Clinical Curative Effect And The FMRI Evaluation Of Repetitive Transcranial Magnetic Stimulation Treatment On Esophageal Cancer Patients With Depression

Objective: To investigate the clinical therapeutic effect of repetitive transcranial magnetic stimulation(rTMS)on esophageal cancer patients and observe the neuroimaging alteration by using functional magnetic resonance imaging(fMRI)method and compare the curative effect of single r TMS treatment and multiple rTMS treatment and study the rehabilitation treatment mechanism.Methods: Twenty two identified esophageal cancer inpatients with depression from November 2015 to December 2016 in Nanchong Central Hospital were recruited to this study and divided into two groups: 12 patients in the single rTMS treatment group(s-rTMS group)and the other 10 patients in the multiple rTMS treatment group(m-rTMS group).The patients in s-rTMS group received one session of high-frequency rTMS(10Hz,110% of resting motor threshold)treatment over the left dorsolateral prefrontal cortex;the m-rTMS group received a 5-day-session rTMS treatment with the same parameters.The Hamilton Depression Scale(HAMD),Self-Rating Depression Scale(SDS)and the fMRI images of each patients in the two groups were collected respectively at the baseline and after the final treatment.After the final treatment,the HAMD,SDS and the amplitude of low frequency fluctuation(ALFF)in two experimental groups were compared with the baseline respectively and between these two groups.Besides,the correlation between the changes of HAMD,SDS scores and the alteration of ALFF was also calculated.Results:(1)No significant differences of the clinical information,baseline HAMD and SDS scores were observed between the s-rTMS and m-rTMS groups(P>0.05).Compared to the baseline,there were significant differences in HAMD and SDS of s-rTMS group and m-rTMS group respectively after the treatment.The inter-group differences of HAMD and SDS scores were also found between two experimental groups.(2)At the baseline,there were no statistical differences(P>0.05)between two groups in ALFF score.The s-rTMS group and m-rTMS group gained statistical differences(P<0.05,)in ALFF between baseline and after the treatment: the ALFF significantly increased in the bilateral frontal lobes,the bilateral anterior cingulate,the right hippocampus,and the right thalamus in srTMS group,and significantly decreased in the left thalamus in s-rTMS group;the ALFF significantly increased in the bilateral frontal lobe,the bilateral anterior cingulate,the right hippocampus,and the right pallidum,and significantly decreased in the bilateral putamen and thalamus in m-rTMS group.Besides,after treatment,the m-rTMS group also revealed more significant improved ALFF in the bilateral middle frontal gyrus,the bilateral anterior cingulate,and the head of the right caudate nucleus than the s-rTMS group.(3)A significantly negative correlation between the HAMD scores changes and the ALFF changes in the anterior cingulate were observed after s-rTMS treatment(R=-0.7,P=0.011),which was also observed in the m-rTMS group(R=-0.84,P=0.0023).In addition,the significant negative correlation was found between the HAMD scores changes and the ALFF changes in the hippocampus(R=-0.87,P=0.001).Conclusion: High frequency rTMS could improve the curative effect on esophageal cancer patients with depression,and the clinical effect of m-rTMS were better than s-rTMS,it may be associated with the influence on neural physiological activities in the related brain areas of rTMS.ALFF is a new research method of brain functional imaging and could be regarded as one of the imaging indicator reflecting the effect of rTMS on the treatment of patients with depression.