Frequency Repetitive Transcranial Magnetic Stimulation Research Articles

Application of Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome: A Pilot Study

ObjectiveTo explore effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on restless legs syndrome (RLS) patients. Methods18 primary RLS patients were divided into rTMS group and sham stimulation group. rTMS treatment group received 15 Hz high-frequency rTMS to stimulate the leg motor representative area of the frontal cortex for 14 days and the sham stimulation group received 15 Hz high-frequency rTMS sham stimulation in primary motor cortex for 14 days. ResultsAfter rTMS, RLS severity scale score, Pittsburgh sleep quality index (PSQI), Hamilton anxiety scale (HAMA) as well as Hamilton depression scale (HAMD24) in rTMS treatment group are significantly lower than before treatment; 1 month and 2 months after treatment, the score remained at low level. Meanwhile, no significant changes have been observed in the above index before rTMS stimulation for the sham stimulation group after 14 days, after 1 month and 2 months. In addition, the results of correlation analysis suggested for all the 18 RLS patients, there was a positive correlation between PSQI score and HAMA as well as HAMD24 scores before and after rTMS stimulation. In addition, the RLS severity score was also positively correlated with PSQI, HAMA and HAMD24 scores. ConclusionsHigh frequency rTMS stimulation reduces the frequency and severity of RLS, improves the quality of sleep, anxiety as well as depression of the patients, and the curative effect can sustain for 2 months. High-frequency rTMS may be used as an alternative treatment option for improving the RLS patients’ quality of life.

Effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the balance and the white matter integrity in patients with relapsing-remitting multiple sclerosis: A long-term follow-up study

ObjectivesRepetitive Transcranial Magnetic Stimulation (rTMS) is considered as a safe and non-invasive developing technique used as a therapeutic method for patients with Relapsing-Remitting Multiple Sclerosis (RRMS) who suffer from disturbances in gait and balance. The aim of our study is to evaluate the long-term effect of high frequency rTMS as a therapeutic option for truncal ataxia in RRMS patients and to assess its impact on the integrity of the white matter (WMI), measured in the form of anisotropy metrics using diffusion tensor imaging (DTI). MethodsThe study was conducted in two phases: phase I; a randomized, single-blind, sham-controlled phase and phase II was a 12 months longitudinal open-label prospective phase. Phase I of the trial involved the randomization of 43 patients with RRMS and truncal ataxia to either real (n = 20) or sham (n = 19) rTMS (2 participants from each treatment group were excluded from the study; one developed a relapse before treatment, 2 declined to participate, and one did not show up). Phase II involved providing 12 actual treatments cycles to all patients; each cycle length is 4 weeks, repeated four times on a trimonthly basis, forming a total of 48 sessions. DTI was used for assessment of the WMI. All patients performed DTI 3 times: Imaging sessions were conducted at the screening visit, at the end of phase I, and after the last session in phase II for the first, second and third sessions respectively. A figure-of-8-shape coil, employing rTMS protocol and located over the cerebellum, was used. rTMS protocol is formed of 20 trains formed of 50 stimuli with 20 s apart (5 Hz of 80 % of resting Motor Threshold “MT”). The Berg Balance Scale (BBS), Time up and go (TUG) test, and 10-m walk test (10MWT) were first evaluated at the start of each cycle and just after the final rTMS session. ResultsThe genuine rTMS group's 10MWT, TUG, and BBS showed substantial improvement (p < 0.01), which is continued to be improved throughout the study Timeline, with a significant difference observed following the final rTMS session (P< 0.001). A longitudinal increase in FA was observed in both the Cerebello-Thalamo-Cortical (CTC) and Cortico-Ponto-Cerebellar (CPC) bilateral, as indicated by means of Fractional Anisotropy (FA) measures (p < 0.05). ConclusionIn ataxic RRMS patients, high frequency rTMS over the cerebellum has a long-term beneficial impact on both balance and WMI.

Retracted: Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Hyperbaric Oxygen (HBO) on Awakening of Coma Patients with Traumatic Brain Injury.

[This retracts the article DOI: 10.1155/2022/6133626.].

Alterations in brain connectivity patterns in schizophrenia patients with auditory verbal hallucinations during low frequency repetitive transcranial magnetic stimulation

ObjectiveAuditory verbal hallucinations (AVH) are a characteristic symptom of schizophrenia. Although low-frequency repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to alleviate the severity of AVH, its exact neurophysiological mechanisms remain unclear. This study aimed to elucidate the alterations in brain connectivity patterns in schizophrenia patients with AVH after low frequency rTMS. Furthermore, the relationship between these alterations and clinical outcomes was examined, thereby identifying potential biomarkers for rTMS treatment efficacy. MethodsA total of 30 schizophrenia patients with AVH and 33 healthy controls were recruited. The patients received 1 Hz rTMS applied to the left temporoparietal junction region over 15 days. Resting-state functional magnetic resonance imaging scans were conducted for all participants. Subsequently, degree centrality (DC) and seed-based functional connectivity (FC) analyses were employed to identify specific alterations in brain connectivity patterns after rTMS treatment. ResultsAt baseline, patients exhibited divergent DC patterns in the frontal, occipital, and limbic lobes compared to healthy controls. In addition, prior to treatment, patients demonstrated altered FC from the superior frontal gyrus seeds that linked to the frontal, temporal, and somatosensory regions. Following rTMS treatment, these abnormalities were notably reversed, correlating with improved clinical outcomes. ConclusionsThese findings demonstrate that schizophrenia patients with AVH exhibited atypical interactions within the frontal and temporal lobes. These alterations might be crucial biomarkers for predicting the efficacy of low frequency rTMS.

Prolonged continuous theta burst stimulation increases motor corticospinal excitability and intracortical inhibition in patients with neuropathic pain: An exploratory, single-blinded, randomized controlled trial

ObjectivesA new paradigm for Transcranial Magnetic Stimulation (TMS), referred to as prolonged continuous theta burst stimulation (pcTBS), has recently received attention in the literature because of its advantages over high frequency repetitive TMS (HF-rTMS). Clinical advantages include less time per intervention session and the effects appear to be more robust and reproducible than HF-rTMS to modulate cortical excitability. HF-rTMS targeted at the primary motor cortex (M1) has demonstrated analgesic effects in patients with neuropathic pain but their mechanisms of action are unclear and pcTBS has been studied in healthy subjects only. This study examined the neural mechanisms that have been proposed to play a role in explaining the effects of pcTBS targeted at the M1 and DLPFC brain regions in neuropathic pain (NP) patients with Type 2 diabetes. MethodsForty-two patients with painful diabetic neuropathy were randomized to receive a single session of pcTBS targeted at the left M1 or left DLPFC. pcTBS stimulation consisted of 1,200 pulses delivered in 1 min and 44 s with a 35–45 min gap between sham and active pcTBS stimulation. Both the activity of the descending pain system which was examined using conditioned pain modulation and the activity of the ascending pain system which was assessed using temporal summation of pain were recorded using a handheld pressure algometer by measuring pressure pain thresholds. The amplitude of the motor evoked potential (MEP) was used to measure motor corticospinal excitability and GABA activity was assessed using short (SICI) and long intracortical inhibition (LICI). All these measurements were performed at baseline and post-pcTBS stimulation. ResultsFollowing a single session of pcTBS targeted at M1 and DLPFC, there was no change in BPI-DN scores and on the activity of the descending (measured using conditioned pain modulation) and ascending pain systems (measured using temporal summation of pain) compared to baseline but there was a significant improvement of >13% in perception of acute pain intensity, increased motor corticospinal excitability (measured using MEP amplitude) and intracortical inhibition (measured using SICI and LICI). ConclusionIn patients with NP, a single session of pcTBS targeted at the M1 and DLPFC modulated the neurophysiological mechanisms related to motor corticospinal excitability and neurochemical mechanisms linked to GABA activity, but it did not modulate the activity of the ascending and descending endogenous modulatory systems. In addition, although BPI-DN scores did not change, there was a 13% improvement in self-reported perception of acute pain intensity.

Effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on brain function of pediatric patients with spastic cerebral palsy

ObjectiveTo observe the changes of Electroencephalogram (EEG) spectrum in children with spastic cerebral palsy before and after treatment, and to analyze the effects of scalp acupuncture combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) therapy on brain function. MethodsFrom January 2021 to December 2022, 90 children aged 2–6 with spastic cerebral palsy were treated at our hospital. The patients were divided into treatment and control groups. The treatment group (combined group, n = 30) received scalp acupuncture combined with low-frequency rTMS treatment. The control group received only scalp acupuncture treatment (n = 30) or rTMS treatment (n = 30). The Gross Motor Function Measure (GMFM), the modified Ashworth spasticity scale, and the Gesell scale were used to assess the motor and developmental functions of pediatric patients with spastic cerebral palsy in each group. ResultsThe patients in the three groups showed different degrees of improvement in EEG after treatment, mainly in wave amplitude reduction, background rhythm slowdown, background rhythm asymmetry improvement and spike and multi-spike/slow wave distribution reduction. The improvement in the scalp-acupuncture combined with low-frequency rTMS group was more significant than that in the other two groups. The GMFCS classification, modified Ashworth score, D and E areas of GMFM, and adaptability, gross motor, and language in Gesell Developmental Diagnostic Scale (GDDS) improved in all three groups after treatment (P < 0.05). In the combined group, the improvement in the modified Ashworth score, the E area of GMFM, and the adaptation, gross motor, and language in the GDDS was more significant than that in the other two groups (P < 0.05). ConclusionBy combining scalp acupuncture with low-frequency rTMS to treat children with spastic cerebral palsy, the brain function is improved by bringing the EEG spectrum towards the normal range, thus improving the mental and developmental functions of the child.

High frequencies (HF) repetitive transcranial magnetic stimulation (rTMS) increase motor coordination performances in volleyball players

IntroductionIt is widely demonstrated that high frequency (HF) repetitive transcranial magnetic stimulation (rTMS) has facilitative effects and is therefore capable to inducing changes in motor responses. One of the most investigated areas is the dorsolateral prefrontal cortex (DLPFC) as it plays a special executive attention role in actively preserving access to stimulus representations and objectives in environments with plenty of distraction such as those of team sports. Volleyball is a team sport in which the attention and coordination components are essential for achieving performance. Thus, the aim of this study was to investigate if HF rTMS at DLPFC in volleyball players can improve homolateral motor coordination and cortical excitability.ResultsThis study was a double-blinded (participant and evaluator) matched-pair experimental design. Twenty right-handed female volleyball players were recruited for the study and were randomly assigned either the active rTMS (n = 10) or the sham stimulation group (n = 10). The stimulation was performed in one session with 10 Hz, 80% of the resting motor threshold (RMT) of the right first dorsal interosseous muscle, 5 s of stimulation, and 15 s of rest, for a total of 1500 pulses. Before and after stimulation, the coordination and the cortical excitability were evaluated. The significant finding of this paper was that HF-rTMS of the DLPFC improved performance in terms of the homolateral interlimb coordination, with a significantly decreased in resting motor threshold and MEP latency of the ipsilateral motor cortex. It seem that HF-rTMS could increase coordination performances when the velocity of the execution is higher (120 bpm and 180 bpm).ConclusionMoreover, in active rTMS group significant differences emerged after stimulation in RMT and in MEP latency, while no differences emerged after stimulation in MEP amplitude. In conclusion we believe that these results may be of great interest to the scientific community and may also have practical implications in the future.

Motor cortical plasticity as a predictor of treatment response to high frequency repetitive transcranial magnetic stimulation (rTMS) for cognitive function in drug-naive patients with major depressive disorder

BackgroundThere is growing evidence that repetitive transcranial magnetic stimulation (rTMS) can improve cognitive function in patients with major depressive disorder (MDD). Few biomarkers are currently available to predict cognitive response in MDD patients. This study aimed to examine whether cortical plasticity played an important role in improving cognitive deficits in MDD patients treated with rTMS. MethodsA total of 66 MDD patients and 53 healthy controls were recruited. MDD patients were randomly assigned to receive 10 Hz active or sham rTMS 5 days per week for 4 weeks. Cognitive function was assessed using the Repeatable Battery for assessing Neuropsychological Status (RBANS), while depressive symptoms were assessed with the Hamilton Rating Scale for Depression (HRSD-24) before and after treatment. We combined transcranial magnetic stimulation and muscle surface electrophysiological recording to measure plasticity in motor cortex areas in healthy controls at baseline and MDD patients before and after treatment. ResultsCompared with healthy controls, cortical plasticity was impaired in MDD patients. Moreover, cortical plasticity was correlated with RBANS total score at baseline in MDD patients. After 4-week 10 Hz rTMS treatment, the impaired cortical plasticity was restored to some extent. Interestingly, 10 Hz rTMS treatment produced effective therapeutic effects on immediate memory, attention, and RBANS total score. Pearson correlation analysis shows that improvements in plasticity were positively correlated with improvement of immediate memory and RBANS total score. ConclusionsOur results show for the first time that 10 Hz rTMS can effectively treat impaired cortical plasticity and cognitive impairment in MDD patients and that changes in plasticity and cognitive function are closely related, which may indicate that motor cortical plasticity may play a vital role in cognitive impairment and that cortical plasticity may serve as a potential predictive biomarker for cognitive improvement in MDD patients.

Heart rate change as a predictor of treatment outcome for ring-coil accelerated low frequency repetitive transcranial magnetic stimulation in major depressive disorder: An exploratory study

Heart rate change as a predictor of treatment outcome for ring-coil accelerated low frequency repetitive transcranial magnetic stimulation in major depressive disorder: An exploratory study

Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders

Background and objectivesAlthough several meta-analyses have suggested the efficacy of non-invasive brain stimulation (NIBS) mainly in prefrontal brain areas to treat mental disorders, no synthetic approach has been performed for other psychiatric disorders rather than depression. The objective is to assess the available evidence of NIBS in the treatment of anxiety disorders. MethodsAn umbrella review (CRD42021239577) was performed only looking for reviews with meta-analyses of randomized clinical trials using a source strategy MeSH keywords in MEDLINE through Pubmed by two independent researchers. The effects of different methods of NIBS in anxiety disorders were assessed using the PICO strategy. The methodological quality was evaluated using AMSTAR-2 and certainty of evidence using the GRADE-pro framework. ResultsFrom 136 screening meta-analyses, 16 from 14 studies were included in the final analysis. Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD) respond best to low frequency repetitive transcranial magnetic stimulation (rTMS), while Posttraumatic Stress Disorder (PTSD) has the largest effect size at high frequency rTMS. Panic Disorder (PD) has no evidence for clinical use of NIBS. There were not identified meta-analyses about other anxiety disorders. In general, the included studies had good methodological quality, but low to moderate evidence for clinical recommendation. ConclusionAvailable evidence reveals NIBS as an effective and safe approach to treat GAD, PTSD and OCD with low recommendation level to clinical application. A great heterogeneity of studies indicates the necessity to develop new randomized clinical trials applying NIBS to treat those and other mental disorders.

The perturbational map of low frequency repetitive transcranial magnetic stimulation of primary motor cortex in movement disorders

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is applied to the primary motor cortex (M1) for the treatment of different movement disorders like Writer's Cramp (WC), Essential tremor (ET), and Spinocerebellar ataxia (SCA). However, the benefits vary, ranging from no effect to significant improvement in tremor. The variation in the benefits obtained from rTMS might be due to the difference in the spread of the stimuli across the brain areas associated with tremor. The spread of stimuli can be evaluated by combining rTMS with resting state functional magnetic resonance imaging (rsfMRI). AimTo determine the spread of low frequency rTMS for WC, ET and SCA after stimulation of M1. MethodThe rsfMRI was collected from the participants with WC (n = 27), ET (n = 30) and SCA (n = 28) at two time points, i.e., before and after the delivery of 1 Hz rTMS. Two measures from dynamic systems theory were calculated to understand how the system interacts with exogenously applied input (rTMS), namely entropy and frustration. While entropy measures the disorder from the rsfMRI time series, frustration quantifies it by assessing the change in sign (positive to negative, and vice-versa) of the functional connections. The two quantities outlined the spread of perturbation due to rTMS. ResultFor WC, a dense architecture of functional connections facilitated the spread across the bilateral areas of the five regions namely- the frontal cortex (frontal-Mid and Sup), motor cortex (supplemental motor area, precentral- and postcentral gyrus), parietal cortex (precuneus), subcortical regions (caudate, thalamus, posterior and mid-cingulate cortex) and the cerebellum (Crus-I and II, Cerebellum III and VI, and Vermis VI). For ET, though the areas belong to the above-mentioned 5 regions, the spread was narrower (i.e., lesser areas in the region). For SCA, the sparse connection between the areas led to minimal spread with no propagation of rTMS perturbation to the cerebellar regions. Interestingly for the three disorders, rTMS reduced the disorderliness (frustration and entropy) of the neural circuit (motor, subcortical and cerebellar regions) but increased the disorderliness in the default mode network (frontal and parietal regions). ConclusionThe spread of perturbation (due to TMS on M1) in the functional circuit varies in the three movement disorders. The current rTMS protocol achieves a wider spread for WC but not for ET and SCA. Findings from the present study suggest that pathology-specific stimulation protocols are required in movement disorders.

The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke.

Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two. This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery. Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up. All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham. Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it. https://www.chictr.org.cn/, identifier ChiCTR2100048558.

Low frequency repetitive transcranial magnetic stimulation promotes plasticity of the visual cortex in adult amblyopic rats.

The decline of visual plasticity restricts the recovery of visual functions in adult amblyopia. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in treating adult amblyopia. However, the underlying mechanisms of rTMS on visual cortex plasticity remain unclear. In this study, we found that low-frequency rTMS reinstated the amplitude of visual evoked potentials, but did not influence the impaired depth perception of amblyopic rats. Furthermore, the expression of synaptic plasticity genes and the number of dendritic spines were significantly higher in amblyopic rats which received rTMS when compared with amblyopic rats which received sham stimulation, with reduced level of inhibition and perineuronal nets in visual cortex, as observed via molecular and histological investigations. The results provide further evidence that rTMS enhances functional recovery and visual plasticity in an adult amblyopic animal model.

Activate & fire: a feasibility study in combining acoustic stimulation and continuous theta burst stimulation in chronic tinnitus

BackgroundLow frequency repetitive transcranial magnetic stimulation (rTMS) is commonly used to inhibit pathological hyperactivity of the auditory cortex in tinnitus. Novel and supposedly superior and faster inhibitory protocols such as continuous theta burst stimulation (cTBS) were examined as well, but so far there is not sufficient evidence for a treatment application in chronic tinnitus. rTMS effects in general are dependent on the brain state immediate before stimulation. This feasibility study was designed based on the concept to shift the pathological intrinsic brain state of tinnitus patients via acoustic stimulation (“activate”) and induce inhibitory effects via cTBS (“fire”).MethodsSeven tinnitus patients with response in residual inhibition received 10 consecutive daily sessions of a combinatory treatment comprised of 3-minute acoustic stimulation with white noise followed by 600 pulses of cTBS over the left temporo-parietal cortex (activate & fire). A control group of 5 patients was treated parallel to the activate & fire data collection with 10 sessions á 3000 pulses of 1 Hz rTMS over the left temporo-parietal cortex.ResultsThe activate & fire protocol was well tolerated except in one patient with tinnitus loudness increase. This patient was excluded from analyses. No statistical superiority of the activate & fire treatment approach in alleviating tinnitus-related symptoms was evident. Power calculations showed an effect size of 0.706 and a needed sample size of 66 for statistical significant group differences. On a descriptive level the activate & fire group demonstrated a stronger decrease in tinnitus-related symptoms.ConclusionThe present feasibility study showed that combining acoustic stimulation with magnetic brain stimulation may be well-tolerable in the majority of patients and represents a promising treatment approach for tinnitus by hypothetically alter the intrinsic state prior to brain stimulation.

Network Meta-Analysis of Non-Conventional Therapies for Improving Upper Limb Motor Impairment Poststroke.

Network meta-analysis is a method that can estimate relative efficacy between treatments that may not have been compared directly within the literature. The purpose of this study is to present a network meta-analysis of non-conventional interventions to improve upper extremity motor impairment after stroke. A literature search was conducted in 5 databases from their inception until April 1, 2021. Terms were used to narrow down articles related to stroke, the upper extremity, and interventional therapies. Randomized controlled trials written in English were eligible if; 50% poststroke patients; ≥18 years old; applied an intervention for the upper extremity, and/or used the Fugl-Meyer upper extremity scale as an outcome measure; the intervention had ≥3 randomized controlled trials with comparisons against a conventional care group; conventional care groups were dose matched for therapy time. A Bayesian network meta-analysis approach was taken to estimate mean difference (MD) and 95% CI. One hundred seventy-six randomized controlled trials containing 6781 participants examining 20 non-conventional interventions were identified for inclusion within the final model. Eight of the identified interventions proved significantly better than conventional care, with modified constraint induced movement therapy (MD, 6.7 [95% CI, 4.3-8.9]), high frequency repetitive transcranial magnetic stimulation (MD, 5.4 [95% CI, 1.9-8.9]), mental imagery (MD, 5.4 [95% CI, 1.8-8.9]), bilateral arm training (MD, 5.2 [95% CI, 2.2-8.1]), and intermittent theta-burst stimulation (MD, 5.1 [95% CI, 0.62-9.5]) occupying the top 5 spots according to the surface under the cumulative ranking curve. Overall, it would seem that modified constraint induced movement therapy has the greatest probability of being the most effective intervention, with high-frequency repetitive transcranial magnetic stimulation, mental imagery, and bilateral arm training all having similar probabilities of occupying the next spot in the rankings. We think this analysis can provide a guide for where future resources and clinical trials should be directed, and where a clinician may begin when considering alternative therapeutic interventions.

A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder

We compared the effectiveness of low frequency repetitive transcranial magnetic stimulation over right dorsolateral prefrontal cortex (DLPFC), right orbitofrontal cortex (OFC) and sham for treatment of obsessive-compulsive disorder (OCD) and sought to determine possible predictors of effective treatment. Sixty OCD patients participated and were randomly allocated to one of the 3 treatment groups. Treatment was administered daily for 10 days. Assessments were made at the beginning and end of therapy as well as three months later using the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory (BDI), and Clinical Global Impression – Severity scale (CGI-S). There were no significant demographic or clinical differences between the groups at baseline. One-way repeated measures ANOVA showed that participants in all 3 groups improved their scores on all rating scales following treatment. A two-way repeated measures ANOVA revealed a significant time and group interaction due to the fact that both active treatment groups outperformed the sham group, although there was no significant difference between the two. Percent improvement had significant negative correlations with the following factors: duration of illness, baseline Y-BOCS, HAM-A, and BDI. We conclude that rTMS over either right DLPFC or OFC has a therapeutic effect on OCD symptoms. Patients with lower Y-BOCS and fewer comorbidities responded best to rTMS.

Low frequency repetitive transcranial magnetic stimulation to the right dorsolateral prefrontal cortex engages thalamus, striatum, and the default mode network.

The positive treatment outcomes of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) when applied over the right dorsolateral prefrontal cortex (DLPFC) in treatment-refractory depression has been verified. However, the mechanism of action behind these results have not been well-explored. In this work we used simultaneous functional magnetic resonance imaging (fMRI) during TMS to explore the effect of LF rTMS on brain activity when applied to the right [RDLPFC1 (MNI: 50, 30, 36)] and left DLPFC sites [LDLPFC1 (MNI: -50, 30, 36), LDLPFC2 (MNI: -41, 16, 54)]. Seventeen healthy adult volunteers participated in this study. To identify brain areas affected by rTMS, an independent component analysis and a general linear model were used. Our results showed an important laterality effect when contrasting rTMS over the left and right sites. Specifically, LF rTMS increased brain activity at the striatum, thalamus, and areas of the default mode network when applied to the right, but not to the contralateral left DLPFC. In contrast, no site differences were observed when evaluating the effect of LF rTMS over the two left sites. These findings demonstrate that LF rTMS to the right DLPFC was able to stimulate the cortico-striato-thalamo-cortical pathway, which is dysregulated in patients with major depressive disorder; therefore, possibly providing some neurobiological justification for the successful outcomes found thus far for LF rTMS in the treatment of depression.

Treatment Response of Transcranial Magnetic Stimulation in Intellectually Capable Youth and Young Adults with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.

To examine current clinical research on the use of transcranial magnetic stimulation (TMS) in the treatment of pediatric and young adult autism spectrum disorder in intellectually capable persons (IC-ASD). We searched peer-reviewed international literature to identify clinical trials investigating TMS as a treatment for behavioral and cognitive symptoms of IC-ASD. We identified sixteen studies and were able to conduct a meta-analysis on twelve of these studies. Seven were open-label or used neurotypical controls for baseline cognitive data, and nine were controlled trials. In the latter, waitlist control groups were often used over sham TMS. Only one study conducted a randomized, parallel, double-blind, and sham controlled trial. Favorable safety data was reported in low frequency repetitive TMS, high frequency repetitive TMS, and intermittent theta burst studies. Compared to TMS research of other neuropsychiatric conditions, significantly lower total TMS pulses were delivered in treatment and neuronavigation was not regularly utilized. Quantitatively, our multivariate meta-analysis results report improvement in cognitive outcomes (pooled Hedges' g = 0.735, 95% CI = 0.242, 1.228; p = 0.009) and primarily Criterion B symptomology of IC-ASD (pooled Hedges' g = 0.435, 95% CI = 0.359, 0.511; p < 0.001) with low frequency repetitive TMS to the dorsolateral prefrontal cortex. The results of our systematic review and meta-analysis data indicate that TMS may offer a promising and safe treatment option for pediatric and young adult patients with IC-ASD. However, future work should include use of neuronavigation software, theta burst protocols, targeting of various brain regions, and robust study design before clinical recommendations can be made.

Efficacy of right sided low frequency repetitive transcranial magnetic stimulation in treatment resistant anxiety disorders

Introduction: The purpose of this study was to determine the efficacy of right sided low frequency rTMS in Treatment Resistant Anxiety Disorders including but not limited to, Generalized Anxiety Disorder, Social Anxiety & Panic Disorder and Post Traumatic Stress Disorder. Patient selection criteria included any patients between the ages of 18-60, with an Anxiety Disorder as a primary diagnosis and a Generalized Anxiety Disorder – 7 Score of 10 or more. All patients were screened for other differential diagnosis’, evidence based psychotherapy for more than a year, documented trials of 3 or more psychopharmacological agents & had no history of substance abuse which yielded 12 patients that were eligible for this study. All patients underwent 36 rTMS treatments over the course of 9 weeks, with an acute taper at starting week 7. All patients received the 1 Hz, Low frequency protocol, Right Dorsolateral Prefrontal Cortex, 2000 pulses with motor thresholds between 100%-120%. Patients completed GAD-7’s on a biweekly basis with reporting done during the middle of the week. Background: The objective of this study was to measure the outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of the Anxiety Based Disorders including GAD, Panic Disorder, & PTSD. Patient demographics both males & females, ages 18-60 years of age, with a mean score of 17.5 on their GAD-7. Methods: All 12 patients underwent 36 rTMS treatments with NeuroStar ™ TMS on the RDLPFC (80%-120% MT, 1 Hz in a sequence of 1 pulse per second for 33:20 minutes providing 2000 inhibitory pulses). Treatment occurred 5 times weekly for 6 weeks with a taper for 3 weeks. Patients would undergo bi-weekly clinical screening via GAD-7 and patient feedback. Results: 100% of participants completed the full course of 36 treatments with an appropriate taper. Patients who received the low frequency right sided TMS treatments had an average of a 14.0 points reduction on their GAD-7 measures, with a mean starting scale of 17.5 and a mean ending scale of 3.5. Conclusions: The results of low frequency right sided TMS for anxiety-based disorders are indicative of a significant clinical response. Low frequency protocols have been found to be mood stabilizing in theory. The GAD-7 scale is explanatory of the sensitivity of such a treatment protocol. Further investigation is warranted. Funding: None Conflicts of Interest: None

Cardiovascular biomarkers of response to accelerated low frequency repetitive transcranial magnetic stimulation in major depression

Background and objectiveRepetitive transcranial magnetic stimulation (rTMS) is an effective and safe treatment for major depressive disorder (MDD). rTMS is in need of a reliable biomarker of treatment response. High frequency (HF) dorsolateral prefrontal cortex (DLPFC) rTMS has been reported to induce significant changes in the cardiac activity of MDD patients. Low frequency DLPFC rTMS has many advantages over HF-DLPFC rTMS and thus this study aims to further investigate the effect of low frequency 1 Hz right hemisphere (R)-DLPFC rTMS on the cardiac activity of MDD patients, as well as the potential of using electrocardiogram (ECG) parameters as biomarkers of treatment outcome. MethodsBaseline ECG sessions were performed for 19 MDD patients. All patients then underwent 40 sessions of accelerated 1 Hz R-DLPFC rTMS one week after the baseline session. ResultsHeart rate (HR) significantly decreased from the resting period to the first and third minute of the 1 Hz R-DLPFC rTMS period. Resting HR was found to have a significant negative association with treatment outcome. Prior to Bonferroni correction, HR during stimulation and the degree of rTMS-induced HR reduction were significantly negatively associated with treatment outcome. No significant changes were observed for the heart rate variability (HRV) parameters. LimitationsSample size (n = 19); the use of electroencephalography equipment for ECG; lack of respiration monitoring; relatively short recording duration for HRV parameters. ConclusionThis novel study provides further preliminary evidence that ECG may be utilized as a biomarker of rTMS treatment response in MDD. Trial registrationClinicalTrials.gov Identifier: NCT04376697.