Unilateral low frequency versus sequential bilateral repetitive transcranial magnetic stimulation: is simpler better for treatment of resistant depression?

Pallanti, Stefano; Bernardi, Silvia; Rollo, A. Di; Antonini, Sarah; Quercioli, Leonardo

doi:10.1016/j.neuroscience.2010.01.063

Cited by 82 publications

(63 citation statements)

References 24 publications

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“…20 Other sham-controlled RCTs have failed to demonstrate a superior efficacy of bilateral rTMS. 21,22 In a meta-analysis, bilateral rTMS and unilateral rTMS (LFR or HFL) were found to have comparable efficacy. 23 Thus, the question remains as to whether sequential bilateral rTMS is a superior treatment approach for depressed patients.…”

Section: J Psychiatry Neurosci 2016;41(4)mentioning

confidence: 99%

Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Blumberger

Maller

Thomson

et al. 2016

jpn

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Section: J Psychiatry Neurosci 2016;41(4)mentioning

confidence: 99%

Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Blumberger

Maller

Thomson

et al. 2016

jpn

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“…Also, we retrieved four RCTs on LF-rTMS for MD from MEDLINE, PsycINFO, EMBASE, CENTRAL, SCOPUS, and PQDT. Of these, only two RCTs met the eligibility criteria (Aguirre et al, 2011;Pallanti et al, 2010), as the remaining only applied LF-rTMS over the left DLPFC (Speer et al, 2009;Speer et al, 2000). Please refer to the Supplementary Material for a detailed description of the study selection procedure.…”

Section: Literature Searchmentioning

confidence: 99%

“…However, questions remain as to whether this neuromodulation technique has clinically relevant effects in MD as RCTs to date have produced conflicting results. For example, Hoppner et al (2003) and Kauffmann et al (2004) showed that LF-rTMS was not superior to sham rTMS, whereas Stern et al (2007) and Pallanti et al (2010) found that LF-rTMS was associated with significantly higher rates of clinical improvement when compared with sham rTMS. A likely reason for these discrepant findings might be the lack of statistical power among some of the individual RCTs (Maxwell et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials

Berlim

Eynde

Daskalakis

2012

Neuropsychopharmacol

245

141

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Clinical trials on low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the right dorsolateral prefrontal cortex have yielded conflicting evidence concerning its overall efficacy for treating major depression (MD). As this may have been the result of limited statistical power of individual trials, we have carried the present systematic review and meta-analysis to examine this issue. We searched the literature for English language randomized, double-blind and sham-controlled trials (RCTs) on LF-rTMS for treating MD from 1995 through July 2012 using EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, and ProQuest Dissertations & Theses, and from October 2008 until July 2012 using MEDLINE. The main outcome measures were response and remission rates as well as overall dropout rates at study end. We used a random-effects model, odds ratios (ORs) and number needed to treat (NNT). Data were obtained from eight RCTs, totaling 263 subjects with MD. After an average of 12.6±3.9 rTMS sessions, 38.2% (50/131) and 15.1% (20/132) of subjects receiving active LF-rTMS and sham rTMS were classified as responders (OR ¼ 3.35; 95% CI ¼ 1.4-8.02; p ¼ 0.007). Also, 34.6% (35/101) and 9.7% (10/103) of subjects receiving active LF-rTMS and sham rTMS were classified as remitters (OR ¼ 4.76; 95% CI ¼ 2.13-10.64; po0.0001). The associated NNT for both response and remission rates was 5. Sensitivity analyses have shown that protocols delivering 41200 magnetic pulses in total as well as those offering rTMS as a monotherapy for MD were associated with higher rates of response to treatment. No differences on mean baseline depression scores and dropout rates for active and sham rTMS groups were found. Finally, the risk of publication bias was low. In conclusion, LF-rTMS is a promising treatment for MD, as it provides clinically meaningful benefits that are comparable to those of standard antidepressants and high-frequency rTMS. Furthermore, LF-rTMS seems to be an acceptable intervention for depressed subjects.

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“…The method of stimulation named ‘sequential bilateral application’ includes a first low-frequency rTMS over the right DLPFC followed by a high-frequency TMS over the left DLPFC, and has been found to be effective than sham treatment in depressed patients [5]. However, a hypothesized additive effect of the sequential bilateral protocol has not been demonstrated [6], and a recent investigation suggested that this rTMS application has a lower efficacy compared to the low-frequency rTMS over the right DLPFC method [7]. Unilateral low-frequency right stimulation has received great attention because of its safety profile, better than the high-frequency approved protocol in order to a much lower risk of inducing an accidental seizure [1].…”

Section: Introductionmentioning

confidence: 99%

Low-Frequency rTMS over Right Dorsolateral Prefrontal Cortex in the Treatment of Resistant Depression: Cognitive Improvement Is Independent from Clinical Response, Resting Motor Threshold Is Related to Clinical Response

et al. 2012

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Background: Clinical studies have shown that repetitive transcranial magnetic stimulation (rTMS) is effective in a certain percentage of treatment-resistant depression (TRD). The left dorsolateral prefrontal cortex (DLPFC) 10 Hz rTMS stimulation received FDA approval in 2008, although different rTMS protocols have also shown their effectiveness in reducing depressive symptoms. We investigated the clinical, cognitive and neurophysiologic effects of a 3 weeks’ protocol of low-frequency rTMS applied over the right DLPFC in resistant depression. Methods: Twenty-eight patients with TRD (age range 28–55) received low-frequency rTMS (1 Hz) over the right DLPFC in a 3-week open trial. Hamilton scales for depression and anxiety, Corsi block-tapping test, phonemic verbal fluency, right and left resting motor thresholds were evaluated in each subject over the trial period. Results: At the end of the trial 42.9% of the subjects were considered as responders. A significant reduction of both HAMD (p < 0.001) and HAMA (p < 0.01) total scores was observed. At the 3rd week, the performances in Corsi test (p < 0.02) and phonemic verbal fluency (p = 0.065) were improved independently from depressive symptoms variation. At the end of the rTMS protocol, a significantly decreased left hemisphere resting motor threshold was registered (p < 0.01), while right hemisphere resting motor threshold did not show significant variation. Conclusion: Low-frequency rTMS over the right DLPFC appeared effective in 42.9% of depressive resistant subjects in this sample. A significant decrease in left hemisphere resting motor threshold was observed only in responders, while a trend for improvement in cognitive function has been found and appeared independent from clinical response.

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Unilateral low frequency versus sequential bilateral repetitive transcranial magnetic stimulation: is simpler better for treatment of resistant depression?

Cited by 82 publications

References 24 publications

Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials

Low-Frequency rTMS over Right Dorsolateral Prefrontal Cortex in the Treatment of Resistant Depression: Cognitive Improvement Is Independent from Clinical Response, Resting Motor Threshold Is Related to Clinical Response

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