The priming effect of repetitive transcranial magnetic stimulation on clinical response to electroconvulsive therapy in treatment-resistant depression: a randomized, double-blind, sham-controlled study

Abstract

Background Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD. Methods In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment. Results After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests. Conclusions rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.

Recent advances in electroconvulsive therapy in clinical practice and research

“…Buday et al found that this strategy resulted in a significantly lower seizure threshold after administering TMS over the dorsolateral prefrontal cortex (DLPFC) 30–80 minutes prior to ECT treatment 48 . Similarly, Rothermel et al found a significantly greater percentage improvement on the HDRS and that a lower electrical charge was needed for stimulation using this method compared to standard ECT 49 . There was no significant difference in cognitive SEs between treatment groups.…”

Advanced Temporally‐Spatially Precise Technologies for On‐Demand Neurological Disorder Intervention

“…[ 10 ] On the other side, in terms of physical neuromodulation, it could be a promising substitute or supplement for drug therapy based on the irritability of neurons and plasticity of synapses, [ 11 ] and currently, transcranial magnetic stimulation (TMS) has been relatively widely accepted in clinic for the treatments of insomnia, depressive disorder, and so on, with its merits of noninvasiveness and painlessness. [ 12 ] Unfortunately, the uneven skull attenuation, the mismatch between bulky machines and blurred scalp markers, as well as the traditional reliance on manual coil movement and parameter adaption, unsurprisingly impose restrictions on the accuracy of stimulation, making the exact therapeutic effects far from satisfaction. [ 13 ] All these challenges prompt scientists to exploit innovative technologies with improved temporal‐spatial precision for NDs, to improve curative efficacy, reduce dosage and off‐target side effects, ensure security and convenience, and alleviate the burden of medical workers.…”

Effect of priming on adjunctive repetitive transcranial magnetic stimulation in treatment of late-life depression: protocol of a prospective randomized sham-controlled study

“…Priming is one such technique, where high-frequency (usually 6 Hz) rTMS is being administered immediately before administering low-frequency rTMS, to enhance the neural response to low-frequency rTMS. [14][15][16] Till-date, there has been no guideline, recommendation, or consensus with regards to the rTMS protocol to be used in LLD. High-frequency rTMS over left DLPFC is the US FDA (United States, Food and Drug Administration) approved protocol for major depression in adults 17 and also it is the most studied protocol in LLD, but has yielded mixed results.…”