Clinical Application And DTI Evaluation Of Repetitive Transcranial Magnetic Stimulation Treatment On Esophageal Cancer Patients With Depression

Objective: To investigate the clinical effect of repetitive transcranial magnetic stimulation(rTMS)in patients with esophageal cancer-related depression,and to evaluate the changes of imaging by using diffusion tensor imaging(DTI).Method: All identified patients were recruited from Department of Oncology and Cardiothoracic Surgery,Nanchong Central Hospital who were hospitalized between November 2015 and December 2016.All the patients were randomized into two groups: m-rTMS group(Multiple-session rTMS)and s-rTMS group(Single-session rTMS).The patients of the m-rTMS group underwent a 5-day-session treatment of rTMS,the s-rTMS group underwent a single-session with the same parameters.All the patients of the two groups underwent the tests of Hamilton Depression Scale(HAMD),Self-rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS)both at baseline and after the last rTMS treatment,and the results were compared with each other inter-and intra-groups.In addition,the DTI examination was conducted in both groups at baseline and immediately after the last rTMS session respectively.And the fractional anisotropy(FA)of the depression-related brain regions were calculated to determine whether there was a significant change.Results: There were 22 patients included in this trial finally.Ten were in the m-rTMS group(6 male and 4 female),and 12 were in the s-rTMS group(6 male and 4 female).No significant difference were found between the two groups of all the clinical scales at baseline.(1)Compared with the baseline,both groups gained significant reduction in HAMD scores(m-rTMS group: P=0.000 and s-rTMS group: P=0.000),SAS scores(m-rTMS group: P=0.000 and s-rTMS group: P=0.001),SDS scores(m-rTMS group: P=0.001 and s-rTMS group: P=0.000).What's more,there were significant difference inter-groups of all the three scores(P=0.001/0.004/0.003).(2)After treatment,the values of FA increased significantly in both groups in the follow brain regions: both sides of hippocampus,thalamus and cingulate;left striatum;right frontal lobe;left superior temporal gyrus and meddle temporal gyrus(P<0.05).Conclusion: High-frequency rTMS could improve the symptoms of depression maybe via the potential compensatory regeneration of nerve fibers which were reflected by increasing FA value of the white matter.DTI as a new method studying white matter morphological structure,could reflect the change of brain area of the depression from the microstructure level.