• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2008.tde-24072008-145234
Document
Author
Full name
Ellison Fernando Cardoso
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Amaro Júnior, Edson (President)
Arantes, Paula Ricci
Araújo, Dráulio Barros de
Conforto, Adriana Bastos
Nitrini, Ricardo
Title in Portuguese
Avaliação do tratamento de depressão em pacientes com doença de Parkinson através de ressonância magnética funcional
Keywords in Portuguese
Depressão/terapia
Doença de Parkinson
Estimulação magnética transcraniana
Fluoxetina
Imagem por ressonância magnética
Abstract in Portuguese
O circuito neuronal relacionado à depressão na doença de Parkinson (DP), assim como os efeitos da terapia antidepressiva nestes pacientes, não é bem estabelecido. Os métodos de neuroimagem podem levar ao melhor conhecimento da patogênese e também dos mecanismos de ação relacionados a um tipo específico de tratamento. Para avaliar as diferenças da atividade neuronal, comparamos 21 pacientes com DP e diagnóstico de depressão e 16 sem depressão através de ressonância magnética funcional (RMf) em uma tarefa cognitiva que inclui percepção emocional e escolha forçada com duas opções. Estes 21 pacientes deprimidos foram aleatorizados em dois grupos de tratamento por 4 semanas: estimulação magnética transcraniana (EMT) ativa sobre o córtex pré-frontal dorsolateral esquerdo ( 5 Hz EMT - 120% do limiar motor) com pílula placebo e EMT placebo com 20 mg diária de fluoxetina. Os pacientes foram submetidos a um experimento de RMf cujo paradigma foi relacionado a eventos apresentação visual de faces de conteúdo emocional. Os pacientes sem depressão realizaram RMf duas vezes (teste reteste) e os deprimidos quatro vezes (duas vezes antes e duas depois do tratamento). As imagens dos pacientes com DP e depressão demonstraram menor atividade no córtex pré-frontal medial quando comparados aos pacientes com DP sem depressão. Ambos os subgrupos de pacientes com DP e depressão apresentaram melhora significativa e similar dos sintomas da depressão. Após o tratamento com EMT ativa observou-se menor atividade do giro fusiforme esquerdo, do cerebelo e do córtex pré-frontal dorsolateral direito e maior atividade do córtex pré-frontal dorsolateral esquerdo e do cíngulo anterior nas imagens de RMf quando comparados àquelas antes do tratamento. Por outro lado a fluoxetina determinou aumento da atividade do córtex pré-motor direito e do córtex pré-frontal medial direito em imagens de RMf realizadas após o tratamento. Observou-se efeito de interação entre os grupos (tempo (pré x pós) versus tipo de tratamento (fluoxetina x EMT)) no córtex préfrontal medial esquerdo sendo maior o aumento no grupo tratado com EMT. Nossos achados mostraram: 1) padrão diferente de atividade cerebral em pacientes com DP com e sem depressão; 2) efeitos antidepressivos da EMT e da fluoxetina foram semelhantes e significativos;e 3) em pacientes com DP e depressão os efeitos da EMT e fluoxetina são associados a diferentes mudanças da atividade cerebral, e em ambos as áreas encontradas são parte da rede neural relacionada à depressão.
Title in English
Evaluation of depression treatment in Parkinson's disease patients with functional magnetic resonance
Keywords in English
Depression/therapy
Fluoxetine
Magnetic resonance imaging
Parkinson disease
Transcranial magnetic stimulation
Abstract in English
The neural circuitry underlying depression in patients with Parkinson's disease (PD) is unknown, let alone the treatment effects of antidepressant therapy. Neuroimaging methods can give insights into the pathogenesis of depression and also in the mechanisms of action related to specific treatment choice. In order to evaluate differences between PD patients with and without concomitant depression we studied 21 patients with PD and depression and 16 PD patients without depression using fMRI. All patients were examined using an event-related fMRI paradigm based on visual presentation of faces with emotional content in a two options forced choice task. Furthermore the twenty-one PD depressed patients were randomized in two active treatment groups for 4 weeks: active rTMS over left dorsolateral prefrontal cortex (5 Hz rTMS - 120% motor threshold) with placebo pill and sham rTMS with fluoxetine 20 mg/day. Event-related fMRI with emotional stimuli was performed before and after treatment - in two sessions (test and re-test) at each time point. The same test-retest approach was adopted in the group of non-depressed PD patients. The analysis showed significant differences between depressed and non-depressed PD patients in the medial pre-frontal cortex, with reduced activation as detected by BOLD effect in the later group. The two groups of depressed PD patients showed a had a significant treatment effect, and with similar mood improvement. After rTMS treatment, there were brain activity decreases in left fusiform gyrus, cerebellum and right dorsolateral prefrontal cortex (DLPFC) and brain activity increases in left DLPFC and anterior cingulate gyrus as compared to baseline. In contrast, after fluoxetine treatment, there was brain activity increases in right premotor and right medial prefrontal cortex. There was a significant interaction effect between groups versus time in the left medial prefrontal cortex, suggesting that the activity in this area changed differently in the two treatment groups. Our findings show that medial prefrontal cortex is a critical area in the depression neural circuitry in PD. Antidepressant effects of rTMS and fluoxetine in PD are associated with changes in different areas of the depression-related neural network.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2008-07-29
 
WARNING: The material described below relates to works resulting from this thesis or dissertation. The contents of these works are the author's responsibility.
  • CARDOSO, Ellison Fernando, et al. Abnormal visual activation in Parkinson's disease patients [doi:10.1002/mds.23101]. Movement Disorders [online], 2010, vol. 25, n. 11, p. 1590-1596.
  • CARDOSO, Ellison Fernando, et al. Depression in Parkinson's disease : Convergence from voxel-based morphometry and functional magnetic resonance imaging in the limbic thalamus [doi:10.1016/j.neuroimage.2009.04.059]. NeuroImage [online], 2009, vol. 47, n. 2, p. 467-472.
  • CARDOSO, Ellison Fernando, et al. rTMS treatment for depression in Parkinson's disease increases BOLD responses in the left prefrontal cortex [doi:10.1017/S1461145707007961]. The International Journal of Neuropsychopharmacology [online], 2008, vol. 11, n. 2, p. 173-183.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2024. All rights reserved.