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Master Thesis

La stimulation magnétique transcrânienne répétée dans le traitement de la dépression résistante : marqueurs de réponses cliniques et neurobiologiques

Abstract : Resistant depression constitutes a major economic burden and leads to a deterioration in the quality of life of patients, sometimes with severe complications. Faced with the failures of various drug treatments, repeated transcranial magnetic stimulation (rTMS) is a non-invasive, well-tolerated technique that has developed considerably over the past twenty years. rTMS has already proven its worth in the treatment of unipolar depression and was validated for this indication by the FDA in 2008. However, to date there is no consensus as to its place in the decision-making algorithm of the resistant depression. Its effectiveness varies depending on the modalities of stimulation and the clinical presentation of the depressive episode.
Thus, the search for clinical and neurobiological response markers would make it possible to offer rTMS to patient profiles likely to respond favorably, thus offering the best chances of remission. We propose an open-label study with the main objective of comparing changes in cerebral metabolism between the group of responder patients and the group of patients who do not respond to an acute course of low-frequency rTMS. We included 20 patients presenting a resistant depressive episode who had benefited from a low-frequency rTMS protocol in the right dorsolateral prefrontal cortex (CPFdl) for 6 weeks in acute treatment, associated with the realization of a PET-CT at the 18FDG before and after the stimulation treatment.
The response rate is 44.4% and the remission rate is 11.1% at the end of acute treatment. We did not observe a difference in cerebral metabolism between responders and non-responders for the 10 regions selected before the treatment of acute rTMS. On the other hand, at the end of treatment, we can note a significant difference in the metabolism of the right cingulate and paracacingular gyrus (GCPD), whose metabolism appears higher in responders than in non-responders, and a result close to significance for the left cingulate and left paracingular (GCPG). We did not observe any significant difference before and after the treatment of acute rTMS between responders and non-responders for the other selected brain regions. In addition, we were able to observe certain results in agreement with the literature, namely:
- A more pronounced bilateral frontal and temporal lobe hypometabolism on the left in patients with resistant depression.
- A reduction in the metabolism of the left mesial temporal lobe after the treatment of acute rTMS.
We also found that hypermetabolism of the left mesial temporal lobe was correlated with symptoms of anxiety, and that these symptoms diminished after treatment of acute rTMS. There is a great variability of responses to this technique and a low number of specific response markers. Several factors can explain these results: the characteristics of the current episode (degree of resistance, severity, duration of the episode), patient characteristics (age, comorbidities), the placebo effect, regions of interest imprecise. A larger sample would also have increased the statistical power of the study. These elements should be taken into account in subsequent studies to determine the profile of patients most able to respond to treatment.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03021945
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Tuesday, November 24, 2020 - 3:36:01 PM
Last modification on : Tuesday, June 8, 2021 - 2:27:42 PM

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  • HAL Id : dumas-03021945, version 1

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Elsa Murry. La stimulation magnétique transcrânienne répétée dans le traitement de la dépression résistante : marqueurs de réponses cliniques et neurobiologiques. Médecine humaine et pathologie. 2020. ⟨dumas-03021945⟩

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