Low-Frequency Accelerated TMS in Patients With Depression and Focal Epilepsy
Abstract number :
3.382
Submission category :
11. Behavior/Neuropsychology/Language / 11A. Adult
Year :
2018
Submission ID :
501894
Source :
www.aesnet.org
Presentation date :
12/3/2018 1:55:12 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Bujarski Krzysztof, Dartmouth-Hitchcock Medical Center; Yinchen Song, Dartmouth-Hitchcock Medical Center; Nicholas Streltzov, Dartmouth-Hitchcock Medical Center; Harold Yang, Dartmouth Hitchock Medical Center; Lindsay Schommer, Dartmouth-Hitchcock Medical
Rationale: Approximately 30% of persons with epilepsy and depression do not adequately respond to standard antidepressant treatments. Despite FDA’s approval of high-frequency transcranial magnetic stimulation (hfTMS) to treat depression, studies in patient with dual diagnosis of epilepsy and depression have been limited due to concerns of worsening seizures. Like hfTMS, low-frequency TMS (lfTMS) has antidepressant properties but contrary to it, is has been shown to have anti-seizure properties. The efficacy of lfTMS in patients with epilepsy and comorbid depression has never been assessed. We performed a safety and feasibility pilot study of lfTMS in patients with focal epilepsy and refractory depression. Methods: We recruited patients from the epilepsy outpatient clinic with diagnosis of focal epilepsy and depression with NDDI-E > 15 unresponsive to at least one antidepressant. We performed 15 hours of accelerated lfTMS spread over 3 days applied to the right frontal lobe. Our primary outcomes were tolerability of the procedure, and seizure frequency before and after treatment. Our secondary outcomes included measurement of depression and quality of life. Results: 5 patients finished 15 hours of accelerated TMS over a period of 3 days. All five patients tolerated the procedure for full duration with no dropouts. Side effects were minimal and involved mild discomfort at the stimulation site. Pre-TMS average seizure frequency was 6.4 seizures per month, post-TMS average seizure frequency was 4.4 seizures/month. Pre-TMS depression score on QUID-SR was 17.8 compared to average score of 8.0 post. Pre-TMS average QOLIE-31 was 33.4, post-TMS average QOLIE-31 was 53.6. Conclusions: We report preliminary evidence on five patients that low-frequency TMS is safe and feasible in patients with depression and focal epilepsy. Likewise, preliminary evidence suggests decrease in seizure frequency, improvement in depression and quality of life. Future sham-controlled efficacy studies treating depression in patients with focal epilepsy need to be performed. Funding: Diamond Foundation Neuroscience