Effect of Repetitive Transcranial Magnetic Stimulation in Drug Resistant Depressed Patients

치료 저항성 우울증 환자에서 반복적 경두개 자기자극후 국소뇌혈류 변화

  • Chung, Yong-An (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Yoo, Ie-Ryung (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Kang, Bong-Joo (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Chae, Jeong-Ho (Department of Psychiatry, College of Medicine, The Catholic University of Korea) ;
  • Lee, Hye-Won (Department of Psychiatry, College of Medicine, The Catholic University of Korea) ;
  • Moon, Hyun-Jin (Department of Psychiatry, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sung-Hoon (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Sohn, Hyung-Sun (Department of Radiology, College of Medicine, The Catholic University of Korea) ;
  • Chung, Soo-Kyo (Department of Radiology, College of Medicine, The Catholic University of Korea)
  • 정용안 (가톨릭대학교 방사선과학교실) ;
  • 유이령 (가톨릭대학교 방사선과학교실) ;
  • 강봉주 (가톨릭대학교 방사선과학교실) ;
  • 채정호 (가톨릭대학교 정신과학교실) ;
  • 이혜원 (가톨릭대학교 정신과학교실) ;
  • 문현진 (가톨릭대학교 정신과학교실) ;
  • 김성훈 (가톨릭대학교 방사선과학교실) ;
  • 손형선 (가톨릭대학교 방사선과학교실) ;
  • 정수교 (가톨릭대학교 방사선과학교실)
  • Published : 2007.02.28

Abstract

Purpose: Repetitive transcranial magnetic stimulation (rTMS) has recently been clinically applied in the treatment of drug resistant depressed patients. There are mixed findings about the efficacy of rTMS on depression. Furthermore, the influence of rTMS on the physiology of the brain is not clear. We prospectively evaluated changes of regional cerebral blood flow (rCBF) between pre- and post-rTMS treatment in patients with drug resistant depression. Materials and Methods: Twelve patients with drug-resistant depression (7 male, 5 female; age range: $19{\sim}52$ years; mean age: $29.3{\pm}9.3$ years) were given rTMS on right prefrontal lobe with low frequency (1 Hz) and on left prefrontal lobe with high frequency (20 Hz), with 20-minute-duration each day for 3 weeks. Tc-99m ECD brain perfusion SPECT was obtained before and after rTMS treatment. The changes of cerebral perfusion were analyzed using statistical parametric mapping (SPM; t=3.14, uncorrected p<0.01, voxel=100). Results: Following areas showed significant increase in rCBF after 3 weeks rTMS treatment: the cingulate gyrus, fusiform gyrus of right temporal lobe, precuneus, and left lateral globus pallidus. Significant decrement was noted in: the precental and middle frontal gyrus of right frontal lobe, and fusiform gyrus of left occipital lobe. Conclusion: Low-frequency rTMS on the right prefrontal cortex and high-frequency rTMS on the left prefrontal cortex for 3 weeks as an add-on regimen have increased and decreased rCBF in the specific brain regions in drug-resistant depressed patients. Further analyses correlating clinical characteristics and treatment paradigm with functional imaging data may be helpful in clarifying the pathophysiology of drug-resistant depressed patients.

목적: 두부 외부에서 두뇌를 직접 자극하는 비침습적 두뇌 자극술인 경두개 자기자극(TMS, transcranial magnetic stimulation)은 특정 두뇌 부위를 자극하여 두뇌 활성을 증가 혹은 감소시킬 수 있다. 특히 반복 TMS(repetitive TMS, 이하 rTMS)는 우울증, 강박장애, 정신분열증 등 일부 신경 정신과적 질환의 새로운 치료법으로서의 가능성이 제시되면서 다양한 연구가 행해지고 있다. 이에 본 연구는 치료 저항성 우울증 환자를 대상으로 rTMS 치료 전후의 국소뇌혈류 변화를 알아보고자 하였다. 대상 및 방법: 1년 이상 적당한 항우울제 투여를 시도하였음에도 불구하고 치료에 반응하지 않았던 치료 저항성 우울증 환자 12명(남: 7, 녀: 5, 나이범위: $19{\sim}52$세, 평균나이: $29.3{\pm}9.3$세)을 대상으로 하여 3주간 15회의 rTMS(우측 전전두엽: 1Hz, 좌측 전전두엽: 20Hz) 치료 시행 전과 치료 후에 Tc-99m ECD SPECT를 얻었다. 치료 전과 후의 차이를 SPM2 소프트웨어를 이용하여 비교하였다.(t=3.14, uncorrected p<0.01, voxel=100) 결과: rTMS 치료 후에 좌측 측두엽 전내측부와 좌측 기저핵 그리고 양측 전전두엽 피질부위에 혈류가 유의하게 증가하였다. 또한 우측 전두엽과 좌측 후두엽에서는 혈류가 유의하게 감소하였다. 결론: 치료 저항성 우울증 환자의 rTMS 치료는 특정 부위 두뇌의 혈류 증가와 감소가 있음을 확인할 수 있었다. 치료 성과 및 개인 특성에 따른 차이에 대한 분석을 시행하고 보다 많은 수의 환자에서 자료가 확보된다면 rTMS 치료의 기전과 우울증의 병태생리를 규명하는데 rTMS-기능 뇌영상 연계 연구가 매우 유용할 것이다.인 PET 연구 절차를 고안하기 위해 고려해야 할 사항들에 대하여 논하였다.TEX>$29.9{\pm}1.8%$, DMF: $7.6{\pm}0.5%$이었다. MEK에서 얻은 $[^{11}C]1$의 비방사능은 98 ($GBq/{\mu}mol$)이다. 각 물질의 질량 분석은 1: m/z 257.3 (M+1), 2: 257.3 (M+1), 3: 271.3 (M+1)이었다. 각 생성물질의 표지효율은 MEK에서 $86.0{\pm}5.5%:5.0{\pm}3.4%:1.5{\pm}1.3%$ $([^{11}C]1:[^{11}C]2:[^{11}C]3)$, CHO에서 $59.7{\pm}2.4%:4.7{\pm}3.2%:1.3{\pm}0.5%$, DEK에서 $29.9{\pm}1.8%:2.0{\pm}0.7%:0.3{\pm}0.1%$, DMF에서 $7.6{\pm}0.5%:0.0%:0.0%$이다. 결론: $[^{11}C]1$은 4가지 반응용매 중 MEK 반응용매에서 가장 높은 표지효율을 나타냈다. 부산물인 $[^{11}C]3$은 고성능 액체 크로마토그래피의 자외선, 방사능 검출기와 질량 분석법을 통해 물질을 추정할 수 있었다.의 개선 효과가 있는 것으로 판단되며 지질과산화에 대해서 강한 억제 활성을 나타내는 것을 알 수 있었다. 이러한 결과로 복분자는 생활 습관병의 예방과 개선에 유효한 것으로 사료되었으며, 지질대사와 과산화지표의 검증을 통해 기능성 식품소재로 활용될 수 있음을 보여주었다.로서 역시 CTV 치료계획에서 적게 조사되었다(p=0.005). 기존의 ICRU 치료계획은 잔류종양의 크기가 작은 경우 불필요하게 정상조직에

Keywords

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