OP 5. Combined left-and right-prefrontal rTMS in depression: Theta-burst vs. tonic rTMS vs. sham stimulation

详细信息    查看全文

• 作者：M. L ; grebe ; M. Schecklmann ; P. Kreuzer ; E. Frank ; T. P?ppl ; J. Prasser ; B. Langguth
• 刊名：Clinical Neurophysiology
• 出版年：2013
• 出版时间：October, 2013
• 年：2013
• 卷：124
• 期：10
• 页码：e58
• 全文大小：36 K

文摘

Repetitive transcranial magnetic stimulation (rTMS) has been proposed to exert antidepressant effects superior to placebo treatment, though effect sizes are moderate. However, data from a randomised multicentre trial cast doubt on an augmenting or accelerating antidepressant effect of continuous rTMS and substantiate the need for exploration of new stimulation protocols. Theta burst stimulation (TBS) provides controllable, consistent, long-lasting, and powerful effects on the cortex physiology and might serve as a rather effective tool than continuous rTMS. Its efficacy has not yet been evaluated though. 61 (minus 7 drop outs) patients suffering from a moderate to severe depressive episode (unipolar, bipolar, or major depression) without psychotic symptoms and scoring at least 18 points on the Hamilton rating scale for depression (HAMD) were included. Patients received 15 sessions (one per day) of either tonic or theta burst or sham rTMS over the dorsolateral prefrontal cortex (DLPFC) as an add-onto regular pharmacotherapy in a randomized, double-blind controlled trial. In detail, we investigated the combination of high frequency (10 Hz) left frontal and low frequency (1 Hz) right frontal versus the combination of intermittent theta burst (iTBS) left frontal and continuous theta burst (cTBS) right frontal and versus placebo treatment. 20 patients were assigned to the theta burst, 17 to the tonic and 17 to the sham rTMS group. Groups were comparable with respect to age and sex. The primary outcome analysis indicates a significant effect of treatment, i.e., all patients exhibited a significant amelioration of symptoms as assessed by HAMD scores. There was no significant difference between the three interventions. However, power analyses indicate an advantage of TBS over tonic and sham rTMS with small effect sizes with negligible effect size between tonic and sham rTMS. Secondary analysis showed that eight weeks after treatment differences between groups get bigger with a linear increase of amelioration of symptoms from sham over tonic to theta burst rTMS. Further analysis with the global assessment of functioning scale and the clinical global impression scale affirmed these findings. For the Beck depression inventory no effects could be found. In conclusion, we found firstly superiority of combined left and right prefrontal rTMS over sham rTMS in depressive patients as an add-onto regular pharmacotherapy. Secondly, we also could demonstrate a superiority of TBS over tonic rTMS for the treatment of depression. Thirdly, effects were small and were highest at the last follow up visit.