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Safe Administration of Low Frequency rTMS in a Patient with Depression with Recurrent Antidepressant-Associated Hyponatremic Seizures
Brain Stimulation ( IF 7.7 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.brs.2020.06.001
Milind Vijay Thanki , Sachin Pradeep Baliga , Soumya Parameshwaran , Naren P. Rao , Urvakhsh Meherwan Mehta , Jagadisha Thirthalli

The incidence of antidepressant-associated hyponatremia ranges between 0.5 and 32% across various treatment settings, with elderly depressed individuals being at maximum risk [1]. It is thought to happen via induction of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and is characterized by nausea, myalgia, weakness and headache [2]. Symptoms usually appear within two weeks of starting the offending agent, and are associated with serum sodium levels <130mEq/l [2]. The CNS effects of hyponatremia occur secondary to osmotic swelling in the glial cells and can progress to seizures, coma and respiratory arrest, causing significant morbidity [3]. Symptoms generally subside with discontinuation of the offending agent or with fluid restriction or both [2]. Due to this, pharmacological management of depression, particularly in the elderly can become challenging. Furthermore, electroconvulsive therapy (ECT), when administered in the background of untreated hyponatremia, is associated with higher risk of prolonged seizures and post-ECT delirium. Practice guidelines therefore recommend correction of the electrolyte abnormality prior to commencing ECT [4]. Repetitive transcranial magnetic stimulation (rTMS) is a potential alternative for acute treatment in depressed individuals with recurrent antidepressant induced hyponatremia. Here we report a case, demonstrating safe and successful administration of rTMS in an elderly individual with depression who had a history of hyponatremic seizures with antidepressants.

中文翻译:

对复发性抗抑郁药相关低钠血症性癫痫患者进行低频 rTMS 安全管理

在各种治疗环境中,抗抑郁药相关低钠血症的发生率介于 0.5% 至 32% 之间,老年抑郁症患者的风险最高 [1]。它被认为是通过诱导不适当的抗利尿激素分泌综合征 (SIADH) 而发生的,其特征是恶心、肌痛、虚弱和头痛 [2]。症状通常在开始使用有问题的药物后两周内出现,并且与血清钠水平 <130mEq/l 相关 [2]。低钠血症的 CNS 效应继发于神经胶质细胞的渗透性肿胀,可发展为癫痫、昏迷和呼吸停止,导致严重的发病率 [3]。症状通常会在停用有问题的药物或限制液体或两者同时消退后消退[2]。因此,抑郁症的药物治疗,特别是在老年人中可能会变得具有挑战性。此外,当在未经治疗的低钠血症背景下进行电惊厥疗法 (ECT) 时,会增加癫痫发作时间延长和 ECT 后谵妄的风险。因此,实践指南建议在开始 ECT 之前纠正电解质异常 [4]。重复经颅磁刺激 (rTMS) 是一种潜在的替代疗法,可用于治疗患有复发性抗抑郁药引起的低钠血症的抑郁症患者。在这里,我们报告了一个案例,证明在患有抑郁症的老年个体中使用 rTMS 是安全和成功的,这些个体有抗抑郁药低钠性癫痫发作史。与长期癫痫发作和 ECT 后谵妄的风险增加有关。因此,实践指南建议在开始 ECT 之前纠正电解质异常 [4]。重复经颅磁刺激 (rTMS) 是一种潜在的替代疗法,可用于治疗患有复发性抗抑郁药引起的低钠血症的抑郁症患者。在这里,我们报告了一个案例,证明在患有抑郁症的老年个体中使用 rTMS 是安全和成功的,这些个体有抗抑郁药低钠性癫痫发作史。与长期癫痫发作和 ECT 后谵妄的风险增加有关。因此,实践指南建议在开始 ECT 之前纠正电解质异常 [4]。重复经颅磁刺激 (rTMS) 是一种潜在的替代疗法,可用于治疗患有复发性抗抑郁药引起的低钠血症的抑郁症患者。在这里,我们报告了一个案例,证明在患有抑郁症的老年个体中使用 rTMS 是安全和成功的,这些个体有抗抑郁药低钠性癫痫发作史。重复经颅磁刺激 (rTMS) 是一种潜在的替代疗法,可用于治疗患有复发性抗抑郁药引起的低钠血症的抑郁症患者。在这里,我们报告了一个案例,证明在患有抑郁症的老年个体中使用 rTMS 是安全和成功的,这些个体有抗抑郁药低钠性癫痫发作史。重复经颅磁刺激 (rTMS) 是一种潜在的替代疗法,可用于治疗患有复发性抗抑郁药引起的低钠血症的抑郁症患者。在这里,我们报告了一个案例,证明在患有抑郁症的老年个体中使用 rTMS 是安全和成功的,这些个体有抗抑郁药低钠性癫痫发作史。
更新日期:2020-09-01
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