| Objective Anxiety disorders have been the highest incidence of psychiatric illness.Repetitive transcranial magnetic stimulation(rTMS)is a physical therapy that has been recommended by guidelines as a treatment for anxiety disorders.Because of the advantages of short stimulation time and high energy,theta burst stimulation(TBS)is a newer therapy and gradually applied in clinical practice.To date,there is no prospective study comparing the two protocols.In this study,TBS and rTMS were used to treat anxiety disorder patients,and their clinical efficacy and EEG oscillation changes were compared to provide a basis for clinical treatment selection.Methods In a bicenter,randomized,controlled trial,according to the ICD-11 diagnostic criteria for generalized anxiety disorder,and Hamilton Anxiety Scale(HAMA)score of14-29,100 patients with anxiety disorders were randomly allocated to treatment groups in a 1:1 ratio,TBS or rTMS.Meanwhile,30 healthy people matched in gender and age were recruited as the control group.Patients in the treatment groups were treated with TBS or rTMS to bilateral prefrontal for 20 sessions(5 days a week for 1 month).Primary outcome measures were changes in HAMA score and EEG oscillation before treatment,after treatment,and 1 month after treatment.EEG oscillations(alpha frequency and power)were calculated by MATLAB.All data used SPSS for statistical analysis.Results In clinical efficacy study,before treatment,there was no significant difference in HAMA score between TBS group and rTMS group(22.16±4.77 points vs 22.22±4.51points).After treatment,HAMA scores in two treatment groups(8.30±2.85 points vs8.96±2.70 points)showed significant reduction than before(p<0.001),but there were no differences in reduction rate(63.01% vs 59.68%),and response rate(48% vs 60%),remission rate(46% vs 28%)between TBS group and rTMS group(p>0.05).1 month after treatment,HAMA scores in two treatment groups(7.08±2.36 points vs 8.54±2.34points)were still reduced with significant difference(p<0.001 vs p=0.005).There were significant differences in reduction rate(17.03% vs 4.48%)and remission rate(66% vs40%)between two treatment groups,but no difference in response rate(p>0.05).In EEG oscillation study,before treatment,alpha frequency was slow and alpha power was low in two treatment groups versus the control group(alpha frequency: 8.91±0.60 Hz,9.11±0.53 Hz vs 10.12±0.35Hz;alpha power: 0.76±0.43 d B,0.79±0.45 d B vs1.24±0.27 d B;p<0.001).After treatment,alpha frequency of TBS group(9.56±0.51Hz)was faster than before(p<0.001),whereas rTMS group was not,and there was significant difference in change rate(7.46% vs-0.73%)between the two treatment groups(p<0.001);alpha power of two treatment groups(0.88±0.35 d B vs 0.89±0.38 d B)were increased than before(p<0.001),and no difference in change rate between two treatment groups(p>0.05).One month after treatment,alpha frequency of TBS group(9.81±0.40Hz)was faster than after treatment(p<0.001),rTMS group was still not.There was significant difference in change rate(2.73% vs 0.41%)between the two treatment groups(p<0.001);alpha power of TBS group(0.90±0.34 d B)was no more changes than after treatment,while rTMS group was decreased(0.84±0.36 d B)with significant difference(p<0.001),and change rate between two treatment groups(4.47%vs-9.18%)was significant difference(p<0.001).Conclusion EEG alpha oscillation activity reduced(frequency slowing,power decreasing)in anxiety disorder patients.Both TBS and rTMS protocols can improve anxiety symptoms by increasing alpha power.In addition,TBS has significant after effect by keeping the faster frequency and higher power of long-term EEG alpha oscillation,which is the main mechanism of better clinical effect. |
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