depression.
机构信息
Unité de Recherche et d'Innovation, Centre Hospitalier Esquirol, Limoges, France.
INSERM, Université de Limoges, CHU Limoges, IRD, U1094 Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France.
出版信息
Transl Psychiatry. 2021 Nov 15;11(1):587. doi: 10.1038/s41398-021-01555-9.
Repeated transcranial magnetic stimulation (rTMS) is a therapeutic brain-stimulation technique that is particularly used for drug-resistant depressive disorders. European recommendations mention the effectiveness of 30 to 64%. The failure rate of treatment is high and clinical improvement is visible only after a certain period of time. It would thus be useful to have indicators that could anticipate the success of treatment and more effectively guide therapeutic choices. We aimed to find predictive indicators of clinical improvement at 1 month after the start of rTMS treatment among the data collected during the care of patients with drug-resistant depression included in the Neuromodulation Unit of the Esquirol Hospital in Limoges since 2007. In total, 290 patients with a pharmaco-resistant depressive episode, according to the Hamilton Depression Rating Scale (HDRS) (score ≥8), before treatment who underwent a complete course of rTMS treatment and did not object to the use of their collected data were included. The clinical response in routine practice, corresponding to a decrease in the HDRS score of at least 50% from inclusion, was determined and complemented by interquartile analysis. A combination of factors predictive of clinical response during care, such as a short duration of the current depressive episode associated with a higher HDRS agitation item value (or a lower perceived sleepiness value) and a higher number of previous rTMS treatments, were identified as being useful in predicting the efficacy of rTMS treatment in routine clinical practice, thus facilitating the therapeutic choice for patients with drug-resistant depression.
重复经颅磁刺激(rTMS)是一种治疗性脑刺激技术,特别用于治疗耐药性抑郁症。欧洲的建议提到其有效性为 30%至 64%。治疗的失败率很高,只有在一定时间后才能看到临床改善。因此,拥有能够预测治疗成功并更有效地指导治疗选择的指标将是有用的。我们旨在从 2007 年以来在利摩日 Esquirol 医院神经调节科接受治疗的耐药性抑郁症患者的数据中,找到 rTMS 治疗开始后 1 个月临床改善的预测指标。共有 290 名根据汉密尔顿抑郁评定量表(HDRS)(评分≥8)患有药物抵抗性抑郁发作的患者在接受完整 rTMS 治疗且不反对使用其收集的数据之前接受了治疗。确定了常规实践中的临床反应,即从纳入开始 HDRS 评分至少降低 50%,并通过四分位距分析进行了补充。在护理过程中,一些因素的组合具有预测临床反应的作用,例如当前抑郁发作持续时间较短,HDRS 激越项目值较高(或感知困倦值较低),以及之前 rTMS 治疗次数较多,这些因素被认为有助于预测 rTMS 治疗在常规临床实践中的疗效,从而为耐药性抑郁症患者的治疗选择提供便利。