Multiple Target Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Neurofeedback for Complete Resolution of Severe OCD, Bipolar Depression, and Anxiety

A core feature of drug-resistant epilepsy is hyperexcitability in the motor cortex, and low-frequency repetitive transcranial magnetic stimulation (rTMS) is a suitable treatment for seizures. However, the antiepileptic effect causing network reorganization has rarely been studied. Here, we assessed the impact of rTMS on functional network connectivity (FNC) in resting functional networks (RSNs) and their relation to treatment response. Fourteen patients with medically intractable epilepsy received inhibitive rTMS with a figure-of-eight coil over the vertex for 10 days spread across two weeks. We designed a 6-week follow-up phase divided into four time points to investigate FNC and rTMS-induced timing-dependent plasticity, such as seizure frequency and abnormal interictal discharges on electroencephalography (EEG). For psychiatric comorbidities, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were applied to measure depression and anxiety before and after rTMS. FNC was also compared to that of a cohort of 17 healthy control subjects. The after-effects of rTMS included all subjects that achieved the significant decrease rate of more than 50% in interictal epileptiform discharges and seizure frequency, 12 (14) patients with the reduction rate above 50% compared to the baseline, as well as emotional improvements in depression and anxiety (p < 0.05). In the analysis of RSNs, we found a higher synchronization between the sensorimotor network (SMN) and posterior default-mode network (pDMN) in epileptic patients than in healthy controls. In contrast to pre-rTMS, the results demonstrated a weaker FNC between the anterior DMN (aDMN) and SMN after rTMS, while the FNC between the aDMN and dorsal attention network (DAN) was greater (p < 0.05, FDR corrected). Importantly, the depressive score was anticorrelated with the FNC of the aDMN-SMN (r = −0.67, p = 0.0022), which was markedly different in the good and bad response groups treated with rTMS (p = 0.0115). Based on the vertex suppression by rTMS, it is possible to achieve temporary clinical efficacy by modulating network reorganization in the DMN and SMN for patients with refractory epilepsy.

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Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Depression

Journal of Psychiatric Practice ◽

10.1097/pra.0000000000000447 ◽

2020 ◽

Vol 26 (1) ◽

pp. 37-45 ◽

Cited By ~ 1

Author(s):

ANGELA L. PHILLIPS ◽

ROBERT L. BURR ◽

DAVID L. DUNNER

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Bipolar Depression ◽

Repetitive Transcranial Magnetic Stimulation

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Pain Psychiatry of Trigeminal Neuralgia

Effective Techniques for Managing Trigeminal Neuralgia - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-5349-6.ch012 ◽

2018 ◽

pp. 243-264

Author(s):

Lily H. Kim ◽

Michael Bret Schneider

Keyword(s):

Transcranial Magnetic Stimulation ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Depression And Anxiety ◽

Surgical Interventions ◽

Holistic Treatment ◽

Carbamazepine Therapy ◽

High Incidence

In addition to the repeated episodes of paroxysmal, electrical facial pain classically associated with the disease, many patients with trigeminal neuralgia (TN) suffer from severe emotional distress. At present, there is no universally agreed pathophysiological explanation for the high incidence of depression and anxiety within this patient population. Despite the unclear understanding, the psychiatric comorbidities should be addressed as a part of comprehensive, multi-modal approach. Anticonvulsants or serotonin and norepineprhine reuptake inhibitors are viable pharmacological options that can supplement the currently used carbamazepine therapy. For medically refractory cases, surgical interventions are being suggested as effective alternatives in managing both the pain and the psychiatric complaints of TN. Examples include microvascular decompression, stereotactic radiosurgery, and repetitive transcranial magnetic stimulation. Continued research to understand TN should take into account the psychiatric burden in this population in order to promote a holistic treatment approach.

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Repetitive transcranial magnetic stimulation in the treatment of bipolar disorder

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320973790 ◽

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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