TY - JOUR
T1 - Deep transcranial magnetic stimulation over the prefrontal cortex
T2 - Evaluation of antidepressant and cognitive effects in depressive patients
AU - Levkovitz, Yechiel
AU - Harel, Eiran V.
AU - Roth, Yiftach
AU - Braw, Yoram
AU - Most, Dana
AU - Katz, Leor N.
AU - Sheer, Aharon
AU - Gersner, Roman
AU - Zangen, Abraham
N1 - Funding Information:
This study was supported by the Rosenzweig-Coopersmith Fund and Brainsway Inc.
PY - 2009/10
Y1 - 2009/10
N2 - Background: Electroconvulsive therapy (ECT) is an effective alternative for pharmacotherapy in treatment-resistant depressive patients, but the side effects limit its use. Transcranial magnetic stimulation (TMS) has been proposed as a refined alternative, but most studies do not indicate that TMS is as effective as ECT for severe depression. Objective: We propose that the limited effectiveness of standard TMS resides in its superficial effect on the cortex, although much of the pathophysiology of depression is associated with deeper and larger brain regions implicated in the reward system. Herein, we tested the effectiveness and safety of a novel TMS coil, the "H-coil," which enables direct stimulation of deeper brain regions, at the expense of focality. Methods: We have studied the antidepressant and cognitive effects induced by 4 weeks of high-frequency (20 Hz) repeated deep TMS (DTMS) over the prefrontal cortex (PFC) of 65 medication-free depressive patients, who have failed to benefit from prior medications. Patients were randomly assigned to various treatment configurations, differing in stimulation intensity and laterality. Effects were assessed by the 24-item Hamilton depression rating scale (HDRS-24) and several secondary outcome measures. Results: A significant improvement in HDRS scores was found when high, but not low, stimulation intensity was used. Several cognitive improvements were evident, and no treatment-related serious adverse events were observed. Conclusions: DTMS over the PFC was found safe and effective in alleviating depression. The results accentuate the significance of deep, high-intensity stimulation over low, and serve as the first study to indicate the potential of DTMS in psychiatric and neurologic disorders.
AB - Background: Electroconvulsive therapy (ECT) is an effective alternative for pharmacotherapy in treatment-resistant depressive patients, but the side effects limit its use. Transcranial magnetic stimulation (TMS) has been proposed as a refined alternative, but most studies do not indicate that TMS is as effective as ECT for severe depression. Objective: We propose that the limited effectiveness of standard TMS resides in its superficial effect on the cortex, although much of the pathophysiology of depression is associated with deeper and larger brain regions implicated in the reward system. Herein, we tested the effectiveness and safety of a novel TMS coil, the "H-coil," which enables direct stimulation of deeper brain regions, at the expense of focality. Methods: We have studied the antidepressant and cognitive effects induced by 4 weeks of high-frequency (20 Hz) repeated deep TMS (DTMS) over the prefrontal cortex (PFC) of 65 medication-free depressive patients, who have failed to benefit from prior medications. Patients were randomly assigned to various treatment configurations, differing in stimulation intensity and laterality. Effects were assessed by the 24-item Hamilton depression rating scale (HDRS-24) and several secondary outcome measures. Results: A significant improvement in HDRS scores was found when high, but not low, stimulation intensity was used. Several cognitive improvements were evident, and no treatment-related serious adverse events were observed. Conclusions: DTMS over the PFC was found safe and effective in alleviating depression. The results accentuate the significance of deep, high-intensity stimulation over low, and serve as the first study to indicate the potential of DTMS in psychiatric and neurologic disorders.
KW - DLPFC
KW - H-coil
KW - VLPFC
KW - bilateral stimulation
KW - deep TMS
KW - major depression
KW - unilateral stimulation
UR - http://www.scopus.com/inward/record.url?scp=70349835168&partnerID=8YFLogxK
U2 - 10.1016/j.brs.2009.08.002
DO - 10.1016/j.brs.2009.08.002
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C2 - 20633419
AN - SCOPUS:70349835168
SN - 1935-861X
VL - 2
SP - 188
EP - 200
JO - Brain Stimulation
JF - Brain Stimulation
IS - 4
ER -