The use of slow-frequency prefrontal repetitive transcranial magnetic stimulation in refractory XXXX .

@entity308 @entity1118 @entity9 @entity158
OBJECTIVE: A number of antidepressant medications, as well as electroconvulsive therapy, have been shown to reduce @entity1118 . Slow-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the right dorsolateral prefrontal cortex has also been shown to have an antidepressant effect. Given the high degree of suffering experienced by subjects with chronic @entity9 and the treatment resistance noted in this population, the use of slow-frequency rTMS as adjuvant therapy may be of significant clinical benefit. METHODS: Fifteen sessions of 1-Hz rTMS (1600 stimulations/session) were applied to the right dorsolateral prefrontal cortex as adjuvant treatment in 9 subjects with refractory @entity9 over 3 weeks. @entity158 and @entity308 ratings were performed at baseline, weekly during rTMS treatment, and monthly for up to 3 months after treatment. RESULTS: Five males and 4 females participated, and all had longstanding refractory @entity9 (range, 1-19 years), with an average baseline @entity158 rating of 7.3 and no @entity308 (Hamilton Rating Scale for @entity308 average, 3.6; range, 0-8). Three subjects had a greater than 50% decline in @entity158 ratings by the completion of rTMS treatments, and 1 subject responded more slowly with greater than 50% improvement in @entity158 by the end of the 3-month follow-up. An improvement in @entity158 ratings was noted in responders within the first week. CONCLUSIONS: Although these are preliminary findings in an open treatment trial, the subjects in this trial are among the least likely to have a placebo response. Given that rTMS is a well-tolerated and noninvasive intervention, any sustained improvement in @entity9 with rTMS is encouraging.
