Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
J Psychosom Res. 2023 Aug;171:111382. doi: 10.1016/j.jpsychores.2023.111382. Epub 2023 May 18.
Repetitive transcranial magnetic stimulation (rTMS) has attracted considerable attention because of its non-invasiveness, minimal side effects, and treatment efficacy. Despite an adequate duration of rTMS treatment, some patients with post-stroke depression (PSD) do not achieve full symptom response or remission.
This was a prospective randomized controlled trial. Participants receiving rTMS were randomly assigned to the ventromedial prefrontal cortex (VMPFC), left dorsolateral prefrontal cortex (DLPFC), or contralateral motor area (M1) groups in a ratio of 1:1:1. Enrollment assessments and data collection were performed in weeks 0, 2, 4, and 8. The impact of depressive symptom dimensions on treatment outcomes were tested using a linear mixed-effects model fitted with maximum likelihood. Univariate analysis of variance (ANOVA) and back-testing were used to analyze the differences between the groups.
In total, 276 patients were included in the analysis. Comparisons across groups showed that 17-item Hamilton Rating Scale for Depression (HAMD-17) scores of the DLPFC group significantly differed from those of the VMPFC and M1 groups at 2, 4, and 8 weeks after treatment (p < 0.05). A higher observed mood score (β = -0.44, 95% confidence interval [CI]: -0.85-0.04, p = 0.030) could predict a greater improvement in depressive symptoms in the DLPFC group. Higher neurovegetative scores (β = 0.60, 95% CI: 0.25-0.96, p = 0.001) could predict less improvement of depressive symptoms in the DLPFC group.
Stimulation of the left DLPFC by high-frequency rTMS (HF-rTMS) could significantly improve depressive symptoms in the subacute period of subcortical ischemic stroke, and the dimension of depressive symptoms at admission might predict the treatment effect.
重复经颅磁刺激（rTMS）因其无创、副作用小和治疗效果好而受到广泛关注。尽管 rTMS 治疗的时间足够长，但一些卒中后抑郁（PSD）患者并未完全缓解症状。
这是一项前瞻性随机对照试验。接受 rTMS 治疗的患者被随机分为腹内侧前额叶皮质（VMPFC）、左侧背外侧前额叶皮质（DLPFC）和对侧运动区（M1）组，比例为 1:1:1。在第 0、2、4 和 8 周进行入组评估和数据采集。使用最大似然法拟合线性混合效应模型测试抑郁症状维度对治疗结果的影响。使用单因素方差分析（ANOVA）和回测分析对组间差异进行分析。
共有 276 例患者纳入分析。组间比较显示，治疗后 2、4 和 8 周时，DLPFC 组的 17 项汉密尔顿抑郁量表（HAMD-17）评分与 VMPFC 和 M1 组相比差异有统计学意义（p<0.05）。观察到的情绪评分较高（β=-0.44，95%置信区间[CI]：-0.850.04，p=0.030）可预测 DLPFC 组抑郁症状的改善程度更大。神经植物性评分较高（β=0.60，95%CI：0.250.96，p=0.001）可预测 DLPFC 组抑郁症状改善程度较小。
高频 rTMS（HF-rTMS）刺激左侧 DLPFC 可显著改善皮质下缺血性卒中亚急性期的抑郁症状，入院时的抑郁症状维度可能预测治疗效果。
