Search

Repetitive transcranial magnetic stimulation (rTMS) is a popular and effective treatment for drug resistant depression. However, there is considerable variability in clinical outcomes, in previous studies and between patients. Because of high requirements for the use of fMRI based neuronavigation, many practitioners of rTMS still choose to use a standard 5 cm rule for rTMS coil placement which leads to large variations in which brain regions are being stimulated. We decided to test the possibilities of a MNI based MR‑less neuronavigation system in rTMS depression treatment, by comparing the physiological effects and clinical outcomes of 3 distinct stimulation targets. Forty‑six patients (thirty‑three female, thirteen male) from the Republican Vilnius psychiatric hospital, all with drug resistant depressive disorder, participated in the study. All patients received high frequency (10 Hz) stimulation for 10 to 15 daily rTMS sessions. However, before the treatment they were randomly sorted into 3 groups according to stimulation target in MNI map: Group 1 received rTMS at point ‑40; 48; 35; Group 2 received rTMS at point ‑46; 45; 38; Group 3 received rTMS at point ‑38; 44; 26. Electroencephalography (EEG) recordings and clinical tests were obtained the day before the rTMS course and after the last session. There were some notable differences in physiological changes between the groups, with the largest EEG band spectral power increases found in Group 1 patients and the lowest in Group 2 patients. There was a significantly larger decrease of the Hamilton Depression Rating Scale (HAM-D) scores in the Group 3 (66.94%) compared to Group 1 (57.52%) and Group 2 (56.02%). This suggests it is possible to achieve higher clinical efficacy and less physiological impact on the brain when using different targets in a neuronavigated MNI based MR‑less rTMS system.

There are many classifications of affective disorders. Differences in approach to depression syndrome lead to new suggestions, comments rating, correction of mental disorders diagnostic methods. We use new, though long known concepts as subclinical, subsyndromal symptoms, mixed affective disorder. Depressive disorder is a common disease faced by doctors in various specialties. Depressive symptoms can mimic a variety of somatic diseases and sometimes take a dangerously long time to be recognized. In clinical practice we are often monitoring ambiguous evaluation of depressive psychopathology, putting priority to pragmatism. However, before initiating adequate treatment it is important for clinicians to assess psychopathological expression of depression syndrome, together with clinical characteristics and the course of disease. We have studied 124 patients, who were treated in the hospital with recurrent depressive disorder, analyzed various psychopathological features and their connection with the course of disease and prognosis.

Klausos sukelti potencialai (KSP) yra elektroencefalogramos pokyciai, kuriuos sukelia sensoriniai klausos dirgikliai. Jų registracija leidžia neinvaziniu būdu gauti neurofiziologinės informacijos apie žmogaus galvos smegenų aktyvumą, susijusį su informacijos apdorojimo procesais. Retų reiksmingų klausos dirgiklių (garso tonų) atpažinimas dažnų nereiksmingų dirgiklių eilėje sukelia KSP bangas N2 ir P300 – vadinamąjį kognityvinį kompleksą. Sių bangų parametrai – latencija ir amplitudė – atspindi laiką, reikalingą įvertinti reiksmingą dirgiklį. P300 amplitudė siejama su galvos smegenų neuroninių isteklių paskirstymu, o N2 amplitudė gali būti susijusi su reiksmingų dirgiklių atpažinimo procesais.Buvo aptikta, kad pacientų, turincių sizofrenijos spektro sutrikimų, N2 ir P300 bangų amplitudės mažesnės. Tai rodo klausos informacijos apdorojimo procesų sutrikimus sergant sizofrenija. Taciau klinikinis KSP taikymas susiduria su tam tikromis problemomis (didelis tarpasmeninis rezultatų issibarstymas), kurioms spresti nutarėme pasitelkti naujus papildomus KSP kognityvinio komplekso parametrus.Sio tyrimo tikslas buvo įvertinti naujus P300 bangos parametrus ir palyginti jų patikimumą su įprastiniais P300 bangos parametrais (amplitude ir latencija), tiriant pacientus, turincius sizofrenijos spektro sutrikimų. Buvo istirti 56 sveiki asmenys ir 22 pacientai, turintys sizofrenijos spektro sutrikimų. KSP buvo registruojami taikant atsitiktinio įvykio (angl. odd-ball) paradigmą – tarp dažnų nereiksmingų dirgiklių atsitiktine tvarka buvo pateikiami retesni reiksmingi dirgikliai, kuriuos tiriamieji turėjo suskaiciuoti. Greta įprastinių parametrų matavome siuos naujus parametrus: latencijos (LP300) ir amplitudės (AP300) santykį, atpažinimo laiką (IT), kognityvinio komplekso statumą (SCC), P300 bangos energiją, P300 bangos nusileidžianciosios dalies greitį (SDS) bei greicio parametrus A ir B. Taip pat matavome tuos pacius isskaiciuotos bangos (gaunama is atsako į nereiksmingus dirgiklius kreivės skaitmeniniu būdu atimant atsako į reiksmingus dirgiklius kreive) parametrus, žymimus sSDS, sA ir sB. Tyrimo metu paaiskėjo, kad kai kurie naujai pasiūlyti parametrai yra statistiskai patikimesni, lyginant pacientų ir kontroline grupes, negu tradiciniai parametrai (amplitudė ir latencija). Daroma isvada, kad siūlomi nauji parametrai gali būti naudingi padedant įvertinti kognityvinių funkcijų pakitimus, esant sizofrenijos spektro sutrikimams, bei atskirti jų potipius. Taip pat skaitmeniniu būdu isskaiciuotos bangos parametrai gali būti naudingesni negu užrasytos tyrimo metu.

Introduction The study of non-memory cognitive functions after ECT has been relatively neglected. Event-related potentials (ERP) are thought to reflect some cognitive processes. ERP P300 is a sensitive indicator of disturbances of attentional and working memory processes. Objectives Aim of this study was to examine the effect of course of ECT on auditory ERP P300. Methods P300 potential was recorded in 22 patients. 12 patients had schizophrenia spectrum disorders and 10 patients had various mood disorders. Mean age of patients was 40±13 years (from 22 to 72 years). ERPs were recorded before the first ECT procedure and after the last ECT. Recordings were made at Fz, Cz and Pz electrode sites. Peak-to-peak (N2-P3) amplitude and latency of P300 wave were analyzed. Correlation between P300 parameters, clinical symptoms (measured using PANSS, MADRS, HAM-D scales) and parameters of ECT procedure - delivered energy, seizure energy index (SEI) and duration of seizure - was evaluated. Results After ECT clinical symptoms have improved. There was also a statistically significant increase in P300 amplitude. Increase was greater in the 20-39 years old patient group. Decrease in P300 latency was insignificant. Correlation between P300 latency and SEI, and between P300 amplitude and delivered energy was more reliable in the mood disorders group. According to HAM-D the improvement of depression symptoms correlates with the decreased latency and increased amplitude of the P300 potential. Conclusions ECT may improve information processing in patients with treatment-resistant schizophrenia spectrum disorders and mood disorders as assessed by event-related potential P300.