Analysing The Influence Factors And Changes In Resting Motor Threshold After RTMS In The Treatment Of GAD

Objectives: This study aims to investigate the relationship between resting motor thershold(RMT)and the efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of generalized anxiety disorder(GAD)by analyzing the influencing factors of RMT changes after rTMS,so as to offer a reference material for the more effective therapeutic scheme of rTMS in the treatment of GAD.Methods: Clinical data of forty-nine eligible subjects with GAD were collected from the Second Affiliated Hospital of Dalian Medical University from Septemper 2020 to January2021.Low-frequency rTMS were applied over the right dorsolateral prefrontal cortex(DLPFC)of the subjects,and RMT,HAMA and HAMD were measured before and after treatment.The subjects were divided into RMT unchanged group and RMT increased group according to the changes of RMT after treatment,the HAMA and HAMD before and after treatment and the improvement rates of HAMA and HAMD between groups were compared,Spearman correlation analysis was used to study the correlation between the increase of RMT and the improvement rates of HAMA,and analyzing the relationship between the changes of RMT and cruative effect of rTMS.The general information(including age、gender、smoking history、drinking history、hypertension and diabetes)、 sleep quality [assessed by Pittsburgh sleep quality index(PSQI)]、cognitive impairment [assessed by Montreal Cognitive Assessment(Mo CA)and mini mental state examination(MMSE)]、depressive symptoms(assessed by HAMD)、anxiety severity(assessed by HAMA)、stroke history、treatment times and treatment intensity were studied by univariate analysis,and the significant factors were analyzed by logistic regression analysis.All data were analyzed by SPSS 23.0 statistical software,and P < 0.05 was considered to be statistically significant.Results: 1.Compared with the RMT、HAMA and HAMD before treatment with rTMS,the RMT were increased and the scores of HAMA and HAMD were decreased in the forty-nine subjects after treatment,the difference was statistically significant(P < 0.05).the scores of HAMA and HAMD were decreased in the RMT unchanged group and RMT increased group after treatment,the difference was statistically significant(P <0.05),the HAMA improvement rates in the RMT increased group were significantly higher than another group,the difference was statistically significant(P < 0.05).Spearman correlation analysis showed that the increase of RMT was positively correlated with the improvement rates of HAMA(r = 0.513,P < 0.01).2.Univariate analysis showed that there were no significant differences in general information(gender、age、smoking history、drinking history、hypertension、diabetes)、depression symptoms、cognitive impairment、anxiety severity and stroke history between the RMT unchanged group and the RMT increased group(P > 0.05);there were significant differences in sleep quality、treatment times and treatment intensity(P < 0.05).3.Logistic regression analysis showed that poor sleep quality(OR=6.221,p=0.028)、at least five times of treatment(OR=12.727,p=0.004)and 80% RMT intensity of treatment(OR=7.894,p=0.026)were independent influencing factors of RMT increased after treatment with rTMS(P < 0.05).Conclusions:1.The changes of RMT were found in the patients with GAD who treated with low-frequency rTMS were applied over the right DLPFC,the increase of RMT indicated that the curative effect was better,and the increase of RMT was positively correlated with the curative effect.2.There have more significant curative effect in the patients with GAD who have poor sleep quality,and enough rTMS treatment intensity(≥ 80% RMT)and frequency(> 5 times)can achieve better clinical therapeutic effect of GAD.