Neurocognitive effects of repetitive transcranial magnetic stimulation in severe
Martis B, Alam D, Dowd SM, Hill SK, Sharma RP, Rosen C, Pliskin N, Martin E, Carson V, Janicak PG.
Clin Neurophysiol. 2003 Jun;114(6):1125-32

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is being
investigated as a potential treatment for depression. Few studies have addressed
the neurocognitive effects of a course of rTMS in severely depressed patients.
We evaluated neurocognitive effects of a 1-4 week course (mean 3 weeks) of rTMS
using an aggressive set of parameters, in 15 severely depressed subjects.
METHODS: A battery of neurocognitive tests relevant to attention, working
memory-executive function, objective memory and motor speed were administered to
15 subjects with treatment-resistant major depression (unipolar and bipolar),
before and after a course of rTMS. Mean z scores were computed for each of 4
cognitive domains and analyzed using repeated measures multivariate analysis of
covariance. Significant interactions were further clarified using univariate
analysis of variance. RESULTS: There was no worsening of performance on any of
the cognitive domains over the baseline-post rTMS period. On the contrary,
evidence of modest but statistically significant improvement in performance was
noted in working memory-executive function, objective memory and fine motor
speed domains over the rTMS treatment period. CONCLUSIONS: There was no evidence
of adverse neurocognitive changes over the baseline-post rTMS period in 15
treatment-resistant depressed subjects undergoing a 3 week (mean) trial of rTMS.
Significant improvements in several domains observed over the rTMS treatment
period could not be explained by improved mood. Practice effects as well as
other factors potentially contributing to these findings are discussed.
SIGNIFICANCE: rTMS is being increasingly studied as a neurophysiological probe
as well as for its potential antidepressive effects. The effects on neuronal
function raise appropriate questions of safety of its use at varying stimulus
parameters and durations. This study contributes to the small body of evidence
of the cognitive effects of rTMS in severely depressed patients.




em Psiquiatría