Non-invasive brain stimulation and psychiatric symptoms in neurological disorders

Abstract

Psychiatric disorders are increasingly recognized as resulting from dysfunction in distributed neural circuitry. The ability of noninvasive brain stimulation to selectively target the circuitry underlying psychiatric disorders has made them valuable tools to study and treat a growing list of conditions including treatment resistant depression, obsessive compulsive disorder, and smoking dependence. FDA approved noninvasive devices for clinical treatment in psychiatry include transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and vagus nerve stimulation (VNS). There is also a range of other noninvasive brain stimulation tools at various stages of research that show promise, including transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), and focused ultrasound (FUS). Since the initial approval of TMS in 2008, a growing number of devices, coils, and dosing strategies have become available that have the potential to reach a broader range of brain regions and accelerate therapeutic response. Research demonstrates that certain forms of TMS, when given simultaneously with cognitive training, may improve selected cognitive functions. Given the high degree of co-morbidity between neurological and psychiatric disorders, these development in noninvasive neuromodulation tools offer alternatives for neurological patients experiencing psychiatric symptoms. The availability to target neuromodulation via neuronavigation may be particularly useful in neurological patients with focal brain lesions. This presentation will review the state of the art of non-invasive neuromodulation tools in psychiatric care and will highlight the latest work with TMS for depression and cognitive function in patients with neurological disorders such as traumatic brain injury, stroke, and neurodegenerative disorders.