title: Mitochondrial myopathy and comorbid major depressive disorder: effectiveness of dTMS on gait and mood symptoms.
abstract: BACKGROUND
  Mitochondrial myopathies (MMs) often present with leukoencephalopathy and psychiatric symptoms, which do not respond to or worsen with psychiatric drugs.
  
  
  METHODS
  A 67-year-old woman with a 10-year history of probable chronic progressive external ophthalmoplegia, an MM, had drug-resistant, anxious-depressive symptoms. Since she had never had seizures, we proposed 20 sessions of deep transcranial magnetic stimulation (dTMS) for her depression. Surprisingly, besides the expected improvement of depression, we observed marked improvement of movement disorder that lasted as long as the patient was undergoing dTMS. She also improved her performance on neuropsychological tests of executive function and cognitive speed. Depressive symptom improvement was persistent, while anxiety symptoms recurred after the end of the sessions.
  
  
  CONCLUSIONS
  dTMS may be an alternative antidepressant strategy in patients with MMs, provided that they are free from seizures. The mechanism of improvement of motor disturbance may relate to dorsolateral prefrontal cortex stimulation and improved executive function and needs further investigation.
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors: Chiara
authors: C
authors: Rapinesi
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Delfina
authors: D
authors: Janiri
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy. Electronic address: giorgio.kotzalidis@uniroma1.it.
authors: Georgios D
authors: GD
authors: Kotzalidis
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors: Daniele
authors: D
authors: Serata
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, Fondazione Padre Alberto Mileno Onlus, Vasto, Chieti, Italy.
authors: Antonio
authors: A
authors: Del Casale
authors: Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors: Paola
authors: P
authors: Scatena
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Claudia
authors: C
authors: Dacquino
authors: DiMA Department (Advanced Molecular Diagnosis), School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors: Giovanna
authors: G
authors: Gentile
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Giovanni
authors: G
authors: Manfredi
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Emanuela
authors: E
authors: Danese
authors: ATID Ltd Advanced Technology Innovation Distribution, Rome, Italy.
authors: Ruggero Nessim
authors: RN
authors: Raccah
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Roberto
authors: R
authors: Brugnoli
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Gemma
authors: G
authors: Callovini
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Vittoria Rachele
authors: VR
authors: Ferri
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Stefano
authors: S
authors: Ferracuti
authors: Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
authors: Abraham
authors: A
authors: Zangen
authors: DiMA Department (Advanced Molecular Diagnosis), School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors: Maurizio
authors: M
authors: Simmaco
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors: Gloria
authors: G
authors: Angeletti
authors: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors: Paolo
authors: P
authors: Girardi
mesh_terms: D000368:Aged; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D017240:Mitochondrial Myopathies / Q000150:complications / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Comorbidity; Deep transcranial magnetic stimulation (dTMS); Dorsolateral prefrontal cortex (DLPFC); Major depressive disorder; Mitochondrial myopathy