Excess Significance Bias in Repetitive Transcranial Magnetic Stimulation Literature for Neuropsychiatric Disorders

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that is being actively explored as a potential therapeutic modality in various neuropsychiatric disorders, such as depression, neuropathic pain, epilepsy, multiple sclerosis, and neurodegenerative disorders, including the Parkinson’s and Alzheimer’s disease. The Food and Drug Administration (FDA) approved rTMS for the treatment of major depression, migraine-associated headaches, and Obsessive Compulsive Disorder (OCD). The fact that a significant proportion of patients suffering from these disorders fail to respond to current pharmacological interventions indicates the need for alternative therapies like rTMS. Objective: The objective was to find and summarize all studies combining the use of rTMS and pharmacological interference in vitro, in order to facilitate future studies. Methods: The results of studies combining the use of rTMS with pharmacological interference in vitro were focused on. The PubMed database was searched using the terms “rTMS”, “repetitive”, “transcranial”, “magnetic”, “stimulation”, “in vitro”, “in vivo”, “cell cultures” untilMarch 2019 and 7 eligible studies were found. Results: Overall results show a synergistic effect of rTMS and pharmacotherapy in vitro with additive effectiveness, better prognosis, and superior potential management. Conclusion: The limited amount of knowledge denotes the need for additional in vitro studies on the combination of rTMS and pharmacotherapy, which could be extended to in vivo studies and ultimately help design clinical trials so as to improve the therapeutic management of patients with a wide array of neuropsychiatric disorders.

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Repetitive transcranial magnetic stimulation: an innovative medical therapy

Psychiatriki ◽

10.22365/jpsych.2021.012 ◽

2021 ◽

Author(s):

Georgios Mikellides ◽

Panayiota Michael ◽

Marianna Tantele

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Antidepressant Medication ◽

Neuropsychiatric Disorders ◽

Target Area ◽

Electromagnetic Pulses ◽

Treatment Of Depression ◽

Dorsolateral Prefrontal ◽

Michael Faraday

Repetitive Transcranial Magnetic Stimulation (rTMS) is an innovative, non-invasive and well tolerated method that could be used as a treatment option for a variety of neuropsychiatric disorders. A large number of studies, for more than 30 years, have demonstrated that is a powerful neuroscience tool for diagnostic and therapeutic purposes. rTMS is based on the phenomenon of electromagnetic mutual induction, that firstly reported by Michael Faraday in 1831. Later, in 1985, Anthony Barker and his colleagues developed the first modern transcranial magnetic stimulation (TMS) device. rTMS uses brief electromagnetic pulses generated by an insulated coil, placed over the scalp. This technique has the ability to modulate the cortical activity of the brain. Daily rTMS stimulation for several weeks has been shown to be effective in reducing symptoms of many neuropsychiatric disorders. Moreover, studies have shown that dorsolateral prefrontal cortex (DLPFC) has a crucial role in improving cognitive performance and, as a result, is a commonly used target area for the treatment of many neuropsychiatric disorders such as depression. 2008 was a significant year for TMS history, as FDA approved for first time a TMS therapy device for the clinical treatment of depression. This approval as well as the National Institute for Health and Care Excellence (NICE) recommendation on TMS for the treatment of depression in 2015 lead to the establishment of rTMS as a first-line treatment for patients that failed in at least one prior antidepressant medication, followed by FDA approvals for the treatment of migraines and OCD. This paper aims to enhance further some of the clinical usefulness of rTMS.

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