ABSTRACT
To date, 33 subjects diagnosed with major depressive disorder have undergone transcranial magnetic stimulation (TMS) in the authors' clinic. Five of these patients showed minimal electroencephalogram (EEG) variants at baseline. The authors describe the course of treatment and serial EEGs in 3 of the 5 patients who did not show progressive EEG changes in association with active rTMS. These three cases suggest that minimal EEG anomalies at baseline need not serve as a contraindication to undergoing rTMS. Two patients with progressive EEG changes in association with sham rTMS in one and active rTMS in the other are also discussed.
Subject(s)
Depressive Disorder/therapy , Transcranial Magnetic Stimulation/therapeutic use , Adult , Aged , Depressive Disorder/physiopathology , Double-Blind Method , Electroencephalography , Female , Humans , Male , Middle Aged , Physical StimulationABSTRACT
Scalp recordings of the electroencephalogram (EEG) have been used in association with repetitive transcranial magnetic stimulation (rTMS) investigations as a safety measure in monitoring ongoing EEG activity and as a neurophysiologic tool in examining the specific effects induced by the magnetic stimulus on the EEG or evoked potentials (EPs). Medline review on the use of EEG or EPs with rTMS reveals that this area has been largely unexplored. Limited available studies attest to the potential for studies combining EEG/EPs and rTMS to be useful in further elucidating the normal brain physiology. Herein, we report on our experience with continuous EEG sampling combined with rTMS in patients with major depression (n = 14), schizophrenia (n = 7), and obsessive-compulsive disorder (n = 5). Our data support the practice of using continuous EEG monitoring when the stimulation parameters fall outside established safety guidelines.
Subject(s)
Depressive Disorder, Major/therapy , Electroencephalography , Electromagnetic Fields , Obsessive-Compulsive Disorder/therapy , Schizophrenia/therapy , Brain Mapping , Cerebral Cortex/physiopathology , Depressive Disorder, Major/physiopathology , Feasibility Studies , Humans , Monitoring, Physiologic , Obsessive-Compulsive Disorder/physiopathology , Schizophrenia/physiopathology , Treatment OutcomeABSTRACT
BACKGROUND: Multiple groups have reported on the use of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant major depression. The purpose of this study is to assess the efficacy of rTMS in unmedicated, treatment-resistant patients who meet criteria for major depression. METHODS: Depressed subjects, who had failed to respond to a median of four treatment trials, were assigned in a randomized double-blind manner to receive either active (n = 10; 20 2-sec trains of 20 Hz stimulation with 58-sec intervals; delivered at 80% motor threshold with the figure-of-eight coil positioned over the left dorsolateral prefrontal cortex) or sham (n = 10; similar conditions with the coil elevated and angled 45 degrees tangentially to the scalp) rTMS. These sequences were applied during 10 consecutive weekdays. Continuous electroencephalogram sampling and daily motor threshold determinations were also obtained. RESULTS: The group mean 25-item Hamilton Depression Rating Scale (HDRS) score was 37.2 (+/- 2.0 SEM) points. Adjusted mean decreases in HDRS scores were 14.0 (+/- 3.7) and 0.2 (+/- 4.1) points for the active and control groups, respectively (p <.05). One of 10 subjects receiving active treatment demonstrated a robust response (i.e., HDRS decreased from 47 to 7 points); three other patients demonstrated 40-45% decreases in HDRS scores. No patients receiving sham treatment demonstrated partial or full responses. CONCLUSIONS: A 2-week course of active rTMS resulted in statistically significant but clinically modest reductions of depressive symptoms, as compared to sham rTMS in a population characterized by treatment resistance.
