title: Transcranial Direct Current Stimulation for Treating Depression in a Patient With Right Hemispheric Dominance: A Case Study.
abstract: We report the case of a 66-year-old male patient with major depressive disorder for the last 6 months. The patient had been diagnosed with dyslexia during childhood and was left-handed. The intervention protocol consisted in 10 consecutive daily transcranial direct current stimulation sessions. However, after 5 days of stimulation, the patient presented with intensification of depressive symptoms and panic attacks. It was hypothetized that the intensification of symptoms may have been due to stimulation protocol itself. Considering the patient was left-handed and presented comorbidity with dyslexia, there was a plausible hypothesis of right hemispheric dominance. This was corroborated by the Edinburgh Handedness Scale. In fact, dyslexic patients present right hemisphere dominance more frequently. The patient also presented a single photon emission computed tomography with a hypoperfusion area over the left posterior parietal lobe. After the patients agreement, a 10-day experimental repetitive transcranial magnetic stimulation low-frequency protocol over the left dorsolateral prefrontal cortex was started to inhibit the area, which was hypothetically hyperactivated following the rationale of right dominance. The patient presented amelioration of depressive and anxious symptoms. Given the hemispheric reversal we show in the present case study, however, it seems that therapies that are beneficial to right-handers could be detrimental to left-handers.
authors.affiliation: From the The Clinical Neuromodulation Laboratory, Santa Casa Medical School, São Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Shiozawa
authors.forename: Mailu Enokibara
authors.initials: ME
authors.lastname: da Silva
authors.forename: Quirino
authors.initials: Q
authors.lastname: Cordeiro
mesh_terms: D000368:Aged; D002560:Cerebrovascular Circulation; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging / Q000523:psychology / Q000628:therapy*; D004292:Dominance, Cerebral; D004410:Dyslexia / Q000150:complications; D007839:Functional Laterality; D006801:Humans; D008297:Male; D010296:Parietal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D011569:Psychiatric Status Rating Scales; D015899:Tomography, Emission-Computed, Single-Photon; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome