Therapeutic Neuromodulation Weblog
Information on therapeutic neuromodulation for and by ISTS members
August 15th, 2007
PMID: 17675907
TITLE: [Efficacy of repetitive transcranial magnetic stimulation (rTMS) in major depression : a review.]
AUTHORS: J Brunelin, E Poulet, C Boeuve, H Zeroug-Vial, T D'amato, M Saoud
AFFILIATION: EA 3092, UCBL, Professeur J. Daléry, CH "Le Vinatier", 95, boulevard Pinel, 69677 Bron cedex.
REFERENCE: Encephale 2007 Mar-Apr 33(2):126-34
Introduction. In 1985, Barker et al. showed that it was possible to
stimulate both nerves and brain using external magnetic stimulation
without significant pain. During the past 10 years, therapeutic effects
of repeated Transcranial Magnetic Stimulation (rTMS) have been widely
studied in psychiatry and its efficacy has been demonstrated in the
treatment of major depressive disorders, particularly as an alternative
to electroconvulsivotherapy (ECT). Facing the large range of studies, we
found necessary to propose an up-to-date review in French of the
methodological and therapeutic variations among them. Method. Based on
an exhaustive consultation of Medline data and the The Avery-George-
Holtzheimer Database of rTMS Depression -Studies, supplemented by a
manual research, only works evaluating the therapeutic efficacy of rTMS
on depressive symptoms were retained, excluding all studies exclusively
investigating the stimulation parameters or the tolerance as well as
case reports. RESULTS: Out the 66 available reports we retained 30
studies. After a description of the main results of these 30 studies,
several elements of the 66 will be discussed. Open studies demonstrated
that short courses rTMS (5 to 10 sessions) produced a decrease in the
mean Hamilton Depression Ratting Scale (HDRS) scores, although
significant remission of depression in individuals was rare. Most
authors had used high frequency rTMS applied to the left Dorso Lateral
Prefrontal Cortex (left DLPFC). However, low frequency rTMS applied to
the right DLPFC was also followed by significant reduction of HDRS
scores. Parallel arm, double blind versus placebo studies are designed
to clarify the therapeutic efficacy of rTMS therapy but conclude in
contradicting results. Literature data globally confirms a greater
efficacy of rTMS compared to placebo (37% responders in the active group
vs 20% in the sham). This efficacy could in fact be even greater
because the sham procedure is disputable in most studies. Indeed,
positioning rTMS coil at 45 or 90 from the scalp may not represent an
accurate sham procedure and the use of real sham coil is to be
recommended. Only one study has suggested that associating rTMS and ECT
could decrease the number of general anesthesia required. Therapeutic
efficacy has been shown by either inhibiting the right DLPFC or by
stimulating the left DLPFC, although some patients exhibit paradoxical
responses. High frequency rTMS (>5 Hz) increases cortical excitability
and metabolism, while low-frequency rTMS stimulation ( 1 Hz) has the
opposite effect. Other parameters are: relevant: intensity (from 80 to
110% of motor threshold), total number of stimulations (from 120 to 2
000) and total number of rTMS sessions (from 5 to 20). As suggested in
most recent studies, higher-intensity pulses, higher number of
stimulation or longer treatment courses may be more effective. Greater
responsiveness to rTMS may be predicted by several patients' factors,
including the absence of psychosis, younger age and previous response to
rTMS therapy. DISCUSSION: Conclusions on these factors and others, such
as the importance of anatomically accurate coil placement and the
distance from the coil to the brain, await further investigation.
Despite heterogeneity of these reports according to methodology and
treatment parameters, the antidepressive properties of rTMS now appear
obvious, opening interesting prospects, in particular in the treatment
of pharmacoresistant major depressive patients and, we hope,
administered as adjuvant therapy in non-resistant depression . CONCLUSION: Thus, many questions remain unanswered concerning the optimal stimulation parameters, pri-vileged indications and maintenance sessions. This justifies the development of structured evaluation trials on
larger samples.
Posted in Scientific Literature | No Comments »
August 15th, 2007
PMID: 17605764
TITLE: Transcranial magnetic stimulation for the treatment of tinnitus: effects on cortical excitability.
AUTHORS: Berthold Langguth, Tobias Kleinjung, Joerg Marienhagen, Harald Binder, Philipp G Sand, Göran Hajak, Peter Eichhammer
AFFILIATION: Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany. Berthold.Langguth@medbo.de
REFERENCE: BMC Neurosci 2007 8():45
BACKGROUND: Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an innovative treatment for chronic tinnitus. The aim of the present study was to elucidate the underlying mechanism and to evaluate the relationship between clinical outcome and changes
in cortical excitability. We investigated ten patients with chronic tinnitus who participated in a sham-controlled crossover treatment trial. Magnetic -resonance-imaging and positron-emission-tomography guided 1
Hz rTMS were performed over the auditory cortex on 5 consecutive days.
Active and sham treatments were separated by one week. Parameters of
cortical excitability (motor thresholds, intracortical inhibition,
intracortical facilitation, cortical silent period) were measured
serially before and after rTMS treatment by using single- and paired-
pulse transcranial magnetic stimulation. Clinical improvement was
assessed with a standardized tinnitus-questionnaire. RESULTS: We noted a
significant interaction between treatment response and changes in motor
cortex excitability during active rTMS. Specifically, clinical
improvement was associated with an increase in intracortical inhibition
, intracortical facilitation and a prolongation of the cortical silent
period. These results indicate that intraindividual changes in cortical
excitability may serve as a correlate of response to rTMS treatment.
CONCLUSION: The observed alterations of cortical excitability suggest
that low frequency rTMS may evoke long-term- depression like effects
resulting in an improvement of subcortical inhibitory function.
Posted in Scientific Literature | No Comments »
August 10th, 2007
PMID: 17652560
TITLE: Repetitive transcranial magnetic stimulation is not as effective as electroconvulsive therapy for major depression.
AUTHORS: Paul B Fitzgerald
AFFILIATION: Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychiatry, Psychology and Psychological Medicine, Melbourne, Australia.
REFERENCE: Evid Based Ment Health 2007 Aug 10(3):78
Posted in Scientific Literature | No Comments »
August 10th, 2007
PMID: 17655558
TITLE: Neurostimulation therapies in depression: a review of new modalities.
AUTHORS: L B Marangell, M Martinez, R A Jurdi, H Zboyan
AFFILIATION: Department of Psychiatry, Baylor College of Medicine, and the South Central Mental Illness Research and Clinical Core, Department of Veterans Affairs, Houston, TX, USA.
REFERENCE: Acta Psychiatr Scand 2007 Sep 116(3):174-81
Objective: In response to an increased understanding of the neurobiology of severe psychiatric disorders, new therapeutic modalities are entering clinical practice that involve the direct stimulation of the brain. Method: We provide a review of published literature regarding the clinical use of vagus nerve stimulation (VNS) therapy, transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) in psychiatric disorders, with an emphasis on treatment-resistant depression (TRD). Results: Vagus nerve stimulation is approved for use in both the EU and US for TRD. TMS has been approved for TRD in Canada , Australia , New Zealand , the European Union and Israel , but not yet in the United States . DBS remains in the early stages of investigation. Conclusion: While additional studies are clearly warranted, treatments that directly stimulate the brain appear to hold great therapeutic promise for severe psychiatric disorders.
Posted in Scientific Literature | No Comments »
August 10th, 2007
PMID: 17655557
TITLE: Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent vs. the earlier rTMS studies.
AUTHORS: M Gross, L Nakamura, A Pascual-Leone, F Fregni
AFFILIATION: Department of Psychiatry, University of Sà £o Paulo, São Paulo , Brazil .
REFERENCE: Acta Psychiatr Scand 2007 Sep 116(3):165-73
Objective: To investigate whether the recent repetitive transcranial magnetic stimulation (rTMS) studies on depression using new parameters of stimulation have shown improved clinical results. Method: We performed a systematic review and a meta-analysis of the rTMS studies on depression published in the past 12 months comparing these results with an earlier meta-analysis that analyzed the results of the initial rTMS studies on depression. Results: Using our inclusion criteria, we selected the meta-analysis of Martin [Br J Psychiatry (2003) Vol. 182, 480-491] that included 13 studies (324 patients) and five studies for the recent meta-analysis (274 patients). The pooled effect size ( standardized mean difference between pretreatment vs. post-treatment) from the random effects model was -0.76 (95% confidence interval, CI, -1 .01 to -0.51). This result was significantly larger than that of the earlier meta-analysis (-0.35, 95% CI -0.66 to -0.04). Conclusion: Our findings suggest that recent rTMS clinical trials have shown larger antidepressant effects when compared with the earlier studies.
Posted in Scientific Literature | No Comments »
August 10th, 2007
PMID: 11692974
TITLE: Transcranial magnetic stimulation in the treatment of mood disorder: a review and comparison with electroconvulsive therapy.
AUTHORS: G Hasey
AFFILIATION: Regional Mood Disorders Program, Department of Psychiatry, McMaster University , Hamilton , Ontario , Canada .
REFERENCE: Can J Psychiatry 2001 Oct 46(8):720-7
OBJECTIVE: To review repetitive transcranial magnetic stimulation (rTMS ) as a mode of therapy for depression. METHOD: The following aspects of rTMS were reviewed and compared with electroconvulsive therapy (ECT): history, basic principles, technical considerations, possible mode of action, safety, adverse effects, and effects on mood in both healthy individuals and those suffering from bipolar disorder (BD) or depression . RESULTS: rTMS may selectively increase or decrease neuronal activity over discrete brain regions. As a result of this focused intervention with TMS, the potential for unwanted side effects is substantially reduced, compared with ECT. In open trials, rTMS and ECT are reported to be equally efficacious for patients having depression without psychosis , but the therapeutic benefits reported in double-blind sham-rTMS controlled trials are more modest. CONCLUSION: The antidepressant and antimanic effects of rTMS depend on technical considerations such as stimulus frequency, intensity, and magnetic coil placement, which may not yet be optimized. Biological heterogeneity among the patients treated with rTMS may also contribute to differing efficacy across clinical trials. rTMS may possess tremendous potential as a treatment for mood disorder, but this has not yet been realized. rTMS must still be regarded as an experimental intervention requiring further refinement.
Posted in Scientific Literature | No Comments »
August 10th, 2007
PMID: 17202547
TITLE: A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression.
AUTHORS: Savitha Eranti, Andrew Mogg, Graham Pluck, Sabine Landau, Rick Purvis, Richard G Brown, Robert Howard, Martin Knapp, Michael Philpot, Sophia Rabe-Hesketh, Renee Romeo, John Rothwell, Denzil Edwards, Declan M McLoughlin
AFFILIATION: Section of Old Age Psychiatry, Department of Biostatistics and Computing, Center for the Economics of Mental Health, Institute of Psychiatry, King's College London, and Department of Psychiatry, Pembury Hospital, Invicta Community Care NHS Trust, Kent, UK.
REFERENCE: Am J Psychiatry 2007 Jan 164(1):73-81
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) has been reported to be as effective as electroconvulsive therapy (ECT) for major depression. The authors conducted a multicenter randomized, controlled trial to test the equivalence of rTMS with ECT. METHOD: Forty-six patients with major depression referred for ECT were randomly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex (N=24) or a standard course of ECT (N=22). The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale (HAM-D) and the proportion of patients with remissions ( Hamilton score , < p>
Posted in Scientific Literature | No Comments »
August 6th, 2007
Schiff et al used deep brain stimulation (DBS), a technique that has previously been used to treat Parkinson's Disease and depression, to increase the level of arousal and motor control in the patient, who had been in a minimally …
Posted in Press Articles | No Comments »
July 6th, 2007
Placing an electrode pad on an open sore? Wrapping an electrical, pulse-producing brace around an arthritic knee? Using electrodes on the brain to wake up a severely brain-damaged patient? Which one of these is science fiction, which is hocus-pocus and which is for real?….
Posted in Press Articles | No Comments »
July 6th, 2007
· What is already reality today is something called neuroprosthetics, an area of neuroscience that uses artificial microdevices to replace the function of impaired nervous systems or sensory organs. Different biomedical devices implanted in the central nervous system, so-called neural interfaces, already have been developed to control motor disorders or to translate willful brain processes into specific actions by the control of external devices……
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