Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China.
Department of Neurology, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China.
J Affect Disord. 2023 Apr 1;326:89-95. doi: 10.1016/j.jad.2023.01.096. Epub 2023 Jan 28.
The incidence of posttraumatic stress disorder (PTSD) following stroke ranges from 6.5 % to 25 %. Presently few studies have focused on its treatment. Repetitive transcranial magnetic stimulation (rTMS) is often applied as a rehabilitation method after stroke, and it also represents a novel approach to PTSD. The aim of this study was to explore the effect of rTMS (or combined with a brief stroke re-exposure) on treating post-stroke PTSD. Sixty participants with post-stroke PTSD were randomly assigned into three groups (rTMS + brief exposure group, TMS + BE; rTMS alone group, TMS; sham treatment group, ST) and received 10 sessions of treatment accordingly over two weeks. Changes in PTSD symptoms (Impact of Event Scale-Revised, IES-R) were evaluated at pre-treatment (T1), the end of the first (T2), and the end of the second treatment week (T3). At the three-month follow-up (T4), a PTSD interview and IES-R assessment were given. Results showed that from T1 to T3, IES-R (and its intrusion subscale) scores of TMS + BE group and TMS group were significantly lower than the ST group, and the effect remained at three-month follow-up. The treatment effect was comparable between TMS + BE group and TMS group at T3, however, it was better for TMS + BE group than TMS group at T2, indicating a brief exposure promotes the effect of rTMS. At follow-up, the rates of PTSD were lower in TMS + BE group and TMS group than ST group. In conclusion, rTMS can effectively treat post-stroke PTSD and the effects may be accelerated by combining a brief exposure procedure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100043444.
创伤后应激障碍（PTSD）在脑卒中后的发病率为 6.5%至 25%。目前，针对其治疗的研究较少。重复经颅磁刺激（rTMS）常用于脑卒中后的康复方法，也是治疗 PTSD 的新方法。本研究旨在探讨 rTMS（或联合短暂性脑卒中再暴露）治疗脑卒中后 PTSD 的效果。60 名脑卒中后 PTSD 患者被随机分为三组（rTMS+短暂性脑卒中再暴露组，TMS+BE；rTMS 组，TMS；假刺激组，ST），并在两周内接受 10 次治疗。分别在治疗前（T1）、第一次治疗结束时（T2）和第二次治疗结束时（T3）评估 PTSD 症状（修订后的事件影响量表，IES-R）的变化。在三个月随访（T4）时，进行 PTSD 访谈和 IES-R 评估。结果显示，从 T1 到 T3，TMS+BE 组和 TMS 组的 IES-R（及其闯入子量表）评分均明显低于 ST 组，且在三个月随访时仍保持这种效果。TMS+BE 组和 TMS 组在 T3 时的治疗效果相当，但在 T2 时 TMS+BE 组优于 TMS 组，表明短暂性脑卒中再暴露可增强 rTMS 的疗效。随访时，TMS+BE 组和 TMS 组的 PTSD 发生率均低于 ST 组。结论：rTMS 可有效治疗脑卒中后 PTSD，联合短暂性脑卒中再暴露可加速治疗效果。临床试验注册号：中国临床试验注册中心，ChiCTR2100043444。
