Pascual-Leone A, Rubio B, Pallardó F, Catalá M D
Departamento de Fisiología, Universidad de Valencia, Spain.
Lancet. 1996 Jul 27;348(9022):233-7. doi: 10.1016/s0140-6736(96)01219-6.
Lesion and neuroimaging studies suggest that left prefrontal lobe dysfunction is pathophysiologically linked to depression. Rapid-rate transcranial magnetic stimulation (rTMS) to prefrontal structures has a lateralised effect on mood in normal volunteers, and several preliminary studies suggest a beneficial effect of rTMS on depression. However, adequately controlled studies have not been conducted.
We have studied the effects of focal rTMS on the depressive symptoms in 17 patients with medication-resistant depression of psychotic subtype. The study was designed as a multiple cross-over, randomised placebo-controlled trial. Sham rTMS and stimulation of different cortical areas were used as controls.
Left dorsolateral prefrontal cortex rTMS resulted in a significant decrease in scores on the Hamilton depression rating scale HDRS (from 25.2 to 13.8) and the self-rated Beck questionnaire BQ (from 47.9 to 25.7). 11 of the 17 patients showed pronounced improvement that lasted for about 2 weeks after 5 days of daily rTMS sessions. No patient experienced any significant undesirable side-effects.
Our findings emphasise the role of the left dorsolateral prefrontal cortex in depression, and suggest that rTMS of the left dorsolateral prefrontal cortex might become a safe, non-convulsive alternative to electroconvulsive treatment in depression.
病灶及神经影像学研究表明，左前额叶功能障碍在病理生理上与抑郁症相关。对前额叶结构进行快速重复经颅磁刺激（rTMS）对正常志愿者的情绪有偏侧化影响，多项初步研究表明rTMS对抑郁症有有益作用。然而，尚未进行充分对照的研究。
我们研究了局部rTMS对17例难治性精神病性亚型抑郁症患者抑郁症状的影响。该研究设计为多次交叉、随机、安慰剂对照试验。采用假rTMS和对不同皮质区域的刺激作为对照。
左侧背外侧前额叶皮质rTMS导致汉密尔顿抑郁量表（HDRS）评分显著降低（从25.2降至13.8），以及贝克自评问卷（BQ）评分显著降低（从47.9降至25.7）。17例患者中有11例在每日进行5天rTMS治疗后显示出明显改善，且持续约2周。没有患者经历任何明显的不良副作用。
我们的研究结果强调了左侧背外侧前额叶皮质在抑郁症中的作用，并表明左侧背外侧前额叶皮质的rTMS可能成为抑郁症电休克治疗的一种安全、无惊厥的替代方法。
