RESUMEN
Early studies of transcranial magnetic stimulation (TMS) have shown no adverse effects on neuropsychological function. However, further research using higher TMS intensities as well as a greater number of TMS pulses and with larger sample sizes is needed. We studied 68 patients with major depressive disorder who were randomized to receive either 15 sessions of sham or real TMS at 110% of the estimated prefrontal cortex threshold to the left dorsolateral prefrontal cortex. Each session consisted of 32 5-second trains of 10-Hz repetitive TMS at 110% adjusted motor threshold. A total of 24,000 pulses were given. Neuropsychological function was assessed before and immediately after TMS treatment with a battery of 8 tests. Using a higher TMS intensity as well as a greater number of pulses and having a larger sample size compared with most previous studies, this study found no negative neuropsychological effects of TMS. Changes in neuropsychological function were unrelated to changes in depression.
Asunto(s)
Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Pruebas Neuropsicológicas , Estimulación Magnética Transcraneal/efectos adversos , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Cognición , Función Ejecutiva , Femenino , Humanos , Masculino , Procesos Mentales , Persona de Mediana Edad , Corteza Prefrontal , Escalas de Valoración Psiquiátrica , Desempeño Psicomotor , Tiempo de Reacción , Conducta Verbal , Adulto JovenRESUMEN
This study evaluated the change in reported pain in patients with medication-resistant major depression receiving transcranial magnetic stimulation (TMS) compared with sham stimulation. In this study, 68 subjects with major depression were randomized to either TMS or sham stimulation. Repetitive TMS was delivered to the left dorsolateral prefrontal cortex at a frequency of 10 Hz in 5-second trains at 110% of the estimated prefrontal cortex threshold. The level of pain was assessed before, during, and after treatment using the Systematic Assessment for Treatment Emergent Effects (SAFTEE) item for pain in the muscles, bones, and joints. Compared with sham, TMS was associated with a significant (p < 0.05) reduction in the SAFTEE pain item during the study. The reduction in pain could not be explained by the antidepressant effects.
Asunto(s)
Trastorno Depresivo Mayor/terapia , Manejo del Dolor , Corteza Prefrontal/fisiología , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/fisiopatología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Resistencia a Medicamentos , Lateralidad Funcional/fisiología , Humanos , Persona de Mediana Edad , Dolor/diagnóstico , Dolor/fisiopatología , Dimensión del Dolor/estadística & datos numéricos , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Resultado del TratamientoRESUMEN
BACKGROUND: Repetitive transcranial magnetic stimulation (TMS) as a treatment for depression has shown statistically significant effects, but the clinical significance of these effects has been questioned. METHODS: Patients with medication-resistant depression were randomized to receive 15 sessions of active or sham repetitive TMS delivered to the left dorsolateral prefrontal cortex at 110% the estimated prefrontal cortex threshold. Each session consisted of 32 trains of 10 Hz repetitive TMS delivered in 5-second trains. The primary end point was treatment response defined as a >or=50% decrease in Hamilton Depression Rating Scale (HDRS) score at both 1 and 2 weeks following the final repetitive TMS treatment. Remission was defined as a HDRS score < 8. RESULTS: The response rate for the TMS group was 30.6% (11/35), significantly (p = .008) greater than the 6.1% (2/33) rate in the sham group. The remission rate for the TMS group was 20% (7/35), significantly (p = .033) greater than the 3% (1/33) rate in the sham group. The HDRS scores showed a significantly (p < .002) greater decrease over time in the TMS group compared with the sham group. CONCLUSIONS: Transcranial magnetic stimulation can produce statistically and clinically significant antidepressant effects in patients with medication-resistant major depression.
Asunto(s)
Trastorno Depresivo Mayor/terapia , Corteza Prefrontal/fisiopatología , Estimulación Magnética Transcraneal/métodos , Adulto , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/fisiopatología , Resistencia a Medicamentos , Terapia por Estimulación Eléctrica , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Resultado del TratamientoRESUMEN
The dorsolateral prefrontal cortex (DLPFC) may participate in the process of language switching in multilingual individuals. We present two cases of bilingual patients who experienced unexpected language switching after receiving high-frequency, repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC as a treatment for major depression. These preliminary findings support the role of the DLPFC in language switching in polyglots and highlight the potential value of rTMS for non-invasively investigating language function in humans. Further investigation is warranted.