Deep rTMS for Neuropsychiatric Symptoms of Huntington’sDisease: Case Report

Journal: Brain Stimulation 9:960-961 (2016)

Authors: M Davis, A Phillips, A Tendler, A Oberdeck

Background:

Huntington’s disease (HD) isan autosomal dominant, progressive, neurodegenerative disorder characterized by abnormalmovements, cognitive dysfunction, and prominent neuropsychiatric symptoms. The prevalence of psychiatric symptoms ranges from33 to 76% causing significant functionalimpairment and decreased quality of life.Emotional symptoms typically precedethe onset of motor symptoms and they are frequently treatment resistant. Suicide continues to be the leading cause of death amongindividuals with HD, and the presence of depressed mood has shownto be associated with, and predictive of suicidality.

Objective:

Toreport on the use of deep repetitive transcranial magneticstimulation (dTMS) in a 77-year-old man with late onset HD andsevere, treatment refractory depression (TRD)and generalizedanxiety disorder (GAD).

Methods:

The patient was administered dTMS using the Brainsway H1 coil over the right dorsolateral prefrontal cortex (DLPFC) at 1 Hz and 120% of themotor threshold, for 1600 pulses per session. This dTMStreatment location and dosage were chosen due to concern about increasing his profound anxiety and increased seizure risk with high frequency dTMS (>1 Hz). The Geriatric Depression Scale (GDS) was utilized as an objective scale to measure symptoms of depression throughout his dTMS treatment series, and anxiety was measured through patient self-report and family observation report.

Results:

Upon completion of 49 daily sessions of dTMS, the patient’s depression score fell 12 points from an initial value of 14/15 to 2/15. He reports feeling satisfied with life, regaining energy, increased interest in activities, and no longer feeling that his situation is hopeless, helpless, or feeling worthless. He remains in remission after eight months without maintenance treatments. Per self and family report, cognitive impairments, generalized anxiety and health anxiety improved significantly. Physical pain, headaches and stomach pain improved over the course of dTMS. Abnormal vocalizations and choreiform movements decreased, possibly from aripiprazole. Side effects from dTMS were mild including lacrimation in the right eye and scalp discomfort at the site of the treatment.

Conclusions:

H-coil rTMS over the DLPFC might be beneficial in treating the emotional symptoms associated with HD. Further investigation is warranted.

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