Journal: Brain Stimulation (2017)
Authors: Sisko E, Rodriguez N, Corbett-Methot S, Sutton-DeBord J, Brown J, Tendler A
Background:
Depressed patients who fail pharmacotherapy and non-invasive brain stimulation, such as TMS and ECT, have limited treatment options. Because depression affects multiple cortical and subcortical networks, multifocal deep TMS (dTMS) may have efficacy in such patients.
Methods:
A 25 year-old-woman diagnosed with bipolar II depression, GAD, panic without agoraphobia, and narcolepsy with cataplexy. She failed every class of antidepressant and concomitant mood-stabilizers including Clozapine and Lithium. Over the past 4 years, she failed bilateral ECT as well as L-DLPFC, R-DLPFC, dmPFC-ACC dTMS stimulation, and combinations of these three (including increased pulses and stimulation intensity). Finally, she was administered daily high-frequency stimulation over the bilateral PFC and insular cortices (using the H4 coil), dmPFC-ACC (using the H7 coil), and low-frequency stimulation over the right PFC (using the H7 coil). After three months, treatment frequency was titrated down to twice weekly maintenance. CGI-S, BDI, BAI, PHQ-9, PSWQ were used to assess symptom severity.
Results:
The patient’s depression and panic attacks remitted with daily administration of the three-part protocol. On twice weekly maintenance, she experiences periodic panic attacks, but her depression remains in remission for nine months.
Conclusions:
Patients with severe TRD may benefit from multifocal dTMS, but further research is needed to establish a-priori biomarkers for the type of treatment and optimal stimulation parameters.
