An open study of repetitive transcranial magnetic stimulation in treatment-resistant depression with Parkinson's disease

ArticleinClinical Neurophysiology 118(10):2189-94 · November 2007with14 Reads
DOI: 10.1016/j.clinph.2007.07.010 · Source: PubMed
Abstract
Major depression is a common concomitant of chronic central nervous system disorders, notably Parkinson's disease (PD). Repetitive transcranial magnetic stimulation (rTMS) has been investigated as a potential treatment for depression in PD and for the movement disorder of PD, but comprehensive testing in multiple areas of performance has seldom been carried out within a single study. We studied the effect of left dorsolateral prefrontal rTMS on several different functional domains. Fourteen PD patients with treatment-resistant depression entered an open, 10-day inpatient study of 10-Hz rTMS, undergoing extensive psychiatric, neuropsychological, and motor testing from baseline to 6 weeks after treatment. Motor testing included a defined "off" state. rTMS was well tolerated. Highly significant improvement in depression scores was seen 3 days and 3-6 weeks after treatment. Improvement was also found in anxiety, movement scores (especially in the off state), and some neuropsychological measures. We found no evidence of increased risk from rTMS in this population. Further controlled trials of rTMS in PD appear worthwhile, and should include a defined "off" state. TMS may be beneficial for depressed PD patients in multiple functional domains.
    • "The key finding of this study indicates that PEMF may significantly reduce anxiety, depression, and obsessivecompulsive symptoms in patients who seek treatment for anxiety. Our findings are consistent with the results of randomized controlled TMS trials on patients with depression (O'Reardon et al, 2007) and also with the findings of both anxiolytic and antidepressant effects of TMS on depressed patients with Parkinson's Disease (Epstein, Evatt, Funk, Girard-Siqueira, Lupei, Slaughter, Athar, Green, McDonald, and Delong, 2007) and on those with panic disorder (Mantovani et al, 2007). Consistently with findings by Mosimann, Rihs, Engeler, Fisch, and Schlaepfer (2000), the PEMF has not induced any significant mood changes in our healthy volunteers. "
    [Show abstract] [Hide abstract] ABSTRACT: In a pilot study, 5 patients with severe anorexia (BMI < 17.5), 5 patients suffering from severe anxiety (Hamilton Anxiety Scale > 41), and 5 normal controls were exposed to one hour long biweekly sessions of transcranial exposure to a low frequency specific pulsed electromagnetic field (PEMF, < 1000 Hz, +/-200µT) during one month. There was a statistically significant improvement following one month of biweekly PEMF in the anxiety group: the patients' scores on Hamilton Anxiety Scale, Hamilton Depression Scale, and Yale‑Brown Obsessive Compulsive Scale significantly decreased (p<.05, 1-tailed). These trends were also in the expected direction in the group of anorexia patients, however, without reaching statistical significance, perhaps due to small sample size and to the short duration of PEMF.
    Full-text · Article · Jan 2015 · Journal of the neurological sciences
    • "Nevertheless , the ability to directly translate these positive findings to dementia patient groups might be limited, as the investigators in these studies did not knowingly include, or report findings on, PD patients with cognitive impairment . As was the case in studies conducted in other populations , an obvious limitation is the open-label nature of several studies [51,52,56]. In all cases, adequately powered, placebo-controlled studies are necessary to confirm these promising results. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Two methods of non-invasive brain stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have demonstrable positive effects on cognition and can ameliorate neuropsychiatric symptoms such as depression. Less is known about the efficacy of these approaches in common neurodegenerative diseases. In this review, we evaluate the effects of TMS and tDCS upon cognitive and neuropsychiatric symptoms in the major dementias, including Alzheimer’s disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), Parkinson’s disease with dementia (PDD), and frontotemporal dementia (FTD), as well as the potential pre-dementia states of Mild Cognitive Impairment (MCI) and Parkinson’s disease (PD). Methods: PubMed (until 7 February 2014) and PsycINFO (from 1967 to January Week 3 2014) databases were searched in a semi-systematic manner in order to identify relevant treatment studies. A total of 762 studies were identified and 32 studies (18 in the dementias and 14 in PD populations) were included. Results: No studies were identified in patients with PDD, FTD or VaD. Of the dementias, 13 studies were conducted in patients with AD, one in DLB, and four in MCI. A total of 16 of the 18 studies showed improvements in at least one cognitive or neuropsychiatric outcome measure. Cognitive or neuropsychiatric improvements were observed in 12 of the 14 studies conducted in patients with PD. Conclusions: Both TMS and tDCS may have potential as interventions for the treatment of symptoms associated with dementia and PD. These results are promising; however, available data were limited, particularly within VaD, PDD and FTD, and major challenges exist in order to maximise the efficacy and clinical utility of both techniques. In particular, stimulation parameters vary considerably between studies and are likely to subsequently impact upon treatment efficacy.
    Full-text · Article · Oct 2014
    • "frequency rTMS improves more than low frequency or sham in MMSE,GDS,IADL Cotelli et al. (2011) [38] "
    [Show abstract] [Hide abstract] ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) represents a promising tool for studying and influencing cognition in people with neurodegenerative diseases. This procedure is noninvasive and painless, and it does not require the use of anesthesia or pharmacological substances. In this systematic critical review we report outcomes from research focused on behavioral cognitive effects induced by rTMS in patients with Alzheimer's disease (AD), Parkinson's disease (PD), and mild cognitive impairment (MCI) preceding AD. There are still major limitations to rTMS use, such as a poor understanding of its after-effects and inter-individual variability in their magnitude, discrepancies in stimulation protocols and study designs, varied selection of the specific stimulated areas and control procedures, and neuropsychological methods for assessment of after-effects; hence, the results of the present research can only be considered preliminary. The future directions are discussed.
    Full-text · Article · Feb 2014
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