RESUMO
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.
Assuntos
Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/estatística & dados numéricos , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Estimulação Magnética Transcraniana/efeitos adversos , Adulto , Idoso , Antidepressivos/uso terapêutico , Estudos de Casos e Controles , Cognição/fisiologia , Terapia Combinada , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/fisiopatologia , Método Duplo-Cego , Eletroconvulsoterapia/efeitos adversos , Eletroconvulsoterapia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/normas , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Efeito Placebo , Córtex Pré-Frontal/fisiopatologia , Índice de Gravidade de Doença , Estimulação Magnética Transcraniana/métodosRESUMO
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.
