Quantitative EEG-Befunde im Rahmen einer repetitiven transkraniellen Magnetstimulation bei Depressionen

Zusammenfassung

Quantitative EEG Untersuchungen bei Depressionen weisen auf Asymmetrien der frontalen Alpha power hin, was mit frontalen Dysfunktionen in Zusammenhang gebracht wird. Die repetitive transkranielle Magnetstimulation (rTMS) wird basierend auf Ergebnissen klinischer Studien als wirksame antidepressive Behandlungsmethode bewertet. Frequenzabhängig ist die rTMS in der Lage, kortikale Funktionen inhibitorisch oder fazilitatorisch zu beeinflussen. Da das EEG direkte Aussagen über TMS evozierte Veränderungen neuronaler Aktivität in hoher zeitlicher Auflösung erlaubt, erfolgten in den letzten Jahren kombinierte TMSEEG-Studien. Postuliert werden könnte, dass eine hochfrequente rTMS über dem frontalen Kortex Veränderungen der frontalen Alpha power bei depressiven Patienten bewirkt. Hierzu stellen wir unsere vorläufigen Untersuchungsergebnisse zum qEEG prä und post sowie im Verlauf einer 10-Hzr-TMS-Behandlungsserie über dem linken dorsolateralen präfrontalen Kortex verglichen mit einer Scheinbehandlung vor. Weder im prä-post-Vergleich noch im Verlauf wurde eine Änderung der absoluten power aller Frequenzbänder gefunden. Die Ergebnisse werden in Bezug zu Ergebnissen aus der Literatur diskutiert.

Summary

Quantitative EEG investigations in depressive disorders show evidence of asymmetries in frontal alpha power, which is hypothesized to be related to frontal dysfunctions. Based on results from clinical studies, repetitive transcranial magnetic stimulation (rTMS) is evaluated as an effective antidepressant treatment. rTMS is able to influence cortical functions either inhibitorically or facilitatorically, dependent on its frequency. Since the EEG allows direct statements on TMS evoked changes of neuronal activity of high temporal resolution, combined TMS-EEG-studies performed in the last years. It could be postulated thata high frequency rTMS over the frontal cortex causes changes of the frontal alpha power in depressive patients. Herein, we discuss our preliminary data of qEEG investigations pre and post and in course of a 10-Hz-rTMS-treatment series over the left dorsolateral prefrontal cortex compared with sham stimulation. We could neither find any differences in pre nor in post EEGs regarding absolute power of all frequency bands. Results will be compared with literature.

Schlüsselwörter

Repetitive transkranielle Magnetstimulation - quantitative EEG Analysen - Depression

Keywords

Repetitive transcranial magnetic stimulation - quantitative EEG analyzing - depression

• Literatur

• 1 Fox NA. If it’s not left, it’s right. Electroencephalograph asymmetry and the development of emotion. Am Psychol 1991; 46: 863-72.
• 2 Harmon-Jones E, Allen JJ. Anger and frontal brain activity: EEG asymmetry consistent with approach motivation despite negative affective valence. J Pers Soc Psychol 1998; 74: 1310-6.
• 3 Baxter LR, Schwartz JM, Phelps ME. et al. Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry 1989; 46: 243-50.
• 4 Bench CJ, Friston KJ, Brown RG, Frackowiak RS, Dolan RJ. Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychol Med 1993; 23: 579-90.
• 5 Davidson RJ, Chapman JP, Chapman LJ. Task-dependent EEG asymmetry discriminates between depressed and non-depressed subjects. Psychophysiol 1987; 24: 585.
• 6 Henriques JB, Davisdon RJ. Left frontal hypoactivation in depression. J Abnorm Psychol 1990; 100: 22-31.
• 7 Gerez M, Tello A. Selected quantitative EEG (QEEG) and event-related potential (ERP) variables as discriminators for positive and negative schizophrenia. Biol Psychiatry 1995; 38: 34-49.
• 8 Begic D, Hotujac L, Jokic-Begic N. Quantitative EEG in ‘positive’ and ‘negative’ schizophrenia. Acta Psychiatr Scand 2000; 101: 307-11.
• 9 Knott V, Labelle A, Jones B, Mahoney C. Quantitative EEG in schizophrenia and in response to acute and chronic clozapine treatment. Schizophr Res 2001; 50: 41-53.
• 10 Sponheim SR, Clementz BA, Iacono WG, Beiser M. Clinical and biological concomitants of resting state EEG power abnormalities in schizophrenia. Biol Psychiatry 2000; 48: 1088-97.
• 11 Merrin EL, Floyd TC. Negative symptoms and EEG alpha in schizophrenia: a replication. Schizophr Res 1996; 19: 151-61.
• 12 Cook IA, Leuchter AF, Morgan M. et al. Early changes in prefrontal activity characterize clinical responders to antidepressants. Neuropsychopharmacology 2002; 27: 120-31.
• 13 Saletu B, Kufferle B, Grunberger J, Foldes P, Topitz A, Anderer P. Clinical, EEG mapping and psychometric studies in negative schizophrenia: comparative trials with amisulpride and fluphenazine. Neuropsychobiology 1994; 29: 125-35.
• 14 Pascual-Leone A, Tormos JM, Keenan J, Tarazona F, Canete C, Catala MD. Study and modulation of human cortical excitability with transcranial magnetic stimulation. J Clin Neurophysiol 1998; 15: 333-43.
• 15 Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry 2003; 160: 835-45.
• 16 Martin JL, Barbanoj MJ, Schlaepfer TE, Thompson E, Perez V, Kulisevsky J. Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis. Br J Psychiatry 2003; 182: 480-91.
• 17 George MS, Stallings LA, Speer AM. et al. Prefrontal repetitive transcranial magnetic stimulation (rTMS) changes relative perfusion locally and remotely. Hum. Psychopharmacol 1999; 14: 161-70.
• 18 Nahas Z, Lomarev M, Roberts DR. et al. Unilateral left prefrontal transcranial magnetic stimulation (TMS) produces intensity-dependent bilateral effects as measured by interleaved BOLD fMRI. Biol Psychiatry 2001; 50: 712-20.
• 19 Siebner HR, Peller M, Willoch F. et al. Lasting cortical activation after repetitive TMS of the motor cortex: a glucose metabolic study. Neurology 2000; 54: 956-63.
• 20 Speer AM, Kimbrell TA, Wassermann EM. et al. Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry 2000; 48: 1133-41.
• 21 Boutros NN, Berman RM, Hoffman R, Miano AP, Campbell D, Ilmoniemi R. Electroencephalogram and repetitive transcranial magnetic stimulation. Depress Anxiety 2000; 12: 166-9.
• 22 Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroencephalogr Clin Neurophysiol 1998; 108: 1-16.
• 23 Loo C, Sachdev P, Elsayed H, McDarmont B. et al. Effects of a 2– to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychologic functioning, electroencephalogram, and auditory threshold in depressed patients. Biol Psychiatry 2001; 49: 615-23.
• 24 Jennum P, Winkel H. Transcranial magnetic stimulation. Its role in the evaluation of patients with partial epilepsy. Acta Neurol Scand Suppl 1994; 152: 93-6.
• 25 Salmelin R, Hari R. Spatiotemporal characteristics of sensorimotor neuromagnetic rhythms related to thumb movement. Neuroscience 1994; 60: 537-50.
• 26 Jing H, Takigawa M. Observation of EEG coherence after repetitive transcranial magnetic stimulation. Clin Neurophysiol 2000; 111: 1620-31.
• 27 Strens LH, Oliviero A, Bloem BR, Gerschlager W, Rothwell JC, Brown P. The effects of subthreshold 1 Hz repetitive TMS on cortico-cortical and interhemispheric coherence. Clin Neurophysiol 2002; 113: 1279-85.
• 28 Ilmoniemi RJ, Virtanen J, Ruohonen J, Karhu J, Aronen HJ, Naatanen R. et al. Neuronal responses to magnetic stimulation reveal cortical reactivity and connectivity. Neuroreport 1997; 08: 3537-40.
• 29 Komssi S, Aronen HJ, Huttunen J, Kesaniemi M, Soinne L, Nikouline VV. et al. Ipsi- and contralateral EEG reactions to transcranial magnetic stimulation. Clin Neurophysiol 2002; 113: 175-84.
• 30 Paus T, Jech R, Thompson CJ, Comeau R, Peters T, Evans AC. Transcranial magnetic stimulation during positron emission tomography: a new method for studying connectivity of the human cerebral cortex. J Neurosci 1997; 17: 3178-84.
• 31 Paus T, Jech R, Thompson CJ, Comeau R, Peters T, Evans AC. Dose-dependent reduction of cerebral blood flow during rapid-rate transcranial magnetic stimulation of the human sensorimotor cortex. J Neurophysiol 1998; 79: 1102-7.
• 32 Jing H, Takigawa M. Nonlinear analysis of EEG after repetitive transcranial magnetic stimulation. J Clin Neurophysiol 2002; 19: 16-23.
• 33 Okamura H, Jing H, Takigawa M. EEG modification induced by repetitive transcranial magnetic stimulation. J Clin Neurophysiol 2001; 18: 318-25.
• 34 Schutter DJ, van Honk J, d’Alfonso AA, Postma A, de Haan EH. Effects of slow rTMS at the right dorsolateral prefrontal cortex on EEG asymmetry and mood. Neuroreport 2001; 12: 445-7.
• 35 Pankseep J. Affective neurosciences: the foundation of human and animal emotions. NewYork: Oxford University Press; 1998
• 36 Jandl M, Bittner R, Sack A, Weber B. et al. Changes in negative symptoms and EEG in schizophrenic patients after repetitive Transcranial Magnetic Stimulation (rTMS): an open-label pilot study. J Neural Transm 2005; 112: 955-67.
• 37 First MB, Spitzer RL, Williams JBW, Gibbon M. Structured clinical interview for DSM IV (SCID). Washington DC: American Psychiatric Press; 1995
• 38 Beck AT, Ward CH, Mendelson Mea. An inventory for measuring depression. Arch Gen Psych 1961; 04: 561-71.
• 39 Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1961; 04: 561-71.
• 40 Davidson J, Turnbull CD, Strickland R, Miller R, Graves K. The Montgomery-Asberg Depression Scale: reliability and validity. Acta Psychiatr Scand 1986; 73: 544-8.
• 41 Pascual-Leone A, Valls-Sole J, Wassermann EM, Brasil-Neto J, Cohen LG, Hallett M. Effects of focal transcranial magnetic stimulation on simple reaction time to acoustic, visual and somatosensory stimuli. Brain 1992; 115 (Pt 4): 1045-59.
• 42 Kwon JS, Youn T, Jung HY. Right hemisphere abnormalities in major depression: quantitative electroencephalographicfindings before and after treatment. J Affect Disord 1996; 40: 169-73.
• 43 Kahkonen S, Komssi S, Wilenius J, Ilmoniemi RJ. Prefrontal TMS produces smaller EEG responses than motor-cortex TMS: implications for rTMS treatment in depression. Psychopharmacology (Berl). 2005