rTMS treatment for depression in Parkinson's disease increases BOLD responses in the left prefrontal cortex.
The mechanisms underlying the effects of antidepressant treatment in patients with Parkinson's disease (PD) are unclear. The neural changes after successful therapy investigated by neuroimaging methods can give insights into the mechanisms of action related to a specific treatment choice. To study the mechanisms of neural modulation of repetitive transcranial magnetic stimulation (rTMS) and fluoxetine, 21 PD depressed patients were randomized into only two active treatment groups for 4 wk: active rTMS over left dorsolateral prefrontal cortex (DLPFC) (5 Hz rTMS; 120% motor threshold) with placebo pill and sham rTMS with fluoxetine 20 mg/d. Event-related functional magnetic resonance imaging (fMRI) with emotional stimuli was performed before and after treatment - in two sessions (test and re-test) at each time-point. The two groups of treatment had a significant, similar mood improvement. After rTMS treatment, there were brain activity decreases in left fusiform gyrus, cerebellum and right DLPFC and brain activity increases in left DLPFC and anterior cingulate gyrus compared to baseline. In contrast, after fluoxetine treatment, there were brain activity increases in right premotor and right medial prefrontal cortex. There was a significant interaction effect between groups vs. time in the left medial prefrontal cortex, suggesting that the activity in this area changed differently in the two treatment groups. Our findings show that antidepressant effects of rTMS and fluoxetine in PD are associated with changes in different areas of the depression-related neural network.
Cardoso
Ellison Fernando
EF
NIF, LIM-44, Department of Radiology, University of São Paulo, São Paulo, Brazil. lim@usp.br
Fregni
Felipe
F
Martins Maia
Fernanda
F
Boggio
Paulo S
PS
Luis Myczkowski
Martin
M
Coracini
Karen
K
Lopes Vieira
Adriana
A
Melo
Luciano M
LM
Sato
João R
JR
Antonio Marcolin
Marco
M
Rigonatti
Sergio P
SP
Cruz
Antonio Cesário
AC
Reis Barbosa
Egberto
E
Amaro
Edson
E
D000339:Affect / Q000187:drug effects; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001931:Brain Mapping / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004644:Emotions / Q000187:drug effects; D005071:Evoked Potentials; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D017397:Prefrontal Cortex / Q000187:drug effects* / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine