No abstract

Depression is a common mental disorder that affects many people worldwide, while a significant proportion of patients remain non-responsive to antidepressant medications. Alternative treatment options such as ketamine therapy and repetitive transcranial magnetic stimulation (rTMS) therapy are offered nowadays. This study aims to describe and compare the acute antidepressive efficacy of both, intramuscular ketamine and rTMS in depression patients seeking help in a naturalistic clinical mental health setting. The clinical records of 24 patients with treatment resistant depression were collected from the clinical base of a real life clinic. Twelve patients were treated with intramuscular ketamine, twice weekly for 8 sessions, and twelve patients were treated with 30 sessions of left dorsolateral prefrontal cortex – intermittent theta-burst stimulation (DLPFC-iTBS). Using three clinical assessments (HDRS, HAM-A, BDI-II), our data reveal that both therapies led to significant improvement in symptoms from pre- to post- treatment, as well as that the two experimental groups did not differ significantly with respect to pre- to post- depressive and anxiety symptoms, indicating that the effect of both experimental groups in our sample was equally effective. Furthermore, our results showed high remission and response rates in both groups, with no statistical differences between the patients of ketamine group and rTMS group in remission and response rates. We show a significant pre- to post- treatment reduction in depressive and anxiety symptoms, with no significant differences between the two experimental groups, indicating that the effect of both therapies was equally effective in our limited sample.

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.

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation therapy that has become a method of choice for the treatment of several neuropsychiatric disorders such as depression and OCD. It is considered to be a safe and well-tolerated treatment, with only few side effects. The most serious adverse event during any rTMS treatment is the potential induction of a seizure. rTMS has shown very encouraging results for treatment-resistant OCD, although the optimal target area and the stimulation frequency are still matters of controversy. Here, we present a 19-year-old female patient with OCD who experienced seizure during the 7th session of her rTMS treatment using the FDA-approved 20-Hz protocol for OCD applied bilaterally over the left and right DMPFC using a double-cone coil. Nonetheless, it still unknown whether the seizure occurred as a consequence of rTMS, as the patient was also in a specific seizure risk group. Future reviews are needed to further clarify the mechanisms that may trigger seizures during rTMS treatments in order to reduce the likelihood of rTMS-induced seizures.

Epilepsy is a common and severe neurological disorder affecting millions of people worldwide. Nowadays, antiseizure medications (ASMs) are the main treatment for most epilepsy patients, although many of them do not respond to ASMs and suffer from drug-resistant epilepsy (DRE). Alternative and novel treatment methods have been offered nowadays, showing promising results for the treatment of DRE. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that has become increasingly popular in the last decades. This article reports a patient with frontal lobe epilepsy. We aimed to investigate whether bilateral orbitofrontal (OFC) low-frequency rTMS (LF-rTMS) is feasible and tolerable, safe, and potentially clinically effective in treating epileptic seizures. The patient’s satisfaction with rTMS therapy was self-reported to be high, as rTMS helped in reducing the frequency of the focal attacks and completely abolished the preceding feeling of fear and panic. Therefore, bilateral OFC rTMS treatment can be well tolerated in patients with frontal epilepsy although the findings of the present case report with regard to clinical efficacy warrant further investigation.