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Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder in Patients with Co-Morbid Multiple Sclerosis

Brain Stimulation, 5, 7, page e22

Background

MDD is the most frequent psychiatric diagnosis in patients with MS, with a lifetime risk of 40-60%. In addition, pain is common in MS. Both depression and pain affect quality of life in MS patients. There are no published studies on TMS as a treatment for these patients. While TMS is gaining insurance coverage for MDD, several insurance companies exclude patients with co-morbid MS.

Methods

Three patients with MDD and co-morbid MS were given an acute course of TMS treatment in a private outpatient setting. Two of the patients also presented with neuropathic pain. One patient received right LF TMS; two received left HF treatment. One parameter modification was required due to a high MT (1.65): the inter-train interval was lengthened to 38 seconds in order to stay within safety guidelines.

Results

HAMD-24 scores dropped to remission levels in all three patients (mean 27 pre- and 6 post-treatment). Both patients reported significant reductions of pain (mean McGill Pain scores went from 21 to 10; mean Visual Analog Pain from 6.7 to 3.0). There was no effect seen on MS symptoms. Normal side effects of scalp pain and headaches were noted in all three patients and managed appropriately. There were no seizures.

Conclusions

In this first-ever report of TMS treatment in patients with MDD and co-morbid MS, all three patients had remission of depression and both patients had substantial reduction of pain. TMS was well tolerated. A larger study is indicated to demonstrate the safety and efficacy of TMS in this patient population.

Footnotes

a Oakdale TMS, Oakdale, New York

b South Shore Neurologic Associates, Patchogue, New York