Clinical impacts of single transcranial magnetic stimulation (sTMS) as an add-on therapy in severely depressed patients under SSRI treatment

Conca, Andreas; Swoboda, E.; Knig, Peter; Koppi, Stefan; Beraus, W.; Knz, Arno; Fritzsche, H; Wei, Peter

doi:10.1002/1099-1077(200008)15:6<429::aid-hup227>3.0.co;2-3

Cited by 37 publications

(16 citation statements)

References 39 publications

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“…However, we did find that a slow anterior iAPF at baseline was associated with a smaller decrease of comorbid depressive complaints as measured on the BDI in agreement with the depression literature [tricyclic antidepressants: Ulrich et al (1984), rTMS: Arns et al (2010, in press); Conca et al (2000)] supporting the notion that a slow anterior iAPF at baseline is related to worse treatment outcome on depressive complaints. In this study only few patients had an iAPF of 8 Hz or lower, whereas in Arns et al (2008, 2010) this group was larger.…”

Section: Discussionsupporting

confidence: 90%

“…Finally, ADHD patients with a slowed individual Alpha Peak Frequency (iAPF) do not respond to stimulant medication (Arns et al 2008) which presumably characterizes a non-specific trait of non-response to various treatments because deviations in this measure have also been found in non-responders (NR) to antidepressants (Ulrich et al 1984) and repetitive transcranial magnetic stimulation (rTMS) in depression (Arns et al 2010, in press; Conca et al 2000). …”

Section: Introductionmentioning

confidence: 99%

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The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

Arns

Drinkenburg

Kenemans

2012

Appl Psychophysiol Biofeedback

121

111

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In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with QEEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment. This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

Arns

Drinkenburg

Kenemans

2012

Appl Psychophysiol Biofeedback

121

111

View full text Add to dashboard Cite

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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: 99%

“…Although different studies have used various frequencies, two overall types have been used: low frequency (≤1 Hz) and high frequency (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). This distinction is important because the two types of stimulation have opposite effects on brain physiology.…”

Section: Pulse Frequency-slow Versus Fast Rtmsmentioning

confidence: 99%

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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“…It enhances short latency intracortical inhibition and reduces intracortical facilitation, but leaves the motor threshold mostly unchanged (Ziemann et al 1996a). It reduces plasticity in experimental (Fitzgerald et al 2005;Werhahn et al 2002;Ziemann et al 2001) and clinical settings (Conca et al 2000;Teo et al 2009;Wan et al 2004), e.g., after stroke, thereby worsening the functional recovery of the patients (Lazar et al 2003). DMO is an NMDA receptor antagonist, and at high dose levels it also has channel-blocking properties (Netzer et al 1993).…”

Section: Methodsmentioning

confidence: 99%

Mechanisms of human motor cortex facilitation induced by subthreshold 5-Hz repetitive transcranial magnetic stimulation

Sommer

Rummel

Norden

et al. 2013

Journal of Neurophysiology

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Our knowledge about the mechanisms of human motor cortex facilitation induced by repetitive transcranial magnetic stimulation (rTMS) is still incomplete. Here we used pharmacological conditioning with carbamazepine, dextrometorphan, lorazepam, and placebo to elucidate the type of plasticity underlying this facilitation, and to probe if mechanisms reminiscent of long-term potentiation are involved. Over the primary motor cortex of 10 healthy subjects, we applied biphasic rTMS pulses of effective posterior current direction in the brain. We used six blocks of 200 pulses at 5-Hz frequency and 90% active motor threshold intensity and controlled for corticospinal excitability changes using motor-evoked potential (MEP) amplitudes and latencies elicited by suprathreshold pulses before, in between, and after rTMS. Target muscle was the dominant abductor digiti minimi muscle; we coregistered the dominant extensor carpi radialis muscle. We found a lasting facilitation induced by this type of rTMS. The GABAergic medication lorazepam and to a lesser extent the ion channel blocker carbamazepine reduced the MEP facilitation after biphasic effective posteriorly oriented rTMS, whereas the N-methyl-d-aspartate receptor-antagonist dextrometorphan had no effect. Our main conclusion is that the mechanism of the facilitation induced by biphasic effective posterior rTMS is more likely posttetanic potentiation than long-term potentiation. Additional findings were prolonged MEP latency under carbamazepine, consistent with sodium channel blockade, and larger MEP amplitudes from extensor carpi radialis under lorazepam, suggesting GABAergic involvement in the center-surround balance of excitability.

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Clinical impacts of single transcranial magnetic stimulation (sTMS) as an add-on therapy in severely depressed patients under SSRI treatment

Cited by 37 publications

References 39 publications

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

Transcranial Magnetic Stimulation in the Treatment of Depression

Mechanisms of human motor cortex facilitation induced by subthreshold 5-Hz repetitive transcranial magnetic stimulation

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