额顶配对联合刺激与单点刺激治疗广泛性焦虑障碍的对照：一项 rTMS 研究。
Frontoparietal paired associative stimulation versus single-site stimulation for generalized anxiety disorder: a pilot rTMS study.
机构信息
From the Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Beijing Key Laboratory of Neuromodulation, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Department of Neurology, Beijing Puren Hospital, Beijing, China (K. Wang)
From the Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Beijing Key Laboratory of Neuromodulation, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Department of Neurology, Beijing Puren Hospital, Beijing, China (K. Wang).
出版信息
J Psychiatry Neurosci. 2022 Apr 27;47(2):E153-E161. doi: 10.1503/jpn.210201. Print 2022 Mar-Apr.
BACKGROUND
At present, the use of repetitive transcranial magnetic stimulation (rTMS) for generalized anxiety disorder (GAD) is limited to single-site interventions. We investigated whether dual-site frontoparietal stimulation delivered using cortical-cortical paired associative stimulation (ccPAS) had stronger clinical efficacy than single-site stimulation in patients with GAD.
METHODS
We randomized 50 patients with GAD to 1 Hz rTMS (10 sessions) using 1 of the following protocols: single-site stimulation over the right dorsolateral prefrontal cortex (dlPFC; 1500 pulses per session); single-site stimulation over the right posterior parietal cortex (PPC; 1500 pulses per session); repetitive dual-site ccPAS (rds-ccPAS) over the right dlPFC and right PPC with 1500 pulses per session (rd-ccPAS-1500); or rds-ccPAS over the right dlPFC and right PPC with 750 pulses per session (rd-ccPAS-750). Both rds-ccPAS treatments used a between-site interval of 100 ms.
RESULTS
Clinical scores for anxiety, depression and insomnia were reduced in all 4 groups after treatment. We found greater improvements in anxiety symptoms in the rds-ccPAS-1500 group compared to the rds-ccPAS-750 and single-site groups. We found greater improvements in depression symptoms and insomnia in the rds-PAS-1500 group compared to the single-site groups. The rds-ccPAS-1500 group also showed significant or trend-level improvements in anxiety symptoms and insomnia at 10-day and 1-month followup. More patients responded to treatment with rds-ccPAS-1500 than with single-site stimulation. The between-group differences in response rates persisted to the 3-month follow-up. Treatment using rds-ccPAS with a between-site interval of 100 ms induced a more significant improvement than the between-site interval of 50 ms we evaluated in a previous study.
LIMITATIONS
These results need to be replicated in a larger sample using sham control and equal-pulse single-site stimulation.
CONCLUSION
Frontoparietal rds-ccPAS may be a better treatment option for GAD.
背景
目前，重复经颅磁刺激（rTMS）在广泛性焦虑症（GAD）中的应用仅限于单部位干预。我们研究了使用皮质-皮质联合刺激（ccPAS）的双部位额顶叶刺激是否比 GAD 患者的单部位刺激具有更强的临床疗效。
方法
我们将 50 名 GAD 患者随机分为 1 Hz rTMS（10 个疗程），使用以下 1 种方案之一：右背外侧前额叶皮质（dlPFC）的单部位刺激（每次 1500 个脉冲）；右顶叶后部皮质（PPC）的单部位刺激（每次 1500 个脉冲）；右 dlPFC 和右 PPC 上的重复双部位 ccPAS（rd-ccPAS），每次 1500 个脉冲（rd-ccPAS-1500）；或右 dlPFC 和右 PPC 上的 rd-ccPAS，每次 750 个脉冲（rd-ccPAS-750）。两种 rd-ccPAS 治疗均采用 100 ms 的位点间间隔。
结果
所有 4 组治疗后焦虑、抑郁和失眠的临床评分均降低。与 rd-ccPAS-750 组和单部位组相比，rd-ccPAS-1500 组焦虑症状改善更明显。rd-ccPAS-1500 组抑郁症状和失眠改善较单部位组更明显。与单部位组相比，rd-ccPAS-1500 组在 10 天和 1 个月随访时焦虑症状和失眠也有显著或趋势水平的改善。与单部位刺激相比，更多的患者对 rd-ccPAS-1500 治疗有反应。在反应率方面，组间差异持续到 3 个月随访。采用间隔 100ms 的 rd-ccPAS 治疗比我们之前研究中评估的间隔 50ms 更能显著改善。
局限性
这些结果需要在更大的样本中使用假对照和等脉冲单部位刺激进行复制。
结论
额顶叶 rd-ccPAS 可能是 GAD 的更好治疗选择。
Zotero 插件