Prefrontal Cortex Transcranial Magnetic Stimulation Research Articles

Transcranial direct current stimulation combined with speech therapy in Fragile X syndrome patients: a pilot study.

Fragile X syndrome (FXS) is the leading cause of genetic intellectual disability. Among the neurobehavioral dysfunctions in FXS individuals, language development and literacy are compromised. Recent evidence hypothesized that the disruption of excitatory glutamatergic and GABAergic inhibitory neurotransmission balance might be responsible for impairment in cognitive function. In this study, we evaluated for the first time, the safety, tolerability, and efficacy of anodal prefrontal transcranial direct current stimulation (tDCS) combined with standard speech therapy to enhance language function in FXS patients. In total, 16 adult FXS patients were enrolled. Participants underwent 45 min of anodic tDCS combined with speech therapy for 5 weeks (3 times per week). Language function was evaluated using the Test for Reception of Grammar-Version 2 (TROG-2) and subtests of the Italian Language Examination (Esame del Linguaggio - II, EDL-II). Right and left dorsolateral prefrontal cortex transcranial magnetic stimulation and concurrent electroencephalography (TMS-EEG) recordings were collected at baseline and after the treatment to evaluate cortical reactivity and connectivity changes. After 5 weeks of combined therapy, we observed a significant improvement in the writing (7.5%), reading (20.3%), repetition (13.3%), and TROG-2 (10.2%) tests. Parallelly with clinical change, TMS-EEG results showed a significant difference in TMS-evoked potential amplitude over the left frontal cortex after treatment (-0.73 ± 0.87 μV) compared to baseline (0.18 ± 0.84 μV). Our study provides novel evidence that left anodal prefrontal tDCS combined with standard speech therapy could be effective in enhancing language function in FXS patients, mainly by inducing a rebalance of the dysfunctional prefrontal cortical excitability.

Unilateral right and bilateral dorsolateral prefrontal cortex transcranial magnetic stimulation in treatment post-traumatic stress disorder: A randomized controlled study

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a potential non-invasive treatment for post-traumatic stress disorder (PTSD). However, the treatment parameters of rTMS required to optimize therapeutic efficacy remains unclear. ObjectiveThe aim of the present study was to investigate the efficacy of bilateral rTMS and unilateral right rTMS and compare the efficacy of bilateral rTMS and unilateral rTMS on PTSD symptoms. MethodsSixty-five veterans with current combat-related PTSD symptoms were randomly selected to receive bilateral rTMS (1200 pulses at 20 Hz followed by 1200 pulses per session), unilateral right rTMS (2400 pulses at 20 Hz) or sham rTMS over the dorsolateral prefrontal cortex (DLPFC). ResultsResults showed significant differences among the 3 groups. Patients demonstrated significant PTSD symptom reductions in the bilateral group compared to the sham group in session five and endpoint. There were no significant differences between the bilateral and unilateral right groups at endpoint. Unilateral right group when compared to sham group showed greater symptom reductions from baseline to endpoint. There were no significant differences between the unilateral right and sham groups in session five. ConclusionOur findings suggest that bilateral and unilateral right rTMS are superior to sham rTMS but does not support the hypothesis that bilateral rTMS is more effective than unilateral high-frequency right-sided rTMS.

Dorsolateral prefrontal cortex transcranial magnetic stimulation as a tool to decrease pain and craving in opiate dependent individuals: a pilot study of feasibility and effect size

Dorsolateral prefrontal cortex transcranial magnetic stimulation as a tool to decrease pain and craving in opiate dependent individuals: a pilot study of feasibility and effect size

Equivalent beneficial effects of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in a large randomized trial in treatment-resistant major depression

Repetitive transcranial magnetic stimulation treatment (rTMS) is an effective treatment for depression but the optimal methods of administration have yet to be determined. Recent studies have produced conflicting results as to whether unilateral rTMS is more or less effective than sequentially applied bilateral rTMS. To address this we conducted a trial comparing sequential bilateral rTMS to right-sided unilateral rTMS using a priming protocol. Patients with treatment-resistant depression (n = 179) were enrolled in a two-arm randomized controlled trial across a 4-wk time period. The primary outcome assessment was the Hamilton Depression Rating Scale. Overall, there was a substantial response rate of >50% (and a 40% remission rate); however, there were no significant differences in clinical response between the two treatment groups. rTMS was well tolerated with a very low discontinuation rate. There was no relationship between response in the current trial and previous response, or non-response, to electroconvulsive therapy. We found no significant differences in clinical response between sequential bilateral rTMS and right-sided unilateral rTMS applied with a priming protocol. The results of this study do not support superior efficacy of bilateral rTMS and instead suggest that other approaches should be explored to increase treatment efficacy.

A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression

A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression

A double blind randomized trial of unilateral left and bilateral prefrontal cortex transcranial magnetic stimulation in treatment resistant major depression

A double blind randomized trial of unilateral left and bilateral prefrontal cortex transcranial magnetic stimulation in treatment resistant major depression

A double blind randomized trial of unilateral left and bilateral prefrontal cortex transcranial magnetic stimulation in treatment resistant major depression

A substantive body of research has demonstrated the efficacy of repetitive transcranial magnetic stimulation treatment (rTMS) in patients with depression. However, the parameters needed to optimize therapeutic efficacy remain unclear. The aim of this study was to investigate whether there is an advantage in efficacy of sequential bilateral rTMS compared to standard high-frequency left sided rTMS. Sixty seven patients with treatment resistant depression were included in a randomised double-blind sham controlled trial of sequential bilateral rTMS compared to standard high-frequency left sided rTMS and sham rTMS over a three-week period. The study also included a further three week comparison of the two active treatment conditions. The primary outcome variable was scores on the 17-item Hamilton Depression Rating Scale (HAMD). In the three-week double-blind phase of the trial there was a greater antidepressant response to unilateral left sided rTMS compared with sham or bilateral rTMS. Across the full six weeks of active rTMS, there was also a consistent pattern of improved response in unilateral left compared to bilateral treatment. Response rates were low in both active groups. This study does not support the hypothesis that sequential bilateral rTMS is more effective than unilateral high-frequency left-sided rTMS.

A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression

Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres. A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions. Outcomes were assessed with standard rating scales. Overall, slightly more than 50% of the patients achieved clinical response criteria. There was no substantial difference in response between the unilateral and bilateral treatment groups. Successful response to rTMS was predicted by a greater degree of baseline depression severity. There is no substantial difference in efficacy between unilateral right-sided rTMS and the two forms of bilateral rTMS assessed in the study. Furthermore, our results call into question the specificity between frequency and laterality and rTMS response.

A study of the effectiveness of high-frequency left prefrontal cortex transcranial magnetic stimulation in major depression in patients who have not responded to right-sided stimulation

The objective of this study was to explore the response rate to high-frequency left-sided repetitive transcranial magnetic stimulation (rTMS) in patients who had failed to respond to right-sided low-frequency stimulation, and to investigate whether there was differential efficacy between stimulation at 5 or 10 Hz. Data from two randomized controlled trials were pooled. In both studies a group of patients were randomized to receive either 5- or 10-Hz left prefrontal rTMS after failing to respond to right-sided stimulation. These patients received blinded 5- or 10-Hz stimulation (but without a sham control) for a period of up to 4 weeks and outcomes were compared. There was a small but significant overall response to left-sided rTMS but no difference in response between the 5- and 10-Hz treatment conditions. There appears to be a significant but modest likelihood of response to left-sided TMS in patients who fail right-sided stimulation, but there is no difference in efficacy between 5- and 10-Hz stimulation.

Acute prefrontal cortex transcranial magnetic stimulation in healthy volunteers: No effects on brain-derived neurotrophic factor (BDNF) concentrations in serum

BackgroundTranscranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex is a brain stimulation technique widely used to treat depression. BDNF serum concentrations have been shown to be decreased in patients with major depressive disorder and can be upregulated by several antidepressive treatment strategies including repetitive TMS. MethodsIn this study we were interested whether acute TMS evolves effects on serum BDNF concentrations in 42 healthy volunteers. ResultsMean BDNF serum concentration in 19 male and 23 female volunteers was 10.70±3.6 ng/ml (n=42) at baseline, and 10.76±3.9 ng/ml (n=42) after TMS treatment. BDNF serum levels did not change after acute TMS (n=42, Z=−0.44, p=0.965). BDNF serum concentrations at baseline did not differ between male (n=19, 10.05±2.6 ng/ml) and female (n=23, 11.25±4.27 ng/ml) participants of the study (n=42, Z=−0.91, p=0.363). ConclusionsOur result suggests that TMS does not change BDNF serum concentrations immediately in healthy human volunteers.