Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova · 2024
[Transcranial magnetic stimulation (rTMS) in the treatment of depressive disorders].
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Lebedeva I S, Pomytkin A N, Panikratova Ya R, Abdullina E G, Kaleda V G
Аннотация
OBJECTIVE: To conduct a comparative assessment of the clinical outcome and tolerability of rTMS using different stimulation protocols, as well as to determine the dynamics of neurophysiological markers of the functional state of the brain.
MATERIAL AND METHODS: Twenty-eight patients (mean age 23.5±4.4 years) with ICD10 diagnoses F21, F31-F34 and clinically significant depression confirmed by psychometric data (HDRS=21.7±5.6) were enrolled in the study. Treatment included co-administration of psychopharmacotherapy and rTMS with projection in the left dorsolateral prefrontal cortex according to two different protocols: 10 Hz (n=16) and intermittent stimulation with theta flashes (n=12), which were randomly selected. The EEG recording method was used in all patients, and in the case of theta flash stimulation, EEG and fMRI were used. The reduction of the psychometric score of 25% or more was considered as a criterion for the effectiveness of therapy, with a reduction of 50% or more, the patient was considered a respondent.
RESULTS: It was demonstrated that 64.9% of patients responded to treatment, and there was also a similarity in the frequency of clinical outcomes when using different rTMS protocols. The results of the EEG study indicated inconsistent neurophysiological mechanisms of changes in the state of the brain during treatment using different transcranial magnetic stimulation protocols.
CONCLUSION: A pilot study of the use of two rTMS protocols (without the task of direct comparison) showed their certain effectiveness in the treatment of depressive disorders in youth patients. The analysis of neurophysiological data allows us to cautiously assume different mechanisms of action of high-frequency stimulation with a frequency of 10 Hz (associated with a decrease in the index of theta activity, which may be associated with the «normalization» of limbic-cortical interactions) and intermittent stimulation by theta flashes (associated with the «normalization» of altered hemispheric asymmetry).
MATERIAL AND METHODS: Twenty-eight patients (mean age 23.5±4.4 years) with ICD10 diagnoses F21, F31-F34 and clinically significant depression confirmed by psychometric data (HDRS=21.7±5.6) were enrolled in the study. Treatment included co-administration of psychopharmacotherapy and rTMS with projection in the left dorsolateral prefrontal cortex according to two different protocols: 10 Hz (n=16) and intermittent stimulation with theta flashes (n=12), which were randomly selected. The EEG recording method was used in all patients, and in the case of theta flash stimulation, EEG and fMRI were used. The reduction of the psychometric score of 25% or more was considered as a criterion for the effectiveness of therapy, with a reduction of 50% or more, the patient was considered a respondent.
RESULTS: It was demonstrated that 64.9% of patients responded to treatment, and there was also a similarity in the frequency of clinical outcomes when using different rTMS protocols. The results of the EEG study indicated inconsistent neurophysiological mechanisms of changes in the state of the brain during treatment using different transcranial magnetic stimulation protocols.
CONCLUSION: A pilot study of the use of two rTMS protocols (without the task of direct comparison) showed their certain effectiveness in the treatment of depressive disorders in youth patients. The analysis of neurophysiological data allows us to cautiously assume different mechanisms of action of high-frequency stimulation with a frequency of 10 Hz (associated with a decrease in the index of theta activity, which may be associated with the «normalization» of limbic-cortical interactions) and intermittent stimulation by theta flashes (associated with the «normalization» of altered hemispheric asymmetry).