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2011, Number 4

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Salud Mental 2011; 34 (4)

Clinical and electrophysiological effect of right and left repetitive transcranial magnetic stimulation in patients with major depressive disorder

García-Anaya M, González-Olvera J, Ricardo-Garcell J, Armas G, Miranda E, Reyes E, Adelina OG

Language: English
References: 65
Page: 291-299
PDF size: 221.13 Kb.


ABSTRACT

Major Depressive Disorder (MDD) is a common psychiatric disorder that represents one of the main public health problems worldwide. It has been projected that for 2020 it will be the second cause of disability-adjusted life years just below ischemic heart disease.
Quantitative electroencephalogram provides the opportunity to study cortical oscillatory activity across the different frequency bands. It constitutes an accessible tool to explore the clinical and neurophysiologic correlates underlying psychiatric disorders as well as the effect of diverse therapeutic options and the performance through cognitive tasks.
Repetitive transcranial magnetic stimulation is a technique that allows the stimulation of the cerebral cortex noninvasively, relatively painlessly and with fairly few side effects.
The vast majority of rTMS studies target left dorsolateral prefrontal cortex (DLPFC) based on imaging studies showing that left prefrontal cortex dysfunction is pathophysiologically linked to depression. However, there is some evidence implicating right PFC in the pathophysiology of depression.
Comparison of antidepressant efficacy of diverse stimulation frequencies is relevant since a main concern around rTMS is its potential to induce seizures; hence we consider that frequency of stimulation is an important aspect to be studied.
For this study we aimed to elucidate the clinical efficacy of rTMS comparing two groups of depressed patients stimulated over DLPFC, one over the left (at 5 Hz) and other over the right (at 1 Hz). We also meant to know if there were clinical and electroencephalographic differential long-term after-effects between those groups of treatment.
We included twenty right-handed patients with a DSM-IVR diagnosis of MDD. They were assigned into two groups of treatment. Group 1 received 5Hz rTMS over the left DLPFC. Group 2 received 1Hz rTMS over the right DLPFC.
We obtained two EEG measurements in order to analyze Z score of broad-band spectral parameters and cross-spectral.
No statistical differences among groups were found in response to treatment after weekly comparisons of clinimetric scores and significant differences between baseline and final assessment by HDRS, MADRS, BDI and HARS.
The major rTMS effect on EEG was observed in the group that received 1 Hz over the right DLPFC and no significant effects were observed for the group that received 5 Hz over the left DLPFC.
Our results propose that administration of 15 sessions on either left (5 Hz) or right (1 Hz) rTMS over DLPFC is sufficient to reach response to treatment, assessed by HDRS, MADRS, BDI and HARS in subjects with MDD. Moreover, in both cases rTMS was able to induce an equivalent antidepressant effect.
The major effect of rTMS on EEG was observed in the right 1 Hz rTMS group where changes were elicited mainly over frontal, central and temporal regions on alpha and particularly beta frequency bands. In a lesser extent for left 5 Hz rTMS group the main effect was observed on anterior regions for beta and particularly alpha frequency bands.
We believe it is pertinent to continue exploring the therapeutic potential of lower stimulation frequencies, for what further research including larger samples is still necessary to confirm these trends.


REFERENCES

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden Disease Study. Lancet 1997;349: 1498-1504.

  2. Belló M, Puentes-Rosas E, Medina-Mora M, Lozano R. Prevalence and diagnosis of depression in Mexico. Salud Pública México 2005;47:4-11.

  3. Kessler RC, Berglund P, Demler O et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289:3095-3105.

  4. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990;264:2524-2528.

  5. Boutros NN, Berman RM, Hoffman R, Miano AP et al. Electroencephalogram and repetitive transcranial magnetic stimulation. Depression Anxiety 2000;12:166-2169.

  6. Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry 2003;53:649-659.

  7. Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol 2008;76:909-922.

  8. Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. Int J Neuropsychopharmacol 2002;5:73-103.

  9. Holtzheimer PE, 3rd, Russo J, Avery DH. A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression. Psychopharmacol Bull 2001;35:149-169.

  10. Martin JL, Barbanoj MJ, Schlaepfer TE, Thompson E et al. Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Br J Psychiatry 2003;182:480-491.

  11. Gross M, Nakamura L, Pascual-Leone A, Fregni F. Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent vs. the earlier rTMS studies. Acta Psychiatr Scand 2007;116:165-173.

  12. Slotema CW, Blom JD, Hoek HW, Sommer IE. Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry 2010;71:873-884.

  13. Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry 2003;160:835-845.

  14. Kobayashi M, Pascual-Leone A. Transcranial magnetic stimulation in neurology. Lancet Neurol 2003;2:145-156.

  15. George MS, Belmaker RH. Transcranial magnetic stimulation in clinical psychiatry. Washington, D.C.: American Psychiatric Press; 2000.

  16. George MS, Lisanby SH, Sackeim HA. Transcranial magnetic stimulation: applications in neuropsychiatry. Arch Gen Psychiatry 1999;56:300-311.

  17. Chen R, Classen J, Gerloff C et al. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology 1997; 48:1398-1403.

  18. Hallett M. Transcranial magnetic stimulation: a primer. Neuron 2007;55:187-199.

  19. Kujirai T, Caramia MD, Rothwell JC et al. Corticocortical inhibition in human motor cortex. J Physiol 1993;471:501-519.

  20. Pascual-Leone A, Davey N, Rothwell J, Wassermann EM. Handbook of transcranial magnetic stimulation. London: Hodder Arnold; 2002.

  21. Pascual-Leone A, Valls-Sole J, Wassermann EM, Hallett M. Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain 1994;117(Pt 4):847-858.

  22. Wagner T, Valero-Cabre A, Pascual-Leone A. Noninvasive human brain stimulation. Annu Rev Biomed Eng 2007;9:527-565.

  23. Bench CJ, Frackowiak RS, Dolan RJ. Changes in regional cerebral blood flow on recovery from depression. Psychol Med 1995;25:247-261.

  24. Drevets WC. Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression. Prog Brain Res 2000;126:413-431.

  25. Ridding MC, Rothwell JC. Is there a future for therapeutic use of transcranial magnetic stimulation? Nature Reviews Neurscience 2007;8:559-567.

  26. Fitzgerald PB, Brown TL, Marston NA, Daskalakis et al. Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Archives General Psychiatry 2003;60:1002-1008.

  27. Ricardo-Garcell J, Gonzalez-Olvera JJ, Miranda E et al. EEG sources in a group of patients with major depressive disorders. Int J Psychophysiol 2009;71:70-74.

  28. Fitzgerald PB, Benitez J, De Castella A, Daskalakis ZJ et al. A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression. Am J Psychiatry 2006;163:88-94.

  29. Fitzgerald PB, Huntsman S, Gunewardene R, Kulkarni J et al. A randomized trial of low-frequency right-prefrontal-cortex transcranial magnetic stimulation as augmentation in treatment-resistant major depression. Int J Neuropsychopharmacol 2006;9:655-666.

  30. George MS, Wassermann EM, Williams WA et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport 1995;6:1853-1856.

  31. George MW E, Kimbrell T, Little J, Williams W et al. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. American J Psychiatry 1997;154:1752-1756.

  32. Kozel FA, George MS. Meta-analysis of left prefrontal repetitive transcranial magnetic stimulation (rTMS) to treat depression. J Psychiatr Pract 2002;8:270-275.

  33. Lisanby SH, Husain MM, Rosenquist PB et al. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology 2009;34:522-534.

  34. Padberg F, Haag C, Zwanzger P et al. Rapid and slow transcranial magnetic stimulation are equally effective in medication-resistant depression: a placebo-controlled study. In: CINP Abstracts 21st Congress; 1998, 1998; p. 103-st0306.

  35. Spronk D, Arns M, Bootsma A, van Ruth R et al. Long-term effects of left frontal rTMS on EEG and ERPs in patients with depression. Clin EEG Neurosci 2008;39:118-124.

  36. Pascual-Leone A, Valls-Sole J, Brasil-Neto JP, Cohen LG, Hallett M. Seizure induction and transcranial magnetic stimulation. Lancet 1992;339:997.

  37. APA. Diagnostic and Statistic Manual of Mental Disorders. Fourth edition, text revision (DSM-IV-TR), 4ta. ed. Arlington VA: American Psychiatric Publishing, Inc.; 2000.

  38. George MS, Wassermann EM, Williams WA et al. Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry Clin Neurosci 1996;8:172-180.

  39. Pascual-Leone A, Catala MD, Pascual-Leone Pascual A. Lateralized effect of rapid-rate transcranial magnetic stimulation of the prefrontal cortex on mood. Neurology 1996;46:499-502.

  40. Szava S, Valdés P, Biscay R et al. Hihg resolution quantitative EEG analysis. Brain Topography 1994;6:211-219.

  41. Valdés P, Valdés M, Carballo JA et al. QEEG in a public health system. Brain Topography 1992;4:259-266.

  42. Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and metaanalysis. J Psychiatry Neurosci 2005;30:83-90.

  43. Chen WH, Mima T, Siebner HR et al. Low-frequency rTMS over lateral premotor cortex induces lasting changes in regional activation and functional coupling of cortical motor areas. Clin Neurophysiol 2003;114:1628-1637.

  44. Fuggetta G, Pavone EF, Fiaschi A, Manganotti P. Acute modulation of cortical oscillatory activities during short trains of high-frequency repetitive transcranial magnetic stimulation of the human motor cortex: a combined EEG and TMS study. Hum Brain Mapp 2008;29:1-13.

  45. Griskova I, Ruksenas O, Dapsys K, Herpertz S et al. The effects of 10 Hz repetitive transcranial magnetic stimulation on resting EEG power spectrum in healthy subjects. Neurosci Lett 2007;419:162-167.

  46. Hamidi M, Slagter HA, Tononi G, Postle BR. Repetitive Transcranial Magnetic Stimulation Affects behavior by Biasing Endogenous Cortical Oscillations. Front Integr Neurosci 2009;3:14.

  47. Okamura H, Jing H, Takigawa M. EEG modification induced by repetitive transcranial magnetic stimulation. J Clin Neurophysiol 2001;18:318-325.

  48. Strens LH, Oliviero A, Bloem BR, Gerschlager W et al. The effects of subthreshold 1 Hz repetitive TMS on cortico-cortical and interhemispheric coherence. Clin Neurophysiol 2002;113:1279-1285.

  49. Funk AP, George MS. Prefrontal EEG asymmetry as a potential biomarker of antidepressant treatment response with transcranial magnetic stimulation (TMS): a case series. Clin EEG Neurosci 2008;39:125-130.

  50. Fierro B, Brighina F, Vitello G et al. Modulatory effects of low- and highfrequency repetitive transcranial magnetic stimulation on visual cortex of healthy subjects undergoing light deprivation. J Physiology 2005;565:659-665.

  51. Huerta PT, Volpe BT. Transcranial magnetic stimulation, synaptic plasticity and network oscillations. J Neuroengineering Rehabilitation 2009;6:7.

  52. Pell GS, Roth Y, Zangen A. Modulation of cortical excitability induced by repetitive transcranial magnetic stimulation: Influence of timing and geometrical parameters and underlying mechanisms Progress Neurobiology 2010;93:59-98.

  53. Salerno A, Georgesco M. Interhemispheric facilitation and inhibition studies in man with double magnetic stimulation. Electroencephalogr Clin Neurophysiol 1996;101:395-403.

  54. Suppa A, Bologna M, Gilio F, Lorenzano C et al. Preconditioning repetitive transcranial magnetic stimulation of premotor cortez can reduce but not enhance short-term facilitation of primary motor cortex. J Neurophysiology 2008;99:564-570.

  55. Terao Y, Ugawa Y. Basic mechanisms of TMS. J Clinical Neurophysiology 2002;19:322-343.

  56. Wang H, Wang X, SCheich H. LTD and LTP induced by transcranial magnetic stimulation in auditory cortex. Neuroreport 1996;7:521-525.

  57. Loo CK, Sachdev PS, Haindl W et al. High (15 Hz) and low (1 Hz) frequency transcranial magnetic stimulation have different acute effects on regional cerebral blood flow in depressed patients. Psychological Medicine 2003;33:997-1006.

  58. Nadeau SE, McCoy KJ, Crucian GP et al. Cerebral blood flow changes in depressed patients after treatment with repetitive transcranial magnetic stimulation: evidence of individual variability. Neuropsychiatry Neuropsychol Behav Neurol 2002;15:159-175.

  59. Speer AM, Benson BE, Kimbrell TK et al. Opposite effects of high and low frequency rTMS on mood in depressed patients: Relationship to baseline cerebral activity on PET. J Affective Disorders 2009;115:386-394.

  60. Eisenegger C, Treyer V, Knoch D. Time-course of «off-line» prefrontal rTMS effects - a PET study. Neuroimage 2008;42:379-384.

  61. Kito S, Fujita K, Koga F. Regional cerebral blood flow changes after lowfrequency transcranial magnetic stimulation of the right dorsolateral prefrontal cortex in treatment-resistant depression. Neurpsychobiology 2008;58:29-36.

  62. Okabe S, Hanajima R, Ohnishi T et al. Functional connectivity revealed by single-photon emission computed tomography (SPECT) during repetitive transcranial magnetic stimulation (rTMS) of the motor cortex. Clinical Neurophysiology 2003;114:450-457.

  63. Speer AM, Willis MW, Herscovitch P, Daube-Witherspoon M et al. Intensity-dependent regional cerebral blood flow during 1-Hz repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers studied with H2 15Opositron emission tomography: I. Effects of primary motor cortex rTMS. Biol Psychiatry 2003;54:818-825.

  64. Speer AM, Willis MW, Herscovitch P et al. Intensity-dependent regional cerebral blood flow during 1-Hz repetitive transcranial magnetic stimulation (rTMS) in healthy volunteers studied with H215O positron emission tomography: I. Effects of primary motor cortex rTMS. Biol Psychiatry 2003;54:818-825.

  65. Fitzgerald PB, Sritharan A, Daskalakis ZJ, De Castella AR et al. A functional magnetic resonance imaging study of the effects of low frequency right prefrontal transcranial magnetic stimulation in depression. J Clinical Psychopharmacology 2007;27:488-492.




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