Volume 23, Issue 3 (Autumn 2021)                   Advances in Cognitive Sciences 2021, 23(3): 92-103 | Back to browse issues page


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Saedi Z, Saedi S. Effect of repetitive transcranial magnetic stimulation on the treatment of depression and social adaptation in patients with stroke. Advances in Cognitive Sciences. 2021; 23 (3) :92-103
URL: http://icssjournal.ir/article-1-1160-en.html
1- Islamic Azad University, Science and Research Branch, Department of Nuclear Engineering-Radiology, Tehran, Iran
2- Department of Psychology, Borujerd Brach, Islamic Azad University, Borujerd, Iran
Abstract:   (924 Views)
Introduction
Stroke is the second leading cause of death globally and is considered one of the most debilitating neurological diseases in adults and is more prevalent in low- and middle-income countries (1). On average, one to ten percent of people who have a stroke die from the disease, and 60 to 70 percent of those with a stroke can live independently. However, this life will be accompanied by long physical and psychological disabilities (2). Therefore, it is crucial to find a new treatment to increase the psychological rehabilitation of patients after stroke. Depression is one of the most common psychiatric disorders in patients with a stroke, and its frequency has been reported from 20% to 65% of cases (4). This disorder in patients causes increased mortality, more physical dependence, and lack of proper response to rehabilitation measures, a process that begins after a stroke and months to years after the stroke is associated with an increased chance of risk (5-7). Findings show that the improvement of this disorder depends on the treatment of disease symptoms such as improved mood, unhappiness, or changes in sleep and appetite, and other factors such as the elimination of defects in the patient's social adjustment have a significant impact on recovery. Social adaptation includes one's interactions with one's environment and the ability to function and flourish in situations such as work, social activity, and all relationships with parents and family (10). Nearly the impact of the disease on depression and, of course, most of Mitella on stroke are recurrent periods and are factors such as low levels of social support, incompatibility, and poor quality of relationships from recurrence of the disease (12). Defective adaptation and social functioning before treatment are rejected and may even lead to the patient being excluded from social spheres or increase the recurrence rate (10(. This study aimed to determine the effectiveness of Repetitive Transcranial Magnetic Stimulation on the treatment of depression and Social adaptation in patients with stroke.
Methods
The present research was a quasi-experimental design with pre-test and post-test with an unequal control group. The study population was all stroke patients referred to Tehran Brain and Cognitive Clinic in the first trimester of 2019, all of whom had trauma to the forehead. According to the recommendation of statistical tests based on at least 15 samples for clinical studies, a sample of 40 people was selected by purposive sampling method based on inclusion and exclusion criteria and randomly divided into experimental and control groups (waiting list)were replaced. Finally, due to the lack of cooperation of some participants and the equalization of the number of people in the two groups, data related to the outcome variables of 30 participants were collected. Inclusion criteria included age range between 25 and 55 years, diagnosis of depressive disorder based on the fifth revised version of the American Psychiatric Association's Diagnostic and Statistical Manual by a psychiatrist, having a moderate depression score, minimum literacy, no need changing drugs in the treatment process, the ability to participate in the study according to the presented schedule, and consent to participate in the research. Exclusion criteria also include a history of concussion or seizures, a history of rTMS treatment, more than six months after a stroke, suicidal ideation, substance use, a history of bipolar disorder or psychotic symptoms, dependence Psychedelics, pregnancy, having a metal, prosthesis, implant, or cardiac pacemaker. Ethical considerations: All subjects who received information in the study at any time could leave the study. They were assured that all information would remain confidential and would only be used for research purposes. For privacy reasons, the subjects' details were not recorded. In the end, all of them received informed consent. So Beck Depression Inventory, & Busque Social Adaptation Self-Assessment Scale and Repetitive Transcranial Magnetic Stimulation device (Magstim; Made in England) were used to measure the study's variables. The experimental group underwent 30 sessions of 20 minutes of repetitive extra cortical magnetic stimulation on the lateral dorsal cortex of the left hemisphere, areas nine and 46 of Broadman at a frequency of 20 Hz, 2.5 seconds of stimulation, and ten seconds interval between each stimulation. Then post-test was performed from both control and experimental groups. Data were analyzed using multivariate covariance with SPSS-21 software. 
Results
The mean and standard deviation of the age of the subjects in the experimental group was 41.5± 9.15, and in the control group was 39.95±4.05. In terms of gender, there were eight females and seven males in the experimental group and six females and nine males in the control group. The control was three undergraduates, eight bachelors, three masters, one PhD. In terms of medication in the experimental group, two people citalopram, four people fluoxetine/desipramine, one person sertraline, two people imipramine/diazepam, three people depakine/trimipramine/risperidone, one person desipramine/chlordiazepoxide, two people amitriptyline and in the control group one person fluoxetine, one person citalopram, two people clomipramine/lamotrigine, one person imipramine/diazepam, three people fluoxetine/desipramine, four people depakine/trimipramine/risperidone, two people fluoxetine/desipramine, one patient was fluoxetine/Xanax.  The  multivariate analysis of variance findings show that the method of repeated magnetic stimulation of the brain in the lateral dorsal region of the left prefrontal cortex, with a frequency of 20 Hz, is effective in improving the signs and symptoms of depression as well as improving performance and social adaptation in patients with stroke (P<0.01)
Conclusion
According to the results of this study, repeated magnetic stimulation of the brain, unlike drugs that have cognitive side effects, improves cognitive function and adaptation, and ultimately depression. Also, stimulation with higher frequency and intensity of stimulation increases the response to treatment in patients who has a stroke. Therefore, it is suggested that the results research results conducted in this field be used in practice in rehabilitation centers for stroke patients. In the research dimension, it is suggested that similar studies be conducted in the form of comparing the method of repeated magnetic stimulation of the brain with therapeutic methods and other psychological problems (anxiety, mobility disabilities, etc.) and considering the role of gender in the impact of this The treatment method will be implemented in order to learn more about this treatment method.
Ethical Considerations
Compliance with ethical guidelines

All subjects who received information about the study could leave the study at any time. They were assured that all information would remain confidential and would only be used for research purposes. For privacy reasons, the subjects' details were not recorded. In the end, all of them received informed consent.
Authors’ contributions
Zeinab Saedi: Defined the concepts in choosing the subject and designing the study. All authors performed a search of the research literature and background and collected and analyzed data. Finally, the writing of the article was done by Sara Saedi. All authors discussed the results and participated in the preparation and editing of the article's final version.
Funding
No financial support has been received from any organization for this research.
Acknowledgments 
We would like to thank all the stroke patients who helped us with this study.
Conflict of interest
This study did not have any conflict of interest.
Full-Text [PDF 881 kb]   (55 Downloads)    
Type of Study: Research |
Received: 2020/08/9 | Accepted: 2021/04/27 | Published: 2021/11/16

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