Low-frequency rTMS is better tolerated than high-frequency rTMS in healthy people: Empirical evidence from a single session study

Kaur, Manreena; Michael, Jessica A.; Fitzgibbon, Bernadette M.; Hoy, Kate Elizabeth; Fitzgerald, Paul B.

doi:10.1016/j.jpsychires.2019.03.015

Cited by 26 publications

(12 citation statements)

References 10 publications

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“…As expected, the difference in heart rate (mean z-scores) with high-frequency rTMS between F3 (mean ¼ 1.50 ± 3.68) and C3 (mean ¼ À0.36 ± 1.11) was significant and of medium to large effect [t (17) Fig. 2 and percentage distributions of optimal site at the individual level are shown in Table 1.…”

Section: High-frequency Ncg-tmssupporting

confidence: 64%

“…The current study aimed to replicate the findings of Iseger et al [16] on high-frequency NCG-TMS applied to the left hemisphere in a larger and independent sample. Secondarily, we aimed to evaluate the applicability of NCG-TMS for low-frequency rTMS treatment, since it is equally efficacious for depression, is better tolerated [17] and potentially safer [18,19] than high-frequency rTMS. In addition, a low-frequency NCG-TMS protocol allows for a longer period of concurrent heart rate recording during rTMS, therefore allowing us to further assess the value of heart-rate variability measures for NCG-TMS as well as testing the direct effects of this rTMS protocol.…”

Section: Introductionmentioning

confidence: 99%

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Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

et al. 2020

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Background: Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiacguided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. Objective: We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. Methods: Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. Results: For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. Conclusion: Opposite patterns of heart rate activity were found for high-and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of lowfrequency NCG-TMS for rTMS site localisation is warranted.

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Section: High-frequency Ncg-tmssupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

et al. 2020

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“…Most accelerated studies to date have employed either high-frequency or intermittent theta-burst stimulation (Baeken et al, 2013; Cole et al, 2020; Fitzgerald et al, 2018; Holtzheimer et al, 2010; LOO et al, 2007). However, 1 Hz right DLPFC protocols have shown better tolerability (Kaur et al, 2019) and similar efficacy to high-frequency left DLPFC protocols in a recent 300-person study on a once-daily regimen (Fitzgerald et al, 2019b), leaving open the question of whether 1 Hz protocols may also be accelerated in a similar fashion. To date, we are only aware of 2 trials having studied 1 Hz arTMS specifically: an initial one was completed in a small patient cohort (N = 7) and used a limited number of sessions (18 over 10 days) (Tor et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…11,12 On conventional once-daily regimens, 1 Hz has shown superiority over sham, with some studies also suggesting similar efficacy to HF. [4][5][6]11,13 1 Hz also offers several potential advantages over HF, including less seizure risks 14,15 , better tolerability 16 , and the potential for implementation on simpler, lower-cost equipment 11,12 , thus possibly increasing scalability and accessibility.…”

Section: Introductionmentioning

confidence: 99%

“…On conventional once-daily regimens, 1 Hz has shown superiority over sham, with some studies also suggesting similar efficacy to HF (Berlim et al, 2012;Brunoni et al, 2017;Lefaucheur et al, 2020;Milev et al, 2016;Miron et al, 2020a). 1 Hz also offers several potential advantages over HF, including less seizure risks (Sun et al, 2012;Vila-Rodriguez et al, 2015), better tolerability (Kaur et al, 2019), and the potential for implementation on simpler, lower-cost equipment (Miron et al, 2020b(Miron et al, , 2020a, thus possibly increasing scalability and accessibility.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Miron

Hyde

Fox

et al. 2020

Preprint

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BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an effective intervention in major depressive disorder (MDD) but requires daily travel to a treatment clinic over several weeks. Shorter rTMS courses retaining similar effectiveness would thus increase the practicality and scalability of the technique, and therefore its accessibility. OBJECTIVE We assessed the feasibility of a novel 5 day accelerated 1 Hz rTMS protocol. We hypothesized that this novel rTMS protocol would be safe and well-tolerated while shortening the overall treatment course. METHODS We conducted a prospective, single-arm, open-label feasibility study. Thirty (30) participants received a one-week (5 days) accelerated (8 sessions per day, 40 sessions total) course of 1 Hz rTMS (600 pulses per session, 50-minute intersession interval) over the right dorsolateral prefrontal cortex (R-DLPFC) using a figure-of-eight coil at 120% of the resting motor threshold (rMT). Depression severity was assessed on the Beck Depression Inventory-II (BDI-II) and 17-item Hamilton Rating Scale for Depression (HRSD-17). RESULTS Response and remission rates 1 week after treatment were 33.3% and 13.3% respectively and increased to 43.3% and 30.0% at 4 weeks after treatment. No serious adverse events occurred. All participants reported manageable pain levels. CONCLUSION 1 Hz rTMS administered 8 times daily for 5 days is safe and well-tolerated. Efficacy at the end of the course was similar to a standard daily course of 1 Hz rTMS, and there appears to be an additional delayed effect. Further validation in a randomized trial is required.

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Side Effects of rTMS Treatment

Fitzgerald

Daskalakis

2022

rTMS Treatment for Depression

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Low-frequency rTMS is better tolerated than high-frequency rTMS in healthy people: Empirical evidence from a single session study

Cited by 26 publications

References 10 publications

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

Side Effects of rTMS Treatment

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