Journal article
Crossover to Bilateral Repetitive Transcranial Magnetic Stimulation: A Potential Strategy When Patients Are Not Responding to Unilateral Left-Sided High-Frequency Repetitive Transcranial Magnetic Stimulation
The journal of ECT, Vol.35(1), pp.3-5
03/2019
DOI: 10.1097/YCT.0000000000000500
PMID: 29877963
Abstract
ABSTRACTClinical trials using left-sided repetitive transcranial magnetic stimulation (rTMS) report remission rates of 14% to 32.6%. A large percentage of patients would not achieve remission with standard rTMS treatment. The question of what clinicians should do when a patient is not responding to standard high-frequency (HF) left-sided rTMS remains unanswered. This prospective case series examines whether crossover to bilateral stimulation enhances antidepressant outcomes in patients not responding to unilateral rTMS. Patients in a major depressive episode received an rTMS clinical protocol of 4 to 6 weeksʼ duration. Stimulation began with HF rTMS (10 Hz) over the left dorsolateral prefrontal cortex (range, 3000–5000 pulses per session). A total of 17 patients without sufficient clinical improvement early in their rTMS course received 1-Hz rTMS (range, 600–1200 pps) over the right dorsolateral prefrontal cortex (added to the HF left-sided stimulation). Hamilton Depression Rating Scale scores decreased from 13.9 ± 3.9 (mean ± SD) from the start of augmentation to 12.2 ± 5.8 at the end of acute treatment, a 1.7-point change, Cohen d effect size = −0.35, 95% confidence interval, −1.01 to − 0.34, suggesting improvement. Remission rate in this sample was 24% (4/17). This case series indicates that crossover to bilateral stimulation is a feasible and potentially effective strategy when patients are not improving with standard rTMS. A randomized controlled trial comparing crossover versus standard rTMS is needed to determine the efficacy of this paradigm.
Details
- Title: Subtitle
- Crossover to Bilateral Repetitive Transcranial Magnetic Stimulation: A Potential Strategy When Patients Are Not Responding to Unilateral Left-Sided High-Frequency Repetitive Transcranial Magnetic Stimulation
- Creators
- Pilar CristanchoNicholas Trapp - University of Iowa Hospital and Clinics, Iowa City, IAShan SiddiqiDavid DixonJ Miller - Division of Biostatistics, School of Medicine, Washington University in St Louis, St Louis, MOEric Lenze
- Resource Type
- Journal article
- Publication Details
- The journal of ECT, Vol.35(1), pp.3-5
- DOI
- 10.1097/YCT.0000000000000500
- PMID
- 29877963
- NLM abbreviation
- J ECT
- ISSN
- 1095-0680
- eISSN
- 1533-4112
- Publisher
- Wolters Kluwer Health, Inc.
- Language
- English
- Date published
- 03/2019
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984003453902771
Metrics
16 Record Views