A Novel Accelerated TMS Protocol for Depression in Epilepsy
Abstract number :
2.47
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2232998
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Krzysztof Bujarski, MD – Dartmouth-Hitchcock Medical Center; Yinchen Song, PhD – Dartmouth-Hitchcock; Lindsay Schommer, APRN – Dartmouth-Hitchcock; Nicholas Streltzov, MS – Dartmouth-Hitchcock; Julia Knight, MD – Dartmouth-Hitchcock; Paul Holtzheimer, MD – Dartmouth-Hitchcock
This is a Late-Breaking abstract.
Rationale: Repetitive transcranial magnetic stimulation (rTMS) is a commonly used treatment for medication-refractory major depressive disorder. However, persons with epilepsy (PWE) and comorbid refractory depression have been excluded from rTMS due to the increased risk of seizures associated with the treatment. Also, standard TMS requires daily (Monday-Friday) treatments for several weeks, making it difficult for PWE to access. In this study, we aimed to investigate the safety, tolerability, and efficacy of a novel rTMS protocol (low-frequency, right hemisphere, and accelerated) hypothesized to have no increased seizure risk and improved accessibility for PWE.
Methods: We recruited adult patients with epilepsy and comorbid refractory depression not responding to prior antidepressant medication. We applied 1 Hz rTMS to the right dorsolateral prefrontal region for 15 hour-long sessions spread over three consecutive days. We measured tolerability, seizure frequency, depression severity, cognition, and quality of life before as well as one month and six months post-treatment.
Results: Twelve (12) participants with focal or generalized epilepsy and comorbid refractory depression were enrolled. All participants (100%) completed 15 sessions of rTMS over 3 consecutive days experiencing only minimal side effects of treatment (SAFTEE-SI significant for “difficulty sitting still,” p=0.05). We did not find any adverse effect of rTMS on seizure frequency (baseline average seizure frequency 2.0/month, at one month post 1.83/month, at 6 months post/2.25, p=0.89) or on any cognitive measures (all RBANS category scores with no significant change, p = 0.08 to 0.688). We found a significant effect of rTMS on depression severity (QIDS-SR; baseline: mean 17.3, SD 3.7; 1-month follow up: mean 8.8, SD 4.6, p< 0.0001; 6-month follow up: mean 9.9, SD 4.1, p=0.008). We found a significant trend for improvement in quality of life (QUALI-31 baseline mean 39.0, SD 15.9, 1-month 53.3, SD 13.6, p=0.058 but not for 6-months (p=0.152).
Cormorbidity (Somatic and Psychiatric)