Transcranial Magnetic Stimulation for Treatment of Depression in Parkinson's Disease
Charles Epstein, M.D.
Rehab R&D Merit Review #F2131-R (2000 - 2002)

The major aim of this study is to carry out a double-blind crossover trial of prefrontal transcranial magnetic brain stimulation (TMS) in patients with Parkinson’s disease (PD) and severe depression. Depression complicates PD in up to 50% of cases, leading to further deterioration of motor performance and quality of life. Antidepressant medication fails or produces intolerable side effects in 25-30% of patients. In these patients, the main alternative treatment for depression is electro convulsive therapy (ECT). Case reports and uncontrolled trials suggest that ECT is effective in ameliorating simultaneously the mood and motor symptoms of PD, but ECT is a complex procedure with cognitive, cardiac, and anesthetic risks. TMS is a new, promising, alternative treatment for refractory depression, which appears to be easier and safer than ECT. Requiring no hospitalization, anesthesia, or recovery time, TMS is now being investigated as an alternative therapy for mood disorders. TMS has not been studied in depressed patients with PD or in patients with other serious central nervous system diseases. This study extends our past and present research in PD, depression, ECT, and TMS. We will comprehensively evaluate the effects of left prefrontal TMS on mood, motor, and neuropsychological function, together with quality of life indices in depressed PD patients. The key issues addressed by these studies include (1) the potential benefit of TMS on mood and movement in depressed PD patients, and (2) the tightness of the association between mood and motor function after TMS. Overall, these studies will provide important new information on the relationships among mood, cognitive and motor function in PD, and their influence on quality of life for these patients. The results will help in directing future applications of TMS as an alternative therapy for brain disorders, and will further elucidate the relative benefits of TMS in depressed PD patients.

Esquema 5


Brain Stimulation for Parkinson's

Aug. 23, 2001 (Ivanhoe Newswire) — Deep brain surgical stimulation is known to help improve motor function in patients with Parkinson's disease. New research finds the stimulation may cause some neuropsychological problems, but maybe not enough to worry about.

Researchers from Spain studied 15 patients 3 months before they underwent deep brain stimulation and 3 months after. The patients underwent a battery of tests including tests measuring memory and other psychological and physical functions.

Researchers found all of the patients improved their motor functions. However, when looking at neuropsychological effects, some patients experienced memory loss. But researchers also report some patients experienced improvement in obsessive-compulsive traits.

Researchers say their study supports the fact that deep brain surgical stimulation does not cause serious neuropsychological deterioration. However, they say the small decline in memory could have implications in patients who have this problem before the surgery. They add further research is needed to find a way to get the most benefit from the stimulation and minimal neuropsychological side effects.

SOURCE: Archives of Neurology, 2001;58:1223-1227: Neuroreport 1996 Sep 2;7(13):2068-70


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