The Therapy Effect And Its Mechanism Of SEM-rTMS In Patients With Depression

Objective:By studying the clinical manifestations,neuro-electrophysiology,as well as neuroendocrine,we explored the sleeping EEG modulated repetitive transcranial magnetic stimulation(SEM-rTMS) on the efficacy in patients with depression and its mechanism.It includes:1,Curative effect and safety of SEM-rTMS.2,Effect of SEM-rTMS on the EEG in patients with depression.3,Effect of SEM-rTMS in patients with depression on the hypothalamus-pituitary-adrenal(HPA) axis.Methods:Following double-blind crossover trial(3×3) program,164 cases diagnosed with depression were randomly divided into 6 groups,each given by a specific sequence of SEM-rTMS(A treatment), (B treatment) and sham rTMS(C therapy) treatments.Before the trial and at the termination of every treatment,patients' Hamilton Depression Rating Scale(HAMD) score,the average total power of brain regions,(δ+θ)/(α+β) ratio of the EEG/brain topographic map(EEG/ BEAM)and serum cortisol(COR) and adrenocorticotropic hormone(ACTH) levels were detected. The 6 groups' average age,gender,disease duration and target detection,before the trial,had no significant difference(P＞0.05).Results:1.Total 164 cases included in the test group,exited 44 cases(26.8%),120 cases(73.2%) compelted the trial.The number of exit,accepted sleep EEG rTMS,conventional rTMS and sham rTMS 3 treatments,had no statistical significance(P＞0.05).2.Before treatment,HAMD points in each group had no significant(P＞0.05).After the 3-phase-therapy,the test results,after statistical analysis,P＜0.001.3.Before treatment,the average total power of the every brain regions and the(δ+θ)/(α+β) ratio had no statistical significance(P＞0.05).After treatment,P＜0.05.After the first phase of the treatment,the HADM points of the subjects who had treated by SEM-rTMS(groupⅢandⅥ) was negatively correlated with the average total power of the every brain regions(both P＜0.05),positively correlatwith the(δ+θ)/(α+β) ratio(both P＜0.05).4.Tested by q test,before treatment,the serum COR and ACTH concentrations in the 6 groups had no statistical significance(P＞0.05).HADM points was positively correlated with the serum COR and ACTH concentrations before therapy(both P＜0.05),and after the first treatment,the HADM points of the subjects who had treated by SEM-rTMS(groupⅢandⅥ) was positively correlated with serum COR and ACTH concentrations(both P＜0.05).5.In the course of treatment,a total of 18 views of side effects,the total test cases achieve 7.5%. Of these,3 cases of dizziness,4 cases of headache,1 case of convulsions,two cases of scalp numbness,5 cases of insomnia,3 cases of other side effects(some patients have overlapping symptoms),found no documented cases of seizures.The above side effects disappeared by reducing the therapeutic dose,or ceased treatment for one day.Only 1 patient with insomnia could not bear and quited.Among them,the sleep EEG rTMS got 6 cases,conventional rTMS got 5 cases,sham rTMS 7 got cases.The 6 groups had no significant difference(P＞0.50).Conclusion:1.SEM-rTMS and Conventional rTMS had significantly efficacy on depression.And the latter surpass the former.2.SEM-rTMS and Conventional rTMS both increased the average total areas of the brain power and lowed(δ+θ)/(α+β) ratio and serum levels of CORT and ACTH,which may be a mechanism of antidepressant rTMS.3.rTMS of therapy doses was safe.However,the conclusions of this study are only preliminary findings bacause of the limited sample size.The effect of SEM-rTMS still a long time to do large sample studies should be done to discover the profound mechanism.