Application of transcranial magnetic stimulation in treatment of drug‐resistant major depression—a report of two cases

Höflich, G.; Kasper, S.; Hufnagel, A.; Ruhrmann, Stephan; Moller, Henry J.

doi:10.1002/hup.470080510

Cited by 210 publications

(90 citation statements)

References 14 publications

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“…Several early case reports (14) and reports of single pulses or very slow trains of TMS applied to multiple sites (15)(16)(17) or at the vertex (18) produced encouraging initial results. In the wake of these studies, more rigorous studies were performed in which sequences of repetitive transcranial magnetic stimulation (rTMS) were applied to one brain region.…”

Section: Clinical Resultsmentioning

confidence: 98%

Transcranial Magnetic Stimulation in the Treatment of Depression

Gershon

Dannon²,

Grunhaus³

2003

AJP

459

246

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Objective: Transcranial magnetic stimulation (TMS) is a noninvasive and easily tolerated method of altering cortical physiology. The authors evaluate evidence from the last decade supporting a possible role for TMS in the treatment of depression and explore clinical and technical considerations that might bear on treatment success. Method:The authors review English-language controlled studies of nonconvulsive TMS therapy for depression that appeared in the MEDLINE database through early 2002, as well as one study that was in press in 2002 and was published in 2003. In addition, the authors discuss studies that have examined technical, methodological, and clinical treatment parameters of TMS. Results:Most data support an antidepressant effect of high-frequency repetitive TMS administered to the left prefrontal cortex. The absence of psychosis, younger age, and certain brain physiologic markers might predict treatment success. Technical parameters possibly affecting treatment success include intensity and duration of treatment, but these suggestions require systematic testing.Conclusions: TMS shows promise as a novel antidepressant treatment. Systematic and large-scale studies are needed to identify patient populations most likely to benefit and treatment parameters most likely to produce success. In addition to its potential clinical role, TMS promises to provide insights into the pathophysiology of depression through research designs in which the ability of TMS to alter brain activity is coupled with functional neuroimaging. (Am J Psychiatry 2003; 160:835-845)In 1831, Michael Faraday discovered that electrical currents can be converted into magnetic fields and vice versa. His principle of mutual induction is the basis of transcranial magnetic stimulation (TMS). In TMS, a bank of capacitors is rapidly discharged into an electric coil to produce a magnetic field pulse (Figure 1). When the coil is placed near the head of a human or animal, the magnetic field penetrates the brain and induces an electric field in the underlying region of the cerebral cortex (4) (Figure 2). An electrical field of sufficient intensity will depolarize cortical neurons, generating action potentials. These then propagate to exert their biological effects. For example, TMS over the left motor cortex causes action potentials that propagate through the corticospinal tract, causing twitches in contralateral skeletal muscles.This new technology has been used to affect underlying brain tissue at several levels. First, TMS can alter regional activity within the cortex. Positron emission tomography (PET) has revealed changes in cortical metabolism and dose-dependent changes in regional cortical blood flow in response to TMS (5-7). Such changes are also observed at sites distant from the magnetic stimulus, showing that the effects of TMS propagate to other parts of the brain (6, 7). The connections demonstrated in this manner correspond to known neural pathways in nonhuman primates, suggesting that the propagation of TMS effects occurs by means of...

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Section: Clinical Resultsmentioning

confidence: 98%

Transcranial Magnetic Stimulation in the Treatment of Depression

Gershon

Dannon²,

Grunhaus³

2003

AJP

459

246

View full text Add to dashboard Cite

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“…This was the starting point of the scientific investigation of effects of depolarizing magnetic fields in a variety of neuropsychiatric disorders. Soon after, open studies of the effects of TMS on patients with major depression were conducted using single-pulse stimulations at frequencies less than 0.3 Hz (Grisaru et al, 1994;Höflich et al, 1993;Kolbinger et al, 1995). In these studies, relatively large areas under the vertex were stimulated bilaterally and involved only very few subjects.…”

Section: Principle Of Transcranial Magnetic Stimulationmentioning

confidence: 99%

Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Affective Disorders

Schläepfer

Kosel²,

Nemeroff

2002

Neuropsychopharmacol

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Transcranial magnetic stimulation (TMS) is a relatively noninvasive technique to interfere with the function of small cortical areas through currents induced by alternating magnetic fields emanating from a handheld coil placed directly above the targeted area. This technique has clear effects on a whole range of measures of brain function and has become an important research tool in neuropsychiatry. More recently, TMS has been studied in psychiatry mainly to assess its putative therapeutic effects in treatment refractory major depression. Most studies indicate that both low-frequency TMS and higher (20 Hz) frequency repetitive TMS may have some antidepressant properties. However, definite therapeutic effects of clinical significance still remain to be demonstrated.

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“…В первых исследованиях эффективности рТМС в ле-чении депрессии [143,144], которые начались еще в 90-х годах, в качестве мишени для стимуляции использовали вертекс. Однако в 1996 г. в экспериментах на здоровых до-бровольцах [145] было показано, что стимуляция пре-фронтальных зон вызывает изменение настроения.…”

Section: депрессияunclassified