RESUMEN
OBJECTIVE: Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex has been shown to have a statistically and clinically significant anti-depressant effect. The present pilot study was carried out to investigate if right prefrontal low-frequency rTMS as an add-on to electroconvulsive therapy (ECT) accelerates the anti-depressant effect and reduces cognitive side effects. METHODS: In this randomised, controlled, double-blind study, thirty-five patients with major depression were allocated to ECT+placebo or ECT+low-frequency right prefrontal rTMS. The severity of depression was evaluated during the course using the Hamilton scale for depression (the 17-item as well as the 6-item scale) and the major depression inventory (MDI). Furthermore, neuropsychological assessment of cognitive function was carried out. RESULTS: The study revealed no significant difference between the two groups for any of the outcomes, but with a visible trend to lower scores for MDI after treatment in the placebo group. The negative impact of ECT on neurocognitive functions was short-lived, and scores on logical memory were significantly improved compared to baseline 4 weeks after last treatment. The ECT-rTMS group revealed generally less impairment of cognitive functions than the ECT-placebo group. CONCLUSION: The addition of low-frequency rTMS as an add-on to ECT treatment did not result in an accelerated response. On the contrary, the results suggest that low-frequency rTMS could inhibit the anti-depressant effect of ECT.
Asunto(s)
Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva/estadística & datos numéricos , Estimulación Transcraneal de Corriente Directa/efectos adversos , Estimulación Magnética Transcraneal/efectos adversos , Adulto , Anciano , Antidepresivos/uso terapéutico , Estudios de Casos y Controles , Cognición/fisiología , Terapia Combinada , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/fisiopatología , Método Doble Ciego , Terapia Electroconvulsiva/efectos adversos , Terapia Electroconvulsiva/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas/normas , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Efecto Placebo , Corteza Prefrontal/fisiopatología , Índice de Severidad de la Enfermedad , Estimulación Magnética Transcraneal/métodosRESUMEN
Post-concussion syndrome (PCS) is often caused by an uncomplicated mild head injury but followed by long-lasting somatic, cognitive and psychiatric symptoms. For many years PCS has been an area of controversy between clinicians. New diagnostic techniques and clinical researches has shed light to some neurobiological aspects behind PCS. In Diagnostic and Statistical Manual of Mental Disorders V PCS is redefined as a neuro-cognitive condition emphasizing the importance of neuropsychological deficits among these patients. New clinical recommendations do not support previous concept of long-term rest, but suggest gradual training back to a daily life.