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OBJECTIVE@#To observe the impacts of acupuncture on depressive mood and sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia, and explore its effect mechanism.@*METHODS@#A total of 60 patients with comorbid mild-to-moderate depressive disorder and insomnia were randomly divided into an observation group (30 cases, 1 case dropped off) and a control group (30 cases, 2 cases dropped off). In the observation group, acupuncture and low frequency repeated transcranial magnetic stimulation (rTMS) were combined for the intervention. Acupuncture was applied to Baihui (GV 20), Yintang (GV 24+), Neiguan (PC 6) and Yanglingquan (GB 34), etc., the needles were retained for 30 min; and the intradermal needles were embedded at Xinshu (BL 15) and Danshu (BL 19) for 2 days. After acupuncture, the rTMS was delivered at the right dorsolateral prefrontal cortex (R-DLPFC), with 1 Hz and 80% of movement threshold, lasting 30 min in each treatment. In the control group, the sham-acupuncture was adopted, combined with low frequency rTMS. The acupoint selection and manipulation were the same as the observation group. In the two groups, acupuncture was given once every two days, 3 times weekly; while, rTMS was operated once daily, for consecutive 5 days a week. The duration of treatment consisted of 4 weeks. Hamilton depression scale-17 (HAMD-17) and Pittsburgh sleep quality index (PSQI) scores were observed before and after treatment, as well as 1 month after the treatment completion (follow-up period) separately. Besides, the levels of nerve growth factor (BDNF) and γ-aminobutyric acid (GABA) in the serum were detected before and after treatment in the two groups.@*RESULTS@#After treatment and in follow-up, the HAMD-17 scores were lower than those before treatment in the two groups (P<0.05), and the scores in the observation group were lower than the control group (P<0.05). After treatment, the total scores and the scores of each factor of PSQI were reduced in the two groups in comparison with those before treatment except for the score of sleep efficiency in the control group (P<0.05); the total PSQI score and the scores for sleep quality, sleep latency, sleep efficiency and daytime dysfunction in the observation group were all lower than those in the control group (P<0.05). In the follow-up, except for the scores of sleep duration and sleep efficiency in the control group, the total PSQI score and the scores of all the other factors were reduced compared with those before treatment in the two groups (P<0.05); the total PSQI score and the scores of sleep quality, sleep latency, sleep duration, sleep efficiency and daytime dysfunction in the observation group were lower than the control group (P<0.05). After treatment, the levels of serum BDNF and GABA were increased in comparison with those before treatment in the observation group (P<0.05), and the level of serum BDNF was higher than that in the control group (P<0.05).@*CONCLUSION@#Acupuncture relieves depressive mood and improves sleep quality in patients with comorbid mild-to-moderate depressive disorder and insomnia. The effect mechanism may be related to the regulation of BDNF and GABA levels and the promotion of brain neurological function recovery.
Subject(s)
Humans , Sleep Initiation and Maintenance Disorders/therapy , Transcranial Magnetic Stimulation , Brain-Derived Neurotrophic Factor , Treatment Outcome , Acupuncture Therapy , Acupuncture Points , gamma-Aminobutyric Acid , Depressive DisorderABSTRACT
Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.
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Objective:To investigate the effects of theta burst stimulation(TBS)mode repeated transcranial magnetic stimulation (r-TMS) in the left prefrontal on negative symptoms and cognitive function in the elderly chronic schizophrenic patients.Methods:Totally 48 patients with stable chronic senile schizophrenia (24 cases in r-TMS treatment group and 24 cases in r-TMS pseudo stimulation control group) were selected. The treatment group was given the TBS mode r-TMS performed in the left dorsolateral prefrontal cortex. The control group was given pseudo stimulation at the same site. Before and after treatment, the brief psychiatric rating scale(BPRS), scale for assessment of negative symptoms(SANS), and positive and negative syndrome scale(PANSS)were used to assess mental symptoms, while Mattis-dementia rating scale(MDRS-2)and social adaptation functioning evaluation(SAFE)were used to assess cognitive function and social function. SPSS 20.0 was used for statistical analysis.Comparisons of the differences between inter groups and intra groups were conducted by independent sample t test and paired t-test. Results:(1)There were significant differences in the total score of PANSS scale((60.17±3.73), (56.67±3.12)), the negative symptom subscale score of PANSS((20.88±2.94), (17.96±2.33)) and the score of SANS((30.67±1.66), (30.25±1.45)) before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of BPRS ( t=3.513, P=0.001), PANSS ( t=6.048, P<0.01), negative symptom subscale ( t=6.610, P<0.01) and SANS ( t=8.239, P<0.01) were significantly different between the two groups. (2)There were significant differences in the scores of MDRS-2 and its sub scales before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of MDRS-2 ( t=6.216, P<0.01), attention ( t=4.596, P<0.01), start/maintain ( t=6.424, P<0.01), concept formation ( t=3.974, P<0.01), construction( t=2.194, P=0.033) and memory ( t=3.162, P=0.003) were significantly different between the two groups.(3)There was no significant difference in the SAFE score between the treatment group and the control group before and after treatment ( t=0.138, 0.142, both P>0.05). Conclusion:TBS can improve the negative symptoms and cognitive function in patients with the elderly chronic schizophrenic, but the effect of social function is not clear.
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Repetitive transcranial magnetic stimulation (rTMS) can achieve neuroplasticity through repeated stimulation of specific cortex, and may be in the ways of inter-hemisphere inhibition or compensation, or both. The various combination of frequency, intensity and duration of stimulation may effect the upper limb function after stroke in different ways.
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Objective To study the effect of high frequency repeated transcranial magnetic stimulation (rTMS) on learning and memory in rats with global cerebral ischemia and to investigate its mechanism.Methods Thirty-five male Sprague-Dawley rats (8-10 weeks old) were randomly divided into sham operation group (n=8),model group (n=9),sham-rTMS (s-rTMS) group (n=9) and rTMS group (n=9).The global cerebral ischemia model was established by modified four-vessel occlusion method.The rTMS group received 10 Hz rTMS stimulation for two weeks,whereas the s-rTMS group received sham stimulation.Morris water maze test was used to detect the spatial learning ability,multi-channel recording technique was used to detect the local field potentials in the hippocampus CA1 region of theta and gamma oscillation,and immunohistochemical staining and Western blotting were used to detect the expression of protein kinase A (PKA) and phosphorylated cyclic adenosine monophosphate response element binding protein (p-CREB) of hippocampus.Results The average escape latency in the model group was longer than that in the sham operation group ((35.16±0.80) s vs (16.57±0.74) s,k=3.723,P=0.013),the spanning platform times and the original platform quadrant swimming time in the model group were shorter than that in the sham operation group (1.14±0.42 vs 4.46±0.23,k=3.185,P=0.042;(14.46±0.73) s vs (29.31±0.42) s,k=3.027,P=0.047).Compared with the sham operation group,the mean power spectral density of theta and gamma reduced ((-68.48±2.61) Hz vs (-59.38±2.25) Hz,k=2.958,P=0.048;(-82.23±4.60) Hz vs (-70.50±4.25) Hz,k=3.729,P=0.021),and the expression of PKA and p-CREB protein decreased in the model group (7 184.26±975.12 vs 25 137.35±1 010.62,k=3.588,P=0.027;1 803.73±336.18 vs 20 175.25±727.23,k=2.912,P=0.049).The average escape latency in the rTMS group was shorter than that in the model group ((24.69± 1.01) s vs (35.16±0.80) s,k=4.082,P=0.034),and the spanning platform times and the original platform quadrant swimming time in the rTMS group was longer than that in the model group (2.42±0.31 vs 1.14±0.42,k=3.296,P=0.039;(23.07±0.67) s vs (14.46±0.73) s,k=4.323,P=0.012).Compared with the rTMS group,the power spectral density of theta and gamma reduced ((-63.81±3.12) Hz vs (-68.48±2.61) Hz,k=3.582,P=0.015;(-75.80±4.58) Hz vs (-82.23±4.60) Hz,k=4.051,P=0.026),and the expression of PKA and p-CREB protein decreased in the model group (13 065.32±1 045.18 vs 7 184.26±975.12,k=3.923,P=0.031;11 032.83±562.86 vs 18 03.73±336.18,k=3.178,P=0.038).Conclusion High frequency rTMS could improve learning and memory of global cerebral ischemia rats,the mechanism of which might be that rTMS enhance the hippocampal theta and gamma oscillations and increase the expression of PKA and p-CREB protein in the hippocampus,thus increasing the hippocampus synaptic plasticity.
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<p><b>OBJECTIVE</b>To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation(HF rTMS)therapy on dyskinesia in patients with incomplete spinal cord injury.</p><p><b>METHODS</b>Randomized controlled trials(RCTs) about HF rTMS therapy on patients with motor incomplete spinal cord injury were searched electronically in PubMed, Google scholar, Cochrane library, Clinical trial, Medline, Web of science, CNKI, VIP, and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score, ASIA lower extremities motor score(LEMS), Modified Ashworth score (MAS), Ten-meter walking test (10MWT) and Walking index for SCI II(WISCI II), and the outcomes were analyzed using RevMan5.2 software provided by the Cochrane information management system.</p><p><b>RESULTS</b>Five RCTs involved 103 patients were included, and 61 patients(experimental group) accepted real rTMS and physical rehabilitation care for SCI, 51 patients(control group) accepted only physical rehabilitation care. There were significant differences in ASIA motor score, LEMS and 10MWT between two groups after HF rTMS therapy (statistics were=2.96,=0.003;=3.04,=0.002;=2.16,=0.03; respectively). When stimulating the leg motor cortex, there was significant difference in MAS between two groups(=2.79,=0.005), and when stimulating the vertex, there was no significant difference(=0.09,=0.93). There was no significant difference in WISCI IIscore after HF rTMS therapy between two groups(=0.90,=0.37).</p><p><b>CONCLUSIONS</b>HF rTMS can raise motor score in patients with incomplete spinal cord injury, improve the spasticity of the lower extremities, and increase the motor ability.</p>
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Despite the fact that pharmacotherapy depressive disorders have proven efficacy, a substantial number of patients are resistant to conventional management. As neuroscientific research about pathophysiology of depression have accumulated, repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have emerged as an important mechanism- based treatment modality. This overview provides a review of therapeutic application of rTMS and tDCS in patients with depression. The clinical and basic studies of rTMS and tDCS in depression were reviewed and integrated using a literature review and interview with experts. rTMS is a noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex. tDCS has a mechanism of modulating cortical excitability in a polarity-specific manner without eliciting action potentials. rTMS and tDCS seem promising for treating depression. Although therapeutic parameters and further technical improvement remain to be systematically investigated, rTMS and tDCS would be a safe and effective intervention to treat depression.
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Humans , Action Potentials , Brain , Depression , Depressive Disorder , Drug Therapy , Head , Magnetic Fields , Neurons , Transcranial Direct Current Stimulation , Transcranial Magnetic StimulationABSTRACT
Objective To study the effects of repeated transcranial magnetic stimulation(rTMS)on Parkinson's plus syndrome(PPS).Methods Fifteen in-patients with PPS were studied between 2005 and 2008.The patients received 1 Hz rTMS at an intensity 30%over the threshold.The rTMS was applied on the hand representive area of the bilateral first motor cortex,50 stimulations on each side,5 arrays,for 5 min,once daily for 15 d.Hamilton's depression scale(HAMD),Hamilton's anxiety scale(HAMA),the unified Parkinson's disease rating scale(UPDRS,which can be subdivided into UPDRS Ⅰ,UPDRS Ⅱ and UPDRS Ⅲ),an activities of daily living scale(ADL),the mini-mental state examination(MMSE)and motor evoked potential(MEP)were assessed before and immediately after 15 d of rTMS treatment. Results Average HAMD,HAMA,UPDRS,UPDRS Ⅱ and UPDRS Ⅲ scores all decreased,and ADL scores increased significantly after treatment,while UPDRSⅠand MMSE scores were unchanged before and after treatment.No significant changes in resting motor threshold or central motor conduction time of the MEP were observed after rTMS treatment. Conclusion Clinical symptoms of PPS patients improved after rTMS treatment and side effects were few.Depression,anxiety,motor function and ability in the activities of daily living improved greatly.Repeated transcranial magnetic stimulation is a potential treatment for PPS patients.There may be no correlation between the effective mechanism of rTMS and cortex excitation.
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Repeated transcranial magnetic stimulation (rTMS) is a noninvasive treatment method recently approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder in adults. Few clinical experiences with TMS or rTMS have been reported in children and adolescents. The clinical application of rTMS in children and adolescents should rest on data showing clinical efficacy and age-related safety. Despite these cautions, rTMS offers the advantage of noninvasive treatment and represents an alternative to classical drug treatment. We reviewed the effect of TMS and rTMS in child and adolescent psychiatric disorders.
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Adolescent , Adult , Child , Humans , Depressive Disorder, Major , Imidazoles , Nitro Compounds , Transcranial Magnetic Stimulation , United States Food and Drug AdministrationABSTRACT
Tourette's disorder is a chronic refractory neuro-behavioral disease. New treatment strategies, such as repeated transcranial magnetic stimulation (rTMS), have been introduced recently. We report the effect of rTMS in a case with Tourette's disorder and attention deficit hyperactivity disorder (ADHD), a common combination in the clinical setting. This was a treatment-refractory patient, who had undergone 2 years of drug treatment and psychiatric consultation. We administered 10 sessions of rTMS for 10 days, resulting in a clear improvement in symptoms not only of Tourette's disorder but also of ADHD. Our observations indicate that rTMS may be effective in the treatment of Tourette's disorder with ADHD.