Contributions
Abstract: P799
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Depression is common in MS and may impact information processing speed. Some patients fail to improve with standard antidepressants. Prefrontal repetitive transcranial magnetic stimulation (rTMS) is an alternative therapeutic tool. Diffusion tensor imaging (DTI) evaluates the integrity of white matter connectivity in vivo yielding an index termed fractional anisotropy (FA).
Objective: To assess the impact of rTMS on the clinical and radiological outcomes of depressed MS patients in relation to certain cognition domains using DTI.
Subjects and methods: Thirty RRMS patients, according to McDonald criteria (2010) having depression, according to DSMV criteria, were divided equally into two arms receiving either left prefrontal cortex rTMS or SSRIs. Patients with current INF-beta treatment were excluded. Beck depression inventory (BDI), paced auditory serial addition test (PASAT) and DTI for left prefrontal cortex were done before and 6 weeks after receiving either intervention.
Results: Mean patientsc age was 29.3y±3.7 and 31.2y±4.7 for either intervention arms. Female/male ratio was 1.7:1. All subjects showed improvement in BDI and PASAT after either intervention (17.6±3.25 pre-rTMS vs 10.6±1.89 post rTMS and 23.00±6.36 pre-rTMS vs 24.87±6.6 post-rTMS respectively, P< 0.001; 17.67±3.15 pre-SSRIs vs 0.6±1.84 post-SSRIs and 23.8±6.45 pre-SSRIs vs 25.07±7.02 post-SSRIs respectively), whereas FA improved only in rTMS group (0.44± 0.03 pre-rTMS vs 0.53±0.05 post-rTMS, P< 0.001), but not in SSRIs group (0.44±0.04 pre-SSRIs vs 0.45±.37 post-SSRIs, P=0.072). No correlation was found between the percent of change of the BDI and PASAT (P>0.05). Disease duration, age at MS onset, and EDSS did not correlate with BDI, PASAT or FA.
Conclusion: Both rTMS and SSRIs are equally effective in improving depression and certain cognitive domains, however, cognition improvement seems to be independent from improved depression. The FA increases only with rTMS denoting positive structural alteration of cortical transmission in MS patients.
Disclosure: The authors report no conflict of interest.
Abstract: P799
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Depression is common in MS and may impact information processing speed. Some patients fail to improve with standard antidepressants. Prefrontal repetitive transcranial magnetic stimulation (rTMS) is an alternative therapeutic tool. Diffusion tensor imaging (DTI) evaluates the integrity of white matter connectivity in vivo yielding an index termed fractional anisotropy (FA).
Objective: To assess the impact of rTMS on the clinical and radiological outcomes of depressed MS patients in relation to certain cognition domains using DTI.
Subjects and methods: Thirty RRMS patients, according to McDonald criteria (2010) having depression, according to DSMV criteria, were divided equally into two arms receiving either left prefrontal cortex rTMS or SSRIs. Patients with current INF-beta treatment were excluded. Beck depression inventory (BDI), paced auditory serial addition test (PASAT) and DTI for left prefrontal cortex were done before and 6 weeks after receiving either intervention.
Results: Mean patientsc age was 29.3y±3.7 and 31.2y±4.7 for either intervention arms. Female/male ratio was 1.7:1. All subjects showed improvement in BDI and PASAT after either intervention (17.6±3.25 pre-rTMS vs 10.6±1.89 post rTMS and 23.00±6.36 pre-rTMS vs 24.87±6.6 post-rTMS respectively, P< 0.001; 17.67±3.15 pre-SSRIs vs 0.6±1.84 post-SSRIs and 23.8±6.45 pre-SSRIs vs 25.07±7.02 post-SSRIs respectively), whereas FA improved only in rTMS group (0.44± 0.03 pre-rTMS vs 0.53±0.05 post-rTMS, P< 0.001), but not in SSRIs group (0.44±0.04 pre-SSRIs vs 0.45±.37 post-SSRIs, P=0.072). No correlation was found between the percent of change of the BDI and PASAT (P>0.05). Disease duration, age at MS onset, and EDSS did not correlate with BDI, PASAT or FA.
Conclusion: Both rTMS and SSRIs are equally effective in improving depression and certain cognitive domains, however, cognition improvement seems to be independent from improved depression. The FA increases only with rTMS denoting positive structural alteration of cortical transmission in MS patients.
Disclosure: The authors report no conflict of interest.