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Frontoparietal paired associative stimulation versus single-site stimulation for generalized anxiety disorder: a
Li Wang1, Qi-Hui Zhou2, Kun Wang2
1From the Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Beijing Key Laboratory of Neuromodulation, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China (L. Wang, Zhou, H. Wang, Hu, Yang, Lin, Y. Wang); the Department of Neurology, Beijing Puren Hospital, Beijing, China (K. Wang) wangyuping01@sina.cn linyc_1@163.com.
Background:
At present, the use of repetitive transcranial magnetic stimulation (rTMS) for generalized anxiety disorder (GAD) is limited to single-site interventions. We investigated whether dual-site frontoparietal stimulation delivered using cortical-cortical paired associative stimulation (ccPAS) had stronger clinical efficacy than single-site stimulation in patients with GAD.
Methods:
We randomized 50 patients with GAD to 1 Hz rTMS (10 sessions) using 1 of the following protocols: single-site stimulation over the right dorsolateral prefrontal cortex (dlPFC; 1500 pulses per session); single-site stimulation over the right posterior parietal cortex (PPC; 1500 pulses per session); repetitive dual-site ccPAS (rds-ccPAS) over the right dlPFC and right PPC with 1500 pulses per session (rd-ccPAS-1500); or rds-ccPAS over the right dlPFC and right PPC with 750 pulses per session (rd-ccPAS-750). Both rds-ccPAS treatments used a between-site interval of 100 ms.
Results:
Clinical scores for anxiety, depression and insomnia were reduced in all 4 groups after treatment. We found greater improvements in anxiety symptoms in the rds-ccPAS-1500 group compared to the rds-ccPAS-750 and single-site groups. We found greater improvements in depression symptoms and insomnia in the rds-PAS-1500 group compared to the single-site groups. The rds-ccPAS-1500 group also showed significant or trend-level improvements in anxiety symptoms and insomnia at 10-day and 1-month followup. More patients responded to treatment with rds-ccPAS-1500 than with single-site stimulation. The between-group differences in response rates persisted to the 3-month follow-up. Treatment using rds-ccPAS with a between-site interval of 100 ms induced a more significant improvement than the between-site interval of 50 ms we evaluated in a previous study.
Limitations:
These results need to be replicated in a larger sample using sham control and equal-pulse single-site stimulation.
Conclusion:
Frontoparietal rds-ccPAS may be a better treatment option for GAD.
