INTRODUCTION A high seizure threshold (ST) is an impeding factor in certain patients, potentially preventing a successful electroconvulsive therapy (ECT) treatment. Several pharmacological and non-pharmacological methods have been put forward to augment ECT in such patients, however, to this date, only a handful of case reports existed about the potential role of repetitive transcranial magnetic stimulation (rTMS), as an augmentation method. OBJECTIVES and Methods: In this randomized, double-blinded, sham controlled study, we set out to test the hypothesis of whether the application of high frequency transcranial magnetic stimulation (HF rTMS) lowers the seizure threshold for electroconvulsive therapy and whether it has an effect on other aspects of ECT treatment, such as seizure duration (SD), efficacy and safety. RESULTS 46 patients treated for a major depressive episode, indicated for ECT, were recruited to this study. A significantly lower seizure threshold was observed in the experimental group during ECT titration, on average a decrease by 34.55%, from 34.23mC to 22.4mC, p < 0.001 (Wilcox test). We had not observed a significant effect of TMS stimulation before ECT on seizure duration or clinical outcome. Another potentially important observation of this study is that 4 patients in the experimental group developed transient symptoms of hypomania/mania, all of which were stabilized after the combined stimulation protocol was halted spontaneously within a week, without the need to administer mood stabilizers. CONCLUSION It is likely that HF rTMS stimulation prior to ECT is a novel and simple way of reducing the ST, which is useful in certain groups of patients undergoing this important treatment modality.

中文翻译：

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通过重复经颅磁刺激在电惊厥治疗中控制癫痫发作阈值。一种新颖的增强方式？

引言 高癫痫阈值 (ST) 是某些患者的阻碍因素，可能会阻止成功的电休克疗法 (ECT) 治疗。已经提出了几种药理学和非药理学方法来增强此类患者的 ECT，然而，到目前为止，只有少数病例报告关于重复经颅磁刺激 (rTMS) 作为增强方法的潜在作用。目标和方法：在这项随机、双盲、假对照研究中，我们着手检验高频经颅磁刺激 (HF rTMS) 的应用是否会降低电惊厥治疗的癫痫发作阈值以及它是否有效果的假设ECT 治疗的其他方面，如癫痫发作持续时间 (SD)、有效性和安全性。结果 本研究招募了 46 名接受 ECT 治疗的重度抑郁发作患者。在 ECT 滴定期间，实验组的癫痫发作阈值显着降低，平均下降 34.55%，从 34.23mC 降至 22.4mC，p < 0.001（Wilcox 测试）。我们在 ECT 之前没有观察到 TMS 刺激对癫痫持续时间或临床结果的显着影响。这项研究的另一个潜在重要观察结果是，实验组中的 4 名患者出现了短暂的轻躁狂/躁狂症状，在一周内自发停止联合刺激方案后，所有这些症状都得到了稳定，无需使用情绪稳定剂。结论 ECT 之前的 HF rTMS 刺激可能是一种减少 ST 的新颖且简单的方法，