A Framework for Combining rTMS with Behavioral Therapy.

K Zoe Tsagaris,Douglas R Labar,Dylan J Edwards

doi:10.3389/fnsys.2016.00082

Abstract

Upon its inception, repetitive transcranial magnetic stimulation (rTMS) was delivered at rest, without regard to the potential impact of activity occurring during or around the time of stimulation. rTMS was considered an experimental intervention imposed on the brain; therefore, the myriad features that might suppress or enhance its desired effects had not yet been explored. The field of rTMS has since grown substantially and therapeutic benefits have been reported, albeit with modest and inconsistent improvements. Work in this field accelerated following approval of a psychiatric application (depression), and it is now expanding to other applications and disciplines. In the last decade, experimental enquiry has sought new ways to improve the therapeutic benefits of rTMS, intended to enhance underlying brain reorganization and functional recovery by combining it with behavioral therapy. This concept is appealing, but poorly defined and requires clarity. We provide an overview of how combined rTMS and behavioral therapy has been delineated in the literature, highlighting the diversity of approaches. We outline a framework for study design and reporting such that the effects of this emerging method can be better understood.

Highlights

The brain is never at rest; the default-mode network comprised of coherent and connected brain networks, operative at times of behavioral rest, has been examined through the use of blood oxygenation level-dependent (BOLD) signals
For future research and reporting, we propose the temporal relationship of repetitive transcranial magnetic stimulation (rTMS) application with behavioral intervention be defined as: concurrent; sequential, interleaved (Figure 2)
Combined therapy of rTMS paired with behavioral intervention has gained traction in the scientific field

Summary

A Framework for Combining rTMS with Behavioral Therapy

The field of rTMS has since grown substantially and therapeutic benefits have been reported, albeit with modest and inconsistent improvements. Work in this field accelerated following approval of a psychiatric application (depression), and it is expanding to other applications and disciplines. Experimental enquiry has sought new ways to improve the therapeutic benefits of rTMS, intended to enhance underlying brain reorganization and functional recovery by combining it with behavioral therapy. This concept is appealing, but poorly defined and requires clarity.

INTRODUCTION

Background

Findings

CONCLUSION