| Objective: To assess the therapeutic effect and cognitive influence ofrepetitive transcranial magnetic stimulation(rTMS) in treatment of bipolardepressive disorder．Methods: Comparative study method was adopted for four weeks.71patients of bipolar depressive disorder and30normal controls were involvedin the study.The patients were randomly assigned to lamotrigine treatment incombination with rTMS (study group) or sham procedure (control group) onleft dorsal-lateral prefrontal cortex (10Hz，90%motor threshold, A singlestimulation session consisted of50trains of50stimuli, with each trainseparated from the subsequent by half of minute pause, and a total of2500stimuli per session). All patients were stimulated with an eight-figured coil fora total of10days (Monday to Friday, every week, for two weeks).The clinicalefficacy was evaluated with the Hamilton Depression Scale-17items and theClinical Global Impression-Severity of Illness (CGI-SI). Side effects weredone with the Treatment Emergent Symptom Scale(TESS).The total numbersof responders (HAM-D total score reduction≥50%with respect to baseline),no responders (HAMD total score reduction <50%with respect to baseline),and remitters (HAM-D total score at endpoint≤7) were computed. TheWisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT)and the digit span test（DST） were used to assess cognitive function of thepatients and normal controls at the baseline and endpoint. All the statistical analyses were performed using SPSS17.0software forWindows. For all the statistical analyses, the alpha level of significance wasset at0.05, and was not adjusted.Results:1. Thirty-six patients were randomly assigned to the study group, and35patients were assigned to the control group. The HAMD，CGI-SI total scoresshowed a statistically significant time effect for all the outcome measures(P＜0.01),and the study group showed lower scores compared to the control groupafter4weeks (P＜0.01)．The two patient groups were matched for genderratio, age, level of education， family history and other general information(P>0.05).2. The response rate was significantly greater in the study groupcompared to the control group after treatment (63.89%vs25.71%,P＜0.01).3. No serious event occurred in the patients during the rTMS study．Nomanic/hypomanic activation and epileptic seizure were detected during thetreatment.4. Twenty-six patients in the study group,22patients in the controlgroup, and30normal controls completed the Neuro-psychological tests. Allthree groups were matched for sex, age, level of education and other generalinformation (P>0.05).5. Neuropsychological assessments showed that there was significantdifference between the patient groups compared to the normal control groupat the baseline(P＜0.01). Intercomparison of three groups showed that therewas not significant difference between the two patient groups (P＞0.05).After4weeks, the neuropsychological assessments except the correct trials ofthe two patient groups were still worse than normal controls, the differencewas a statistically significance(P＜0.01).The improvement of the cognitive function in the study was superior than that in the control group，neverthelessthe numbers of perseverative errors,categories,CPT and the score of digitspan-forward were worse than those in the normal control(P＜0.05).Theoutcomes of neuropsychological tests in the control group were significantlyworse than those in the normal control group except for the significantimprovement in the correct trials on WCST(P＜0.01).6. Age, the course of disease, the severity of depressive symptoms werecorrelated with the cognitive dysfunction of the patients. There was nocorrelation between the cognitive dysfunction and sex, education of thepatients.7. The correlation between cognitive impairments and the severity ofdepressive symptoms was not simple parallel relationship. The improvementof the cognitive function was negatively correlated with decrease rate ofHAMD. The results of neuropsychological tests suggested that some type ofcognitive impairments of bipolar disorder might be trait markers, such asexecutive function, sustained attention, instantaneous memory; they hadnothing to do with the clinical status. But some types may be state andillness-related, such as attention conversion ability, the impairment could berestored normal levels when the clinical symptoms were improved.Conclusions：1. Augmentative rTMS was effective and well tolerated in bipolardepressive patients. It suggests that rTMS can be used as a good choice in thetreatment of bipolar depressive disorder.2. Patients with bipolar depressive disorder existed cognitiveimpairment, such as frontal executive function, attention and memory ability,et al. Age,the course of disease, the severity of depressive symptoms werecorrelated with the cognitive dysfunction of the patients. There was no correlation between the cognitive dysfunction and sex, education of thepatients. The correlation between cognitive impairments and the severity ofdepressive symptoms was not simple parallel relationship.3. RTMS could enhance early effects and improve the cognitive functionof the bipolar depressive disorder patients．The improvement of the cognitivefunction was negatively correlated with decrease rate of HAMD. |
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