Brain Stimulation

2021 ◽  
pp. 259-272
Author(s):  
André Aleman ◽  
Jozarni J. Dlabac-De Lange ◽  
Prasad Padala
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Direct Current ◽  
Brain Stimulation ◽  
Magnetic Stimulation ◽  
Negative Symptoms ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Modalities ◽  
Published Evidence ◽  
New Treatment

Apathy is a disabling condition with a large burden of disease and lack of effective treatments. Over the past decades, new treatment modalities have been explored, including neuromodulation with repetitive transcranial magnetic stimulation (rTMS). An accepted treatment for depression in many countries, rTMS is well tolerated and has few side effects. The published evidence indicates that rTMS can reduce apathy/negative symptoms, although effects may be modest and transient. Less evidence is available for transcranial direct current stimulation, though it may also have potential to improve apathy. Thorough studies are needed to establish moderators of effect in order to optimize treatment parameters and thereby achieve more durable and clinically relevant effects.

scholarly journals Focal brain stimulation with repetitive transcranial magnetic stimulation (rTMS): implications for the neural circuitry of depression

2002 ◽  
Vol 33 (1) ◽  
pp. 7-13 ◽  
Author(s):  
SARAH H. LISANBY
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Major Depression ◽  
Brain Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Severe Depression ◽  
Medical Procedure ◽  
Variable Degree ◽  
Cognitive Side Effects

BRAIN STIMULATION IN THE TREATMENT OF MAJOR DEPRESSIONRepetitive transcranial magnetic stimulation (rTMS) is an experimental medical procedure that is currently under investigation for its potential therapeutic value in major depression and other psychiatric and neurological disorders (Wassermann & Lisanby, 2001). The idea of using brain stimulation to treat depression dates back to the origins of ECT, and includes more recently developed techniques such as deep brain stimulation and vagus nerve stimulation. The value of brain stimulation in psychiatry is still most clearly seen in the, as yet, unparalleled efficacy of ECT in treating severe depression (American Psychiatric Association, 2001). While ECT is the most effective and most rapidly acting treatment for depression, it also causes a variable degree of undesirable cognitive side effects that limit its clinical utility and prevent many patients who could benefit from receiving this often life-saving treatment (McElhiney et al. 1995; Lisanby et al. 2000b). The search for an effective somatic treatment for medication resistant depression with fewer cognitive side effects than ECT has motivated much of the work with rTMS in psychiatry.

scholarly journals Comparing the Effects of Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy in the Treatment of Depression: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Beppe Micallef-Trigona
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Magnetic Stimulation ◽  
Rating Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Severe Depression ◽  
Treatment Modalities ◽  
Treatment Of Depression

Electroconvulsive therapy (ECT) is the longest standing psychiatric treatment available and has unequivocal benefit in severe depression. However this treatment comes with a number of side effects such as memory impairment. On the other hand, Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new form of treatment which has been shown to be efficacious in patients suffering from a number of psychopathologies, including severe depression, with few reported side effects. Due to its potential therapeutic efficacy and lack of side effects, rTMS has gained traction in the treatment of depression, with a number of authors keen to see it take over from ECT. However, it is not clear whether rTMS represents a therapeutic alternative to ECT. This meta-analysis will therefore compare the “gold standard” treatment for severe depression, with the relatively new but promising rTMS. A literature search will be performed with the intention to include all randomised clinical trials. The null hypothesis is that there is no difference in the antidepressant efficacy between the two types of treatment modalities. Statistical analysis of Hamilton Depression Rating Scale (HDRS) scores will be performed.

scholarly journals Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hyune June Lee ◽  
Sung Min Kim ◽  
Ji Yean Kwon
Keyword(s):  
Systematic Review ◽  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Effect Size ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Peripartum Depression

Abstract Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

scholarly journals Safety and tolerability of repeated sessions of deep transcranial magnetic stimulation in obesity

Endocrine ◽  
2020 ◽  
Author(s):  
Anna Ferrulli ◽  
Stefano Massarini ◽  
Concetta Macrì ◽  
Livio Luzi
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Magnetic Stimulation ◽  
Weight Control ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Hypertensive Crisis ◽  
Experimental Treatment ◽  
Moderate Intensity ◽  
Good Tolerability ◽  
Local Pain

Abstract Purpose Repetitive Transcranial Magnetic Stimulation (rTMS) has been demonstrated to be effective in body weight control in individuals with obesity. Most clinical trials on rTMS provided a reassuring safety profile. In the present work, we present an extensive analysis on both severe and mild Adverse Events (AEs) in obese individuals treated with rTMS. Methods We examined the intensity, duration, correlation with the treatment, up to 1 year after the end of rTMS treatment. Results Descriptive analysis included a total of 63 subjects undergoing a 5-week deep rTMS experimental treatment for obesity (age 48.3 ± 10.4 years; BMI 36.3 ± 4.4 kg/m2): 31 patients were treated with high-frequency rTMS (HF), 13 with low-frequency rTMS (LF), and 19 were sham treated (Sham). Thirty-two subjects (50.8%) reported a total of 52 AEs, including mainly moderate (51.9%) events. The most frequently reported side effects were headaches of moderate intensity (40.4%) and local pain/discomfort (19.2%) and resulted significantly more frequent in HF group compared to other groups (p < 0.05). No significant differences among groups were found for the other reported AEs: drowsiness, insomnia, paresthesia, vasovagal reactions, hypertensive crisis. No AEs potentially related to the rTMS arised up to 1 year from the end of the treatment. Conclusions This is the first comprehensive safety analysis in obese patients treated with rTMS. The analysis did not reveal any unexpected safety concerns. Only headaches and local pain/discomfort have been significantly more frequent in the HF group, confirming the good tolerability of rTMS even in the obese population potentially more susceptible to side effects of brain stimulation.

scholarly journals Repetitive transcranial magnetic stimulation in the treatment of bipolar disorder

2020 ◽  
Vol 10 ◽  
pp. 204512532097379
Author(s):  
Danielle Hett ◽  
Steven Marwaha
Keyword(s):  
Bipolar Disorder ◽  
Transcranial Magnetic Stimulation ◽  
Side Effects ◽  
Magnetic Stimulation ◽  
Sleep Problems ◽  
Bipolar Depression ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Total N ◽  
Depressive Episodes

Bipolar disorder (BD) is a debilitating mood disorder marked by manic, hypomanic and/or mixed or depressive episodes. It affects approximately 1–2% of the population and is linked to high rates of suicide, functional impairment and poorer quality of life. Presently, treatment options for BD are limited. There is a strong evidence base for pharmacological (e.g., lithium) and psychological (e.g., psychoeducation) treatments; however, both of these pose challenges for treatment outcomes (e.g., non-response, side-effects, limited access). Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is a recommended treatment for unipolar depression, but it is unclear whether rTMS is an effective, safe and well tolerated treatment in people with BD. This article reviews the extant literature on the use of rTMS to treat BD across different mood states. We found 34 studies in total ( N = 611 patients), with most assessing bipolar depression ( n = 26), versus bipolar mania ( n = 5), mixed state bipolar ( n = 2) or those not in a current affective episode ( n = 1). Across all studies, there appears to be a detectable signal of efficacy for rTMS treatment, as most studies report that rTMS treatment reduced bipolar symptoms. Importantly, within the randomised controlled trial (RCT) study designs, most reported that rTMS was not superior to sham in the treatment of bipolar depression. However, these RCTs are based on small samples ( NBD ⩽ 52). Reported side effects of rTMS in BD include headache, dizziness and sleep problems. Ten studies ( N = 14 patients) reported cases of affective switching; however, no clear pattern of potential risk factors for affective switching emerged. Future adequately powered, sham-controlled trials are needed to establish the ideal rTMS treatment parameters to help better determine the efficacy of rTMS for the treatment of BD.

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