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Case Reports
. 2017 May 30:8:96.
doi: 10.3389/fpsyt.2017.00096. eCollection 2017.

Acute Frontal Lobe Dysfunction Following Prefrontal Low-Frequency Repetitive Transcranial Magnetic Stimulation in a Patient with Treatment-Resistant Depression

Guilhem Carle  1   2   3 , Mehdi Touat  4   5 , Nicolas Bruno  1   3 , Damien Galanaud  3   6 , Charles-Siegfried Peretti  1   3 , Antoni Valero-Cabré  2   3   7   8 , Richard Levy  2   3   4 , Carole Azuar  2   3   9
Affiliations
Case Reports

Acute Frontal Lobe Dysfunction Following Prefrontal Low-Frequency Repetitive Transcranial Magnetic Stimulation in a Patient with Treatment-Resistant Depression

Guilhem Carle et al. Front Psychiatry. .

Abstract

The potential of repetitive transcranial magnetic stimulation (rTMS) to treat numerous neurological and psychiatric disorders has been thoroughly studied for the last two decades. Here, we report for the first time, the case of a 65-year-old woman suffering from treatment-resistant depression who developed an acute frontal lobe syndrome following eight sessions of low-frequency rTMS (LF-rTMS) to the right dorsolateral prefrontal cortex while also treated with sertraline and mianserin. The pathophysiological mechanisms underlying such an unexpected acute frontal lobe dysfunction are discussed in relation to the therapeutic use of LF-rTMS in combination with pharmacotherapy in depressed patients.

Keywords: antidepressant; depression; executive dysfunction; frontal syndrome; state-dependency; transcranial magnetic stimulation.

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Figures

Figure 1
Figure 1
(A) 1.5 T brain magnetic resonance imaging (MRI) performed on day 1 showing a right dorsolateral prefrontal cortex (rDLPFC) hyperintensity on diffusion-weighted imaging with a significant decreased apparent diffusion coefficient (ADC) as compared to the homotopic region in the left hemisphere [difference of 0.039 × 10−3 mm2/s, showing 0.723 in the rDLPFC versus 0.762 in the left DLPFC (×10−3 mm2/s)]; (B) control brain MRI performed on day 9 after the onset of symptoms using the same MRI scanner and identical acquisition parameters revealing normal ADC levels on both DLPFC areas [no significant difference, showing 0.803 in the rDLPFC versus 0.785 in the left DLPFC (×10−3 mm2/s)].
Figure 2
Figure 2
(A) Brain 99mTc-hexamethylpropyleneamine oxime single-photon emission computerized tomography (99mTc-HMPAO SPECT) performed 13 days after the onset of symptoms revealing a significant decrease in regional cerebral blood flow (rCBF) within the right dorsolateral prefrontal cortex (see white arrows); (B) a 10-month control 99mTc-HMPAO SPECT showing a complete cancelation of the right frontal rCBF decrease present during the symptoms.
See this image and copyright information in PMC

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