RESUMEN
The authors investigated the use of slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the unaffected hemisphere to decrease interhemispheric inhibition of the lesioned hemisphere and improve motor function in patients within 12 months of a stroke. Patients showed a significant decrease in simple and choice reaction time and improved performance of the Purdue Pegboard test with their affected hand after rTMS of the motor cortex in the intact hemisphere as compared with sham rTMS.
Asunto(s)
Corteza Motora/fisiología , Paresia/terapia , Accidente Cerebrovascular/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Femenino , Lateralidad Funcional/fisiología , Mano/inervación , Mano/fisiología , Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Destreza Motora/fisiología , Inhibición Neural/fisiología , Vías Nerviosas/fisiología , Vías Nerviosas/fisiopatología , Paresia/etiología , Paresia/fisiopatología , Tractos Piramidales/fisiología , Tractos Piramidales/fisiopatología , Tiempo de Reacción/fisiología , Recuperación de la Función/fisiología , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Estimulación Magnética Transcraneal/normas , Resultado del TratamientoRESUMEN
OBJECTIVE: To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation (rTMS) in treating depression in patients with Parkinson's disease. METHODS: 42 patients were enrolled into two groups: group 1, active rTMS (15 Hz rTMS for 10 days) and placebo drug treatment; group 2, sham rTMS and fluoxetine 20 mg/day. A specially designed sham coil was used for sham stimulation. The unified Parkinson's disease rating scale (UPDRS), activities of daily living (ADL), Hamilton rating scale for depression (HRSD), Beck depression inventory (BDI), and mini-mental state examination (MMSE) were assessed by a rater blinded to treatment arm. RESULTS: HRSD and BDI were improved to the same extent in both groups after two weeks of treatment (38% and 32% for group 1, 41% and 33% for group 2, respectively). At week 8 there was a tendency for worse motor UPDRS scores in group 2 (NS). ADL showed improvement at week 8 only in group 1. MMSE improved in both groups after treatment, but faster in group 1 than in group 2. There were fewer adverse effects in group 1 than in group 2. CONCLUSIONS: rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects.