Frequency Repetitive Transcranial Magnetic Stimulation Research Articles

The Effects of high frequency repetitive transcranial magnetic stimulation on negative symptoms of schizophrenia: Findings from a randomized, double-blind, sham-controlled trial

Background: Negative symptoms in patients with schizophrenia are associated with poor functional outcome and are difficult to treat with currently available pharmacological and psychosocial treatment strategies. This study aimed to assess safety and efficacy of 20-Hz rTMS applied over left dorsolateral pre-frontal cortex (DLPFC) for four weeks (40,000 total stimulation pulses).

Combination Therapy of Low Frequency Repetitive Transcranial Magnetic Stimulation and Intensive Physical Therapy for a Chronic Stroke Patient: A Case Study

Combination Therapy of Low Frequency Repetitive Transcranial Magnetic Stimulation and Intensive Physical Therapy for a Chronic Stroke Patient: A Case Study

The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury

BackgroundFunctional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI.PurposeOur randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs.Patients and methodsOur study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential).ConclusionOur study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.

Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation on Depression and Cognition of Patients with Traumatic Brain Injury: A Randomized Controlled Trial.

BackgroundThis study was conducted to investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) of the right dorsolateral prefrontal cortex on depression and cognition in patients with traumatic brain injury.Material/MethodsTo accomplish this, 13 patients who were diagnosed with traumatic brain injury were divided into an experimental group (n=7) and a control group (n=6). The experimental group received rTMS during a 30-minute session 5 days per week for 2 weeks; the control group received sham rTMS. The patients were then evaluated for depression using the Montgomery-Asberg Depression Rating Scale (MADRS) and for cognitive function using the Trail Making Test (TMT) and the Stroop Color Word Test (SCWT).ResultsA significant decrease in MADRS, TMT, and SCWT was observed after the intervention in the experimental group (P<0.01), and there was a significant difference in the change value of MADRS, TMT, and SCWT compared to the control group (P<0.01). Moreover, the effect size for gains in the experimental group and control group was very strong for MADRS, TMT, and SCWT (effect size=1.44, 1.49, and 1.24 respectively).ConclusionsThe results of this study suggest that application of low frequency rTMS to the right dorsolateral prefrontal cortex of patients with traumatic brain injury has a positive effect on depression and cognition.

High frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex modulates sensorimotor cortex function in the transition to sustained muscle pain

Based on reciprocal connections between the dorsolateral prefrontal cortex (DLPFC) and basal-ganglia regions associated with sensorimotor cortical excitability, it was hypothesized that repetitive transcranial magnetic stimulation (rTMS) of the left DLPFC would modulate sensorimotor cortical excitability induced by muscle pain. Muscle pain was provoked by injections of nerve growth factor (end of Day-0 and Day-2) into the right extensor carpi radialis brevis (ECRB) muscle in two groups of 15 healthy participants receiving 5 daily sessions (Day-0 to Day-4) of active or sham rTMS. Muscle pain scores and pressure pain thresholds (PPTs) were collected (Day-0, Day-3, Day-5). Assessment of motor cortical excitability using TMS (mapping cortical ECRB muscle representation) and somatosensory evoked potentials (SEPs) from electrical stimulation of the right radial nerve were recorded at Day-0 and Day-5. At Day-0 versus Day-5, the sham compared to active group showed: Higher muscle pain scores and reduced PPTs (P < 0.04); decreased frontal N30 SEP (P < 0.01); increased TMS map volume (P < 0.03). These results indicate that muscle pain exerts modulatory effects on the sensorimotor cortical excitability and left DLPFC rTMS has analgesic effects and modulates pain-induced sensorimotor cortical adaptations. These findings suggest an important role of prefrontal to basal-ganglia function in sensorimotor cortical excitability and pain processing.

High frequency repetitive transcranial magnetic stimulation of the motor cortex can alleviate non-fluent aphasia after stroke

To investigate the effects of High frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on non-fluent aphasia in patients after stroke. Six stroke patients displaying non-fluent aphasia were randomly assigned to an rTMS group and a control group using a random number table. Both groups were treated with conventional language therapy. While the rTMS group was additionally given 5 Hz rTMS over the motor cortex (M 1) of the affected hemisphere 5 days a week for 4 weeks. The patients were stimulated at 100% of the motor threshold (MT), with 2 second trains and intervals of 3 seconds 120 times (1200 pulses) in a session. Before and after the 4 weeks of treatment, the Western Aphasia Battery (WAB) and the Communicative Abilities in Daily Living (CADL) test were conducted in both groups to evaluate their language function and communication ability. Only spontaneous speech improved significantly ( P < 0.05) in the control group after 4 weeks of treatment. In the rTMS group, the spontaneous speech, auditory comprehension, repetition, naming and aphasia quotient (AQ) had all improved significantly ( P < 0.05). Moreover, after the treatment, the average score of the auditory comprehension, repetition, naming and AQ of the rTMS group were significantly higher than those of the control group ( P < 0.05). rTMS applied to the motor cortex of the affected hemisphere can significantly improve language function in those exhibiting non-fluent aphasia after stroke.

The Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation on White Matter Structural Connectivity in Children with Cerebral Palsy.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment technique for recovery of movement disorders by altering cortical plasticity. In this research, we studied the effects of low-frequency rTMS on white matter (WM) structural connectivity and clinical parameters in children with cerebral palsy (CP).,Four spastic hemiplegic CP children were randomly divided into experimental and control groups. In the experimental group, at first, 1Hz rTMS treatment was performed 4 days/week for 3 weeks on two hemiplegia patients over a contralesional primary motor cortex (M1). Then, 1Hz rTMS treatment was performed 4 days/week for 3 weeks followed by a 30min occupational therapy (OT). In the control group, two CP children received sham rTMS for 3 weeks and then sham rTMS combined with OT for 3 weeks in the same schedule as the experimental group. Evaluations performed using diffusion tensor imaging (DTI), and clinical measurements of gait performance before and after the treatment. Graph theoretical analysis was used to characterize topological changes of structural connectivity. Our findings demonstrate the 1Hz rTMS is effective in improving motor activity in spastic hemiplegic CP children, and is more effective when combined with OT.

Repetitive transcranial magnetic stimulation (rTMS) in alcohol dependence: study protocol of a randomized controlled clinical trial of efficacy and working mechanisms

BackgroundHigh frequency repetitive transcranial magnetic stimulation (HF-rTMS) has gained interest as a neuromodulation treatment technique for alcohol dependence. Single sessions of HF-rTMS have consistently shown to decrease craving for substances. However, the results of randomized controlled clinical trials investigating the effect of multiple HF-rTMS sessions in alcohol dependence on abstinence rates and craving are inconsistent. Furthermore, they lack information on the effect of HF-rTMS on cognition and brain functioning.MethodsA single center, single blind, randomized controlled trial with 80 abstinent alcohol dependent subjects in treatment randomized (1:1) to either treatment as usual (TAU) plus ten sessions of active HF-rTMS or TAU plus 10 sessions of placebo/ sham HF-rTMS will be performed. The effects of ten HF-rTMS sessions on craving and neurocognitive functions are obtained. In addition a subset of participants will undergo an MR scanning session before the first and after the last HF-rTMS session in order to investigate the effect of ten HF-rTMS sessions on brain functioning. The primary outcome is the continued abstinence rate after the add-on HF-rTMS treatment.DiscussionThis study uses a randomized controlled trial to examine the clinical, neurocognitive and brain functioning effects of ten add-on HF-rTMS sessions in alcohol dependent individuals in treatment. If the add-on treatment is effective, this may add to the evidence needed for approval of this additional treatment method for alcohol dependence by regulatory authorities.Trial registrationThe Netherlands National Trial Register (NTR), NTR5291, 6-July-2015.

The Effectiveness of High-frequency Repetitive Transcranial Magnetic Stimulation in Persistent Somatoform Pain Disorder: A Case Series

Somatoform pain disorders (SPD) are common, disabling and do not respond well to existing treatment modalities. We investigated the usefulness of 18 sessions of high frequency repetitive transcranial magnetic stimulation delivered at the left dorsolateral prefrontal cortex (DLPFC) in five right-handed patients with SPD. All patients reported significant improvement in pain relief and activities of daily living. High-frequency repetitive transcranial magnetic stimulation (rTMS) delivered at the left DLPFC may be useful in SPD.

Cognitive effects of bilateral high frequency repetitive transcranial magnetic stimulation in early phase psychosis: a pilot study.

Cognitive dysfunction is a core facet of schizophrenia that is present early in the course of the illness and contributes to diminished functioning and outcomes. Repetitive transcranial magnetic stimulation (rTMS) is a relatively new neuropsychiatric intervention. Initially used in treatment resistant depression, investigators are now studying rTMS for other psychiatric diseases such as schizophrenia. In this study we examined the effect of high frequency rTMS on cognitive function in a group of individuals with early phase psychosis. Twenty subjects were randomized (1:1) in double-blind fashion to rTMS or sham condition. Over two weeks subjects underwent ten sessions of high frequency, bilateral, sequential rTMS targeting the dorsolateral prefrontal cortex (DLPFC). Prior to beginning and following completion of study treatment, subjects completed a cognitive assessment and magnetic resonance imaging. Subjects receiving rTMS, compared to sham treatment, displayed improvement on a standardized cognitive battery both immediately following the course of study treatment and at follow-up two weeks later. Imaging results revealed that left frontal cortical thickness at baseline was correlated with treatment response. The study treatment was found to be safe and well tolerated. These results suggest that rTMS may hold promise for the treatment of cognitive dysfunction in the early phase of psychosis, and that MRI may provide biomarkers predicting response to the treatment.

Investigating the use of high frequency repetitive transcranial magnetic stimulation for primary progressive apraxia of speech (P3.196)

Investigating the use of high frequency repetitive transcranial magnetic stimulation for primary progressive apraxia of speech (P3.196)

T264. Differential Effects of Left and Right Prefrontal High Frequency rTMS on Resting State fMRI in Healthy Individuals

High frequency repetitive transcranial magnetic stimulation (HF-rTMS) has gained interest in treatment of psychiatric disorders such as depression and substance dependence. It is postulated that HF-rTMS accomplishes its effect by influencing neuronal networks. The dorsolateral prefrontal cortex (dlPFC) is frequently chosen as target for HF-rTMS. However, little is known about the differential effect of left and right dlPFC HF-rTMS on resting state functional connectivity networks in healthy individuals.

Single Session Low Frequency Left Dorsolateral Prefrontal Transcranial Magnetic Stimulation Changes Neurometabolite Relationships in Healthy Humans.

Background: Dorsolateral prefrontal cortex (DLPFC) low frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise as a treatment and investigative tool in the medical and research communities. Researchers have made significant progress elucidating DLPFC LF-rTMS effects—primarily in individuals with psychiatric disorders. However, more efforts investigating underlying molecular changes and establishing links to functional and behavioral outcomes in healthy humans are needed.Objective: We aimed to quantify neuromolecular changes and relate these to functional changes following a single session of DLPFC LF-rTMS in healthy participants.Methods: Eleven participants received sham-controlled neuronavigated 1 Hz rTMS to the region most activated by a 7-letter Sternberg working memory task (SWMT) within the left DLPFC. We quantified SWMT performance, functional magnetic resonance activation and proton Magnetic resonance spectroscopy (MRS) neurometabolite measure changes before and after stimulation.Results: A single LF-rTMS session was not sufficient to change DLPFC neurometabolite levels and these changes did not correlate with DLPFC activation changes. Real rTMS, however, significantly altered neurometabolite correlations (compared to sham rTMS), both with baseline levels and between the metabolites themselves. Additionally, real rTMS was associated with diminished reaction time (RT) performance improvements and increased activation within the motor, somatosensory and lateral occipital cortices.Conclusion: These results show that a single session of LF-rTMS is sufficient to influence metabolite relationships and causes widespread activation in healthy humans. Investigating correlational relationships may provide insight into mechanisms underlying LF-rTMS.

P.3.017 - Differential effects of left and right prefrontal magnetic stimulation on resting state connectivity in healthy individuals

Introduction High frequency repetitive transcranial magnetic stimulation (HF-rTMS) has gained great interest in multiple clinical and research fields. With HF-rTMS a coil – wherein an alternating current is running – is placed on top of the skull, creating a magnetic field that influences the perpendicular neural tissue, thereby stimulating the neuronal activity of the targeted cortical area [1]. Although it is believed that HF-rTMS accomplishes its effect by influencing entire neuronal networks [2]. One cortical area frequently chosen as stimulation target is the dorsolateral prefrontal cortex (dlPFC), as it is part of the control network. However, despite its popularity and frequent use, very little is known about the differential effect of HF-rTMS over the left and right dlPFC on intrinsic functional connectivity networks in healthy individuals. Therefore the current study will address this issue. Methods The current study assessed the differential effects of left or right dlPFC HF-rTMS (corrected for sham) on intrinsic functional connectivity networks in a sample of 45 healthy individuals. The study was a randomized, single-blind trial with two sessions. During the first session demographic data were obtained and a baseline resting state functional magnetic resonance imaging (rsfMRI) scan was performed. During the second session subjects were randomized to either sham dlPFC HF-rTMS (n=15), left active dlPFC HF-rTMS (n=15) or right active dlPFC HF-rTMS (n=15) directly followed by a second rsfMRI scan. A HF-rTMS session consisted of sixty trains of 5 seconds at a frequency of 10Hz. During the sham condition the coil was tilted 90 degrees relative to the skull. This condition was used in order to correct for time and placebo effects. Independent Component Analysis (ICA) were performed to assess baseline differences and stimulation effects on within and between network functional connectivity. The five components of interest were the left frontal parietal network, right frontal parietal network, default mode network, salience network and reward network. Results The three stimulation groups did not differ on within as well as between functional connectivity of the five components of interest at baseline. Regarding the stimulation effects on within network connectivity, stimulation of the left dlPFC resulted in decreased functional connectivity in the salience network whereas right dlPFC stimulation resulted in increased functional connectivity within this network. Regarding the stimulation effects on between network connectivity, no differences between left or right dlPFC stimulation were found. Discussion Stimulation of either the left or the right dlPFC (compared to sham stimulation) thus seems to lead to opposite effects within the salience network. Since the role of this network in directing attention between internal and external processes [3], and decreased functional connectivity is associated with worsened cognitive functioning in aging [4], the results of this study might have implications for the clinical effects of HF-rTMS over the dlPFC. Therefore future (clinical) studies should implement questionnaires and/ or neurocognitive tasks in order to be able to relate changes in functional connectivity to changes in cognitive functioning.

The Effects of Repetitive Transcranial Magnetic Stimulation at Dorsolateral Prefrontal Cortex in the Treatment of Migraine Comorbid with Depression: A Retrospective Open Study.

ObjectiveThe literature on managing migraine non-responsive to pharmacological approaches and that co-occurring with depression is scanty. The comorbid condition predicts a poorer prognosis for migraine as well as depression. The present report assesses efficacy and tolerability of high frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex as a treatment modality for migraine with comorbid depression.MethodsThe current retrospective chart review assesses effectiveness of high frequency rTMS over left dorsolateral prefrontal cortex as a treatment modality to manage migraine occurring comorbid with depression in 14 subjects.ResultsThe mean scores on Migraine Disability Assessment Test (MIDAS) and depression rating scale reduced significantly from 21.14±3.01 and 20.71±3.95 at baseline to 13.93±6.09 and 14.21±5.52 respectively, after rTMS. There was significant improvement in migraine frequency, severity and functional disability assessed using MIDAS scores (p<0.05) following high frequency rTMS compared to baseline.ConclusionThere is a role of applying rTMS as a potential therapeutic modality in the integrated management of a distinct subgroup of migraine patients with comorbid depression.

Changes in canine cerebral perfusion after accelerated high frequency repetitive transcranial magnetic stimulation (HF-rTMS): A proof of concept study

Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a treatment for several neuropsychiatric disorders in human beings, but the neurobiological effects of rTMS in dogs have not been investigated to date. A proof of concept study was designed to evaluate the effect of rTMS on cerebral perfusion, measured with single photon emission computed tomography (SPECT), in dogs. An accelerated high frequency (aHF)-rTMS (20Hz) protocol was applied to the canine left frontal cortex. To accurately target this area, eight dogs underwent a 3 Tesla magnetic resonance imaging (MRI) scan before stimulation. The left frontal cortex was subjected to five consecutive aHF-rTMS sessions with a figure-of-eight coil designed for human beings at an intensity of 110% of the motor threshold. The dogs underwent 99mTc-d,1 hexamethylpropylene amine oxime (HMPAO) SPECT scans 1 week prior to and 1day after the stimulations. Perfusion indices (PIs) were determined semi-quantitatively; aHF-rTMS resulted in significantly increased PIs in the left frontal cortex and the subcortical region, whereas no significant differences were noted for the other regions. Behaviour was not influenced by the stimulation sessions. As has been observed in human beings, aHF-rTMS applied to the left frontal cortex alters regional cerebral perfusion in dogs.

Successful administration of repetitive transcranial magnetic stimulation in a woman with Bulimia Nervosa comorbid with depressive disorder

Repetitive transcranial magnetic stimulation is an effective treatment option for treatment resistant depressive disorder. The presented case suggests that repetitive transcranial magnetic stimulation might be effective in inhibition of binge eating and purging behaviors. This case suggests that left dorsolateral prefrontal stimulation with high frequency repetitive transcranial magnetic stimulation could be a potential treatment option for bulimia nervosa comorbid with depressive disorder

The effects of Task-Oriented Activity after applying Low Frequency Repetitive Transcranial Magnetic Stimulation on Cerebral Motor Evoked Potential Emplitude and Latency in Stroke Patients

To investigate the effects of task-oriented activities under the residual effect after repetitive transcranial magnetic stimulation (rTMS) on cerebral motor evoked potential (MEP) amplitude, cerebral motor evoked potential (MEP) latency in stroke patients, this study conducted an intervention program on two groups (experimental group - TIL, control groups – GRT, each consisting of 10 patients) of chronic stroke patients. The program−which was conducted three times a week for 6 weeks−evaluated the MEP amplitudes, MEP latency before and after the experiment. In an inter-group test of MEP amplitude and MEP latency, all groups showed an increase between pre- and post-test evaluations. In an intergroup examination on MEP amplitude and MEP latency, a significant difference was observed between the TIL and GRT groups.

Glutamate is down-regulated and tinnitus loudness-levels decreased following rTMS over auditory cortex of the left hemisphere: A prospective randomized single-blinded sham-controlled cross-over study

Using a prospective randomized single-blinded sham-controlled cross-over design, we studied the efficacy of low frequency (1-Hz) repetitive transcranial magnetic stimulation (rTMS) over auditory cortex of the left temporal lobe as an experimental treatment modality for noise-induced tinnitus. Pre/post outcome measures for sham vs. active rTMS conditions included differential changes in tinnitus loudness, self-perceived changes in the Tinnitus Handicap Questionnaire (THQ), and neurochemical changes of brain metabolite concentrations using single voxel proton magnetic resonance spectroscopy (1H-MRS) obtained from left and right auditory cortical areas. While no subject in our sample had complete abatement of their tinnitus percept, active but not sham rTMS significantly reduced the loudness level of the tinnitus perception on the order of 4.5 dB; improved subscales in several content areas on the THQ, and down regulated (reduced) glutamate concentrations specific to the auditory cortex of the left temporal lobe that was stimulated.In addition, significant pair-wise correlations were observed among questionnaire variables, metabolite variables, questionnaire-metabolite variables, and metabolite-loudness variables. As part of this correlation analysis, we demonstrate for the first time that active rTMS produced a down regulation in the excitatory neurotransmitter glutamate that was highly correlated (r = 0.77, p < 0.05) with a reduction in tinnitus loudness levels measured psychoacoustically with a magnitude estimation procedure. Overall, this study provides unique information on neurochemical, psychoacoustic, and questionnaire-related profiles which emphasizes the emerging fields of perceptual and cognitive MRS and provides a perspective on a new frontier in auditory and tinnitus-related research.

A Randomized Controlled Trial of Right Low Frequency rTMS Combined with Escitalopram in Treatment of Patients with First-episode Depression in General Hospitals

Objective: To explore the clinical efficacy of right low frequency repetitive transcranial magnetic stimulation (rTMS) therapy combined with escitalopram in treating outpatients with first-episode depression. Methods: Seventy-eight patients with depressive disorder of ICD-10 criteria were recruited for the trial. All subjects were randomly divided into the active rTMS group (receive active rTMS) and sham group (receive sham rTMS). Each group received low frequency active or sham rTMS combined with 10 mg escitalopram per day. Patients in the active rTMS group were treated with active rTMS for continuous two weeks, while the sham patients were treated with pseudo stimulation. HAMD, HAMA and TESS were used to assess the efficacy and side effects before the treatment and at the ends of the second week and the fourth week of treatment, respectively. Results: 1) At the end of 4 weeks’ treatment, patients in the active rTMS group had a response rate of 87.8 % while the patients in the sham group had 41.5 %; 2) patients in the active rTMS group showed a significant efficacy at the end of 2 weeks, which was significantly different from the patients in the sham group; 3) Patients in the active rTMS group got a significantly lower score in HAMA at the end of 2 weeks, and there was a significant difference from the sham group; 4) There was only a local pain response. Conclusion: The right low-frequency rTMS technique combined with escitalopram in treatment of depressive patients in general hospitals has a significant better effect than mono-pharmacotherapy and can shorten the time of treatment.