Repetitive Transcranial Magnetic Stimulation Therapy Research Articles

Adjunctive repetitive transcranial magnetic stimulation therapy’s effectiveness in treating a sample of patients with major depressive disorder refractory to first-line drug treatment

BackgroundThe usefulness of repetitious transcranial magnetic stimulation (rTMS) and its protocols in the treatment of major depressive disorder (MDD) remains controversial. This study aimed to evaluate the efficacy of rTMS in treating a sample of patients with MDD who did not respond to conventional treatment.ResultsThe Hamilton Depression Rating Scale (HDRS) scores for the active rTMS group were 19.66 ± 6.70 at baseline, 12.50 ± 6.69 at 2 weeks, and 11.23 ± 6.59 at 4 weeks. The average HDRS scores for the sham rTMS group were 20.03 ± 7.40 at baseline, 19.36 ± 6.86 at 2 weeks, and 18.53 ± 7.10 at 4 weeks (F = 5.98; p < 0.01). The Clinical Global Impression-Severity Scale (CGI-S) scores were significantly lower in the second and fourth weeks than the baseline due to the significant interaction between time effects and the groups (F = 9.95, p = 0.002). This condition was also similar to the CGI-Improvement Scale and Brief Illness Perception Questionnaire (Brief IPQ), and the intervention group showed a significantly lower score than the control group (p < 0.05).ConclusionsThis study showed that rTMS using the employed protocol was promising for patients with MDD resistant to first-line drug therapy. Further studies are required to ensure our observation.Trial registrationTrial registration number: IRCT20190612043877N1Trial registry Record URL: https://irct.behdasht.gov.ir/trial/63919

Analyzing the Combination Effects of Repetitive Transcranial Magnetic Stimulation and Motor Control Training on Balance Function and Gait in Patients with Stroke-Induced Hemiplegia

Objective: To analyze the effects of repetitive transcranial magnetic stimulation combined with motor control training on the treatment of stroke-induced hemiplegia, specifically focusing on the impact on patients’ balance functionand gait. Methods: Fifty-two cases of hemiplegic stroke patients were randomly divided into two groups, 26 in the control group and 26 in the observation group, using computer-generated random grouping. All participants underwent conventional treatment and rehabilitation training. In addition to these, the control group received repetitive transcranialmagnetic pseudo-stimulation therapy + motor control training, while the observation group received repetitive transcranial magnetic stimulation therapy + motor control training. The balance function and gait parameters of both groups were compared before and after the interventions and assessed the satisfaction of the interventions in both groups. Results: Before the invention, there were no significant differences in balance function scores and each gait parameter between the two groups (P &gt; 0.05). However, after the intervention, the observation group showed higher balance function scores compared to the control group (P &lt; 0.05). The observation group also exhibited higher step speed and step frequency, longer step length, and a higher overall satisfaction level with the intervention compared to the control group (P &lt; 0.05). Conclusion: The combination of repetitive transcranial magnetic stimulation and motor control training in the treatment of stroke-induced hemiplegia has demonstrated positive effects. It not only improves the patient’s balance function and gait but also contributes to overall physical rehabilitation.

Effect of neuronavigated repetitive Transcranial Magnetic Stimulation on pain, cognition and cortical excitability in fibromyalgia syndrome.

Fibromyalgia syndrome is a widespread chronic pain condition identified by body-wide pain, fatigue, cognitive fogginess, and sleep issues. In the past decade, repetitive transcranial magnetic stimulation has emerged as a potential management tool.. In the present study, we enquired whether repetitive transcranial magnetic stimulation could modify pain, corticomotor excitability, cognition, and sleep. Study is a randomized, sham-controlled, double-blind, clinical trial; wherein after randomizing thirty-four fibromyalgia patients into active or sham therapy (n = 17 each), each participant received repetitive transcranial magnetic stimulation therapy. In active therapy was given at 1Hz for 20 sessions were delivered on dorsolateral prefrontal cortex (1200 pulses, 150 pulses per train for 8 trains); while in sham therapy coil was placed at right angle to the scalp with same frequency. Functional magnetic resonance imaging was used to identify the therapeutic site. Pain intensity, corticomotor excitability, cognition, and sleep were examined before and after therapy. Baseline demographic and clinical parameters for both active and sham groups were comparable. In comparison to sham, active repetitive transcranial magnetic stimulation showed significant difference in pain intensity (P < 0.001, effect size = 0.29, large effect) after intervention. Other parameters of pain perception, cognition, and sleep quality also showed a significant improvement after the therapy in active therapy group only, as compared to sham. Findings suggest that repetitive transcranial magnetic stimulation intervention is effective in managing pain alongside cognition and sleep disturbances in patients of fibromyalgia. It may prove to be an important tool in relieving fibromyalgia-associated morbidity.

The role of repetitive transcranial magnetic stimulation therapy in functional bowel disease.

This study investigates the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a biophysical therapy for alleviating symptoms of functional bowel disorder (FBD) and associated psychological symptoms by targeting the brain-gut axis. We conducted a comparative analysis involving 226 subjects, comprising the FBD group (n = 113) and a healthy control group (n = 113). Within the FBD group, participants were further divided into those who received rTMS therapy (FBD treatment group, n = 63) and those who did not (FBD control group, n = 50). The FBD treatment group was subcategorized based on the number of rTMS treatments received. We evaluated various factors, including gender, age, monthly household income, daily activity level, and sleep quality, as potential risk factors for FBD. Severity assessments of FBD and associated symptoms (constipation, anxiety, depression, and somatization disorders) were conducted using validated scales before and after treatment. Our findings revealed a higher incidence of FBD in women, with most cases emerging at age 50 or older. We identified lower monthly household income, reduced daily activity levels, and poorer sleep quality as factors associated with a higher likelihood of FBD. FBD patients exhibited higher scores for constipation, anxiety, depression, and somatization disorders compared to healthy controls. rTMS therapy was effective in reducing gastrointestinal symptoms, anxiety, depression, and somatization disorders among FBD patients. Notably, the extent of improvement was positively correlated with the number of rTMS sessions. No adverse effects were observed during the study. Our study underscores the efficacy of biophysical therapy, specifically repetitive transcranial magnetic stimulation, in mitigating FBD symptoms and associated psychological distress. The treatment's effectiveness is positively linked to the frequency of rTMS sessions.

Cost-effectiveness analysis comparing repetitive transcranial magnetic stimulation therapy with antidepressant treatment in patients with treatment-resistant depression in Japan

Repetitive transcranial magnetic stimulation (rTMS) for patients with treatment-resistant depression (TRD) became covered by the National Health Insurance (NHI) in Japan since 2019. Although the evidence of rTMS for TRD is well established, the cost-effectiveness of rTMS versus antidepressants has not been thoroughly analyzed in Japan. Thus, we aimed to evaluate the cost-effectiveness of rTMS for TRD under the NHI system using a microsimulation model to compare the direct costs and quality-adjusted life years (QALYs). Model inputs of clinical parameters and the utility were derived from published literature. Cost parameters were estimated from the Japanese Claim Database. The robustness of the analyses was evaluated with sensitivity analysis and scenario analysis. The analysis estimated that rTMS increased effectiveness by 0.101QALYs and total cost by ¥94,370 ($689) compared with antidepressant medications. As a result, the incremental cost-effectiveness ratio (ICER) of rTMS was estimated to be ¥935,984 ($6,832)/QALY. In the sensitivity and scenario analyses, ICER did not exceed ¥5 million ($36,496)/QALY as the reference value of the Japanese public cost-effectiveness evaluation system. rTMS therapy for TRD can be a cost-effective treatment strategy compared to antidepressant medication under the NHI system in Japan.

Comparing the Effect of Repetitive Transcranial Magnetic Stimulation Therapy and Aerobic Exercise as an Add-on Therapy on the Cognitive Function of Patients with Depression

Background: Cognitive disturbances are a major cause of disability in depression. The antidepressant medication effectively improves cognitive function. However, its adverse effect limits its use, so add-on treatment is needed to support its effectiveness. Aim: This study aims to compare the efficacy of aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) as an add-on treatment for improving cognitive function. Material and Methods: Twenty-seven patients with first episodes of moderate and severe depression were recruited from the outpatient psychiatry clinic to join this randomized controlled trial. Participants were allocated to three groups: antidepressant only, antidepressant with add-on aerobic exercise, and antidepressant with add-on rTMS therapy. All participants received 2 weeks of intervention. Cognitive functions were assessed using Montreal Cognitive Assessment (MOCA). Results: No differences were found in baseline characteristic data between groups. Total MOCA score increased after intervention in a group with no add-on treatment (p=0.007), with add-on aerobic exercise (p=0.011), and with add-on rTMS therapy (p=0.017). Hence, there was no between-group difference (p=0.222). The MOCA subtest analysis revealed between-group differences in changes in delayed recall subtest score (p=0.01). The group with add-on rTMS therapy improved better than the group with antidepressants only (p=0.005). Conclusion: The addition of rTMS therapy resulted in better improved delayed recall function than the addition of aerobic exercise or without any add-on treatment. This finding supports the application of rTMS therapy as an add-on treatment to improve the cognitive function of patients with depression.

Effect of transcranial magnetic stimulation on functional outcome in patients with incomplete spinal cord injury: A randomized controlled study

Background. Incomplete spinal cord injury is a common disorder leading to sensory or motor function loss. Objective. This study aimed to investigate the effect of repetitive transcranial magnetic stimulation therapy (rTMS) on functional outcome in patients with incomplete spinal cord injury. Design. A prospective randomized controlled trial. Setting. Agouza Rehabilitation Hospital Out clinic. Methods. Forty male patients with chronic traumatic incomplete spinal cord injury aging from 25 to 45years. Patients were randomly divided into two equal groups (group A and group B).Group A was the study group that received rTMS in addition to designed physical therapy program including BWST training and Group B was the control group that received the same designed physical therapy program including BWST training. The functional gait was assessed using walking index for spinal cord injury (WISCI II) and gait speed was assessed using 10 m walk test. Measurements were performed before and after treatment and three months after end of the treatment as follow up. Results. There was a statistically significant improvement in WISCI II and 10m walk test at post treatment and follow up compared with that pre-treatment in study group (P &lt; 0.05). There was no statistically significant improvement in all outcome variables at post treatment and follow up compared with that pretreatment in control group (P &gt; 0.05).There was a statistically significant improvement in patients who received rTMS with BWST compared with patients received BWST only in WISCI II and 10 m walk test at post treatment (p = 0.01 and p = 0.001 respectively) compared to pre treatment. The gained effect was lost at follow up measurement compared to post treatment in WISCI II and the gained effect was maintained at follow up measurement compared to post treatment in 10m walk test score. Conclusion. It was proven that rTMS add a valuable effect for restoring function in patients with incomplete spinal cord injury, particularly in cases when the effect of BWST has reached a plateau.

Analysis of the Efficacy of High-frequency Repetitive Transcranial Magnetic Stimulation Therapy Combined with General Acupuncture in the Treatment of Postpartum Depression

Objective: To analyze the effect of postpartum depression treated with high-frequency repetitive transcranial magnetic stimulation combined with general acupuncture. Methods: Screening 45 patients with postpartum depression diagnosed in our hospital during the period from August 2019 to August 2022 as study subjects, according to the treatment plan chosen by the patients, we included 22 patients who received conventional conservative medication into the control group, and then 23 patients who received high-frequency repetitive cranial magnetic stimulation combined with general acupuncture into the observation group, followed by the Postpartum Depression Assessment Scale ( EPDS) to assess the extent of the condition of the patients in both groups before and after treatment, and finally to observe the symptom performance of the patients in both groups before and after treatment, as so as to evaluate the efficacy. Results: After the treatment, the EPDS scores of patients in both groups were significantly reduced, but the EPDS scores of patients in the observation group were significantly lower than those in the control group (P&lt;0.05); the clinical symptoms of patients in the observation group improved significantly after the treatment, and the overall treatment effect was better than that of the control group (P&lt;0.05). Conclusion: High-frequency repetitive transcranial magnetic stimulation therapy combined with general acupuncture, this treatment has a better therapeutic effect on postpartum depression, with strong clinical application value, and it has the significance of promoting reference.

Transcranial Magnetic Stimulation for Post-Stroke Dyslexia 1 Case and Clinical Analysis

Objective: To investigate the efficacy of repetitive transcranial magnetic stimulation therapy combined with speech training on the speech function of patients with post-stroke aphasia, understanding the mechanisms of cognitive neuropsychological recovery in patients with dyslexia. METHODS: One case of aphasia patients was collected and treated with repetitive transcranial magnetic stimulation and speech therapy, and the patients' Chinese language aphasia examination assessment and hydrogen protons nuclear magnetic resonance spectroscopy results were collected before and after treatment. Based on the combination of neurocognitive psychological model, the relationship between the change of speech function and the dual-channel model before and after patients' repetitive transcranial magnetic stimulation combined with speech therapy was investigated. RESULTS: After 2 months of treatment, the patient's reading function, conversation, comprehension, repetition, and naming function improved when compared with before, and hydrogen protons nuclear magnetic resonance spectroscopy suggested that the patient's bilateral cerebral hemispheres Cr/Ch, and NAA/Cr all increased after treatment compared with before. Conclusion: Transcranial magnetic stimulation therapy combined with speech training can promote the increase of brain metabolites and improve patients' reading function, providing a new therapeutic idea for the treatment of post-stroke dyslexia, Meanwhile, the combination of repetitive transcranial magnetic stimulation technique and hydrogen proton MRI spectroscopy can be used as a non-invasive treatment-examination combination to explore the mechanisms of recovery from dyslexia.

Effectiveness of adjunctive low-frequency repetitive transcranial magnetic stimulation therapy over the left dorsolateral prefrontal cortex in patients with obsessive-compulsive disorder refractory to medical treatment:A double-blind, randomized clinical trial

Obsessive-compulsive disorder (OCD) is a common psychiatric disorder. The Food and Drug Administration (FDA) approved repetitive transcranial magnetic stimulation (rTMS) to treat OCD in 2018. So far, various approaches to treat this disorder have been evaluated. We evaluated the effect of adjunctive low-frequency rtMS over the left dorsolateral prefrontal cortex in patients with OCD refractory to treatment. The present clinical trial was done on 37 patients with OCD referring from the psychiatry clinic, 22 Bahman Hospital, Qazvin province, between 2018 and 2020 and patients were randomly divided into two groups. The intervention group received rTMS treatment at 1Hz for 20min (1200 pulses/day) over the left DLPFC area as adjunctive to the medical treatment three times a week and for five weeks, whereas those in the control group were subjected to only the sham condition plus their medical treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOC.S) was completed by patients before the study, following sessions 5 and 10 during the intervention, at the end of the intervention, and three to six months after the intervention under the direct supervision of a psychiatrist. SPSS software version 26 was used to compare the results between the two groups. The intervention group showed significantly lower mean Y-BOCS scores after the intervention and at follow-up (P<0.05) and all patients of the intervention group showed significantly lower Y-BOCS scores than their own baseline scores (P<0.05). Also, using antipsychotic agents along with the serotonergic agents yielded significantly lower scores in the intervention group at the end of the intervention (P<0.05). All the patients were found with higher follow-up scores than their scores at the end of the intervention; however, this difference was not significant (p>0.05). Adjunctive low-frequency (1Hz) rTMS over the left DLPFC is able to effectively reduce Y-BOCS score in OCD patients refractory to treatment following 15 sessions, and the reduction was durable even after three to six months. Using antipsychotic agents as an adjuvant with serotonergic agents was identified as a possible predictor for response to adjunctive rTMS therapy.

Repetitive transcranial magnetic stimulation therapy markedly reduces anxiety in adults with major depressive disorder: A retrospective analysis of 664 patients

Abstract Background: Patients with MDD commonly have comorbid anxiety that can severely affect quality of life and, in some cases, predicts inferior response to antidepressant treatment. Nonetheless, for some antidepressant treatments, it is also established that clinical improvement in depressive symptoms is accompanied by improvement in comorbid anxiety symptoms. However, there is limited information on the impact of treatment with TMS on the severity of comorbid anxiety symptoms in MDD patients. Methods: Patient data was extracted from a clinical registry of patients treated with left-sided high frequency TMS. Six hundred and sixty-four (664) patients were identified who demonstrated at least moderate depression and anxiety symptom severity prior to commencing treatment for MDD. These patients had total scores greater than 10 on both the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales. Patients were aged 22 to 70 years and had received a minimum course of 20 left-sided treatments. Results: GAD-7 response was defined as a postTMS decrease from baseline in GAD-7 scores ≥ 6 (minimally clinically important difference) and remission was defined as a final GAD-7 score < 5; 65.5% of patients (95% CI: 61.9%. 69.1%) were GAD-7 responders and 34% met the remission criterion. Mean change in the GAD-7 score was -8.0 ± 5.7 (p<0.0001). Mean change in total score on the PHQ-9 was -10.5±6.7 (p<0.0001), and 58.9% of patients demonstrated a 50% or greater improvement in PHQ-9 score. The correlation between change scores on the GAD-7 and PHQ-9 was 0.75 (p<00001), indicating substantial covariation. Conclusions: High frequency TMS may reduce symptoms of both anxiety and depression in adults with MDD. We will also contrast this group with significant co-morbid anxiety to MDD patients with low baseline levels of anxiety in likelihood of antidepressant response to TMS. Keywords: TMS, anxiety, depression, high frequency

The evidence is in: Repetitive transcranial magnetic stimulation is an effective, safe and well-tolerated treatment for patients with major depressive disorder.

Despite more than 25 years of research establishing the antidepressant efficacy of repetitive transcranial magnetic stimulation, there remains uncertainty about the depth and breadth of this evidence base, resulting in confusion as to where repetitive transcranial magnetic stimulation fits in the therapeutic armamentarium in the management of patients with mood disorders. The purpose of this article is to provide a concise description of the evidence base supporting the use of repetitive transcranial magnetic stimulation in the context of the stages of research that typically accompanies the development of evidence for a new therapy. The antidepressant efficacy for the use of repetitive transcranial magnetic stimulation in the treatment of depression has been established through a relatively traditional pathway beginning with small case series, progressing to single-site clinical trials and then to larger multisite randomised double-blind controlled trials. Antidepressant effects have been confirmed in numerous meta-analyses followed more recently by large network meta-analysis and umbrella reviews, with evidence that repetitive transcranial magnetic stimulation may have greater efficacy than alternatives for patients with treatment-resistant depression. Finally, repetitive transcranial magnetic stimulation has been shown to produce meaningful response and remission rates in real-world samples of greater than 5000 patients. The evidence for the antidepressant efficacy of repetitive transcranial magnetic stimulation therapy is overwhelming, and it should be considered a routine part of clinical care wherever available.

Identification of psychiatric disorder subtypes from functional connectivity patterns in resting-state electroencephalography.

The understanding and treatment of psychiatric disorders with neurobiological and clinical heterogeneity could benefit from the identification of disease subtypes on the basis of data acquired with established neuroimaging technologies. Here, we report the identification of two clinically relevant subtypes of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) on the basis of robust and distinct functional-connectivity patterns, prominently within the frontoparietal-control and default-mode networks. We identified the disease subtypes by analysing, via unsupervised and supervised machine learning, the power-envelope-based connectivity of signals reconstructed from high-density resting-state electroencephalography in four datasets from patients with PTSD and MDD, and show that the subtypes are transferable across independent datasets recorded under different conditions. The subtype whose functional connectivity differed most from those of healthy controls was less responsive to psychotherapy treatment for PTSD and failed to respond to an antidepressant medication for MDD. By contrast, both subtypes responded equally well to two different forms of repetitive transcranial magnetic stimulation therapy for MDD. Our data-driven approach may constitute a generalizable solution for connectome-based diagnosis.

Neuronavigation based 10 sessions of repetitive transcranial magnetic stimulation therapy in chronic migraine: an exploratory study.

Chronic migraine is a disease of altered cortical excitability. Repetitive transcranial magnetic stimulation provides a novel non-invasive method to target the nociceptive circuits in the cortex. Motor cortex is one such potential target. In this study, we targeted the left motor cortex using fMRI-guided neuronavigation. Twenty right-handed patients were randomized into real and sham rTMS group. Baseline subjective pain assessments were done using visual analog scale (VAS) and questionnaires: State-Trait Anxiety Inventory, Becks Depression Inventory, and Migraine Disability Assessment (MIDAS) questionnaire. Objectively, pain was assessed by means of thermal pain thresholds using quantitative sensory testing. For corticomotor excitability parameters, resting motor thresholds and motor-evoked potentials were mapped. For rTMS total, 600 pulses in 10 trains at 10Hz with an intertrain interval of 60s were delivered in each session. Ten such sessions were given 5days per week over 2 consecutive weeks. The duration of each session was 10min. Real rTMS was administered at 70% of Resting MT. All the tests were repeated post-intervention and after 1month of follow-up. There are no studies reporting the use of fMRI-based TMS for targeting the motor cortex in CM patients. We observed a significant reduction in the mean VAS rating, headache frequency, and MIDAS questionnaire in real rTMS group which was maintained after 1month of follow-up. Ten sessions of fMRI-based rTMS over the left motor cortex may provide long-term pain relief in CM, but further studies are warranted to confirm our preliminary findings.

The Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation Therapy on Serum Brain-Derived Neurotropic Factor Level and Motor Ability in Ischemic Stroke Patients: A Single-Center Study

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder.&#x0D; AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients.&#x0D; METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples.&#x0D; RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p &lt; 0.5). The Mann–Whitney U-test showed a more significant change (p &lt; 0.5) in the treatment group than in the control (p = 0.5).&#x0D; CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.

Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta-analysis.

IntroductionTherapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of Parkinson's disease (PD) have been reported; however, the protocols of these studies varied greatly. The aim of this meta‐analysis was to evaluate the optimal rTMS parameters for motor recovery of PD.MethodsElectronic databases were searched for studies investigating the therapeutic effects of rTMS on motor function in patients with PD. The section III of the Unified Parkinson's Disease Rating Scale (UPDRS) was extracted as the primary outcome, and the standardized mean difference (SMD) with 95% confidence interval (CI) was calculated.ResultsTwenty‐three studies with a total of 646 participants were included. The pooled estimates of rTMS revealed significant short‐term (SMD, 0.37; p < 0.00001) and long‐term (SMD, 0.39; p = 0.005) effects on motor function improvement of PD. Subgroup analysis observed that high‐frequency rTMS (HF‐rTMS) was significant in improving motor function (SMD, 0.48; p < 0.00001), but low‐frequency rTMS (LF‐rTMS) was not. In particular, when HF‐rTMS targeted over the primary motor cortex (M1), in which the bilateral M1 revealed a larger effect size than unilateral M1. Compared to single‐session, multi‐session of HF‐rTMS over the M1 showed significant effect size. In addition, HF‐rTMS over the M1 with a total of 18,000–20,000 stimulation pulses yielded more significant effects (SMD, 0.97; p = 0.01) than other dosages.ConclusionsIn conclusion, multi‐session of HF‐rTMS over the M1 (especially bilateral M1) with a total of 18,000–20,000 pulses appears to be the optimal parameters for motor improvement of PD.

Repetitive Transcranial Magnetic Stimulation Therapy is a Potential Therapeutic Option for Primary Orthostatic Tremor. (P6.059)

Repetitive Transcranial Magnetic Stimulation Therapy is a Potential Therapeutic Option for Primary Orthostatic Tremor. (P6.059)

A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression

BackgroundRepetitive transcranial magnetic stimulation (rTMS) was approved in 2008 in the United States, and there are relatively few studies describing its use in regular clinical practice since approval. MethodsFrom April 2011 to October 2014, ten sites within the National Network of Depression Centers (NNDC) provided data on 62 evaluable patients with a depressive episode. Treatment was determined naturalistically. Response was assessed by the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) as the primary outcome, and the Patient Health Questionnaire-9 (PHQ-9) and the clinician-rated Clinical Global Impression (CGI) as secondary depression measures. ResultsEnrolled patients exhibited significant treatment resistance, with 70.2% reporting more than 4 prior depressive episodes. Most patients received treatment with standard parameters (10Hz over the left dorsolateral prefrontal cortex), although 22.6% of the patients received 1 or 5Hz stimulation at some point. Over 6 weeks of treatment, response and remission rates were 29.4% and 5.9%, respectively, for the QIDS-SR; 39.2% and 15.7%, respectively, for the PHQ-9; and 50.9% and 17.9%, respectively, for the CGI. Moderator analyses revealed no effect of prior depressive episodes, history of ECT or gender, although early life stress predicted a better response to rTMS therapy. LimitationsThe study was an open-label, registry trial, with relatively coarse clinical data, reflecting practice only in academic, depression-specialty centers. Because of the relatively small size and heterogeneity of the sample, type 2 errors are possible and positive findings are in need of replication. ConclusionrTMS demonstrates effectiveness in clinical practice within the NNDC, although remission rates appear slightly lower in comparison with other recent naturalistic studies.

Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: a systematic review and meta-analysis

Objectives: A meta-analysis and systematic review was conducted to investigate the potential effects of repetitive transcranial magnetic stimulation on dysphagia in patients with stroke, including different parameters of frequency and stimulation site. Methods: PubMed, Embase, MEDLINE databases and the Cochrane Library, were searched for randomized controlled studies of repetitive transcranial magnetic stimulation treatment of dysphagia published before March 2016. Results: Six clinical randomized controlled studies of a total of 163 stroke patients were included in this meta-analysis. A significant effect size of 1.24 was found for dysphagic outcome (mean effect size, 1.24; 95% confidence interval (CI), 0.67–1.81). A subgroup analysis based on frequency showed that the clinical scores were significantly improved in dysphagic patients with low frequency repetitive transcranial magnetic stimulation treatment (P < 0.05) as well as high frequency repetitive transcranial magnetic stimulation treatment (P < 0.05). A stimulation site stratified subgroup analysis implied significant changes in stroke patients with dysphagia for the unaffected hemisphere (P < 0.05) and the bilateral hemisphere stimulation (P < 0.05), but not for the affected hemisphere (P > 0.05). The analysis of the follow-up data shows that patients in the repetitive transcranial magnetic stimulation groups still maintained the therapeutic benefit of repetitive transcranial magnetic stimulation four weeks after the last session of repetitive transcranial magnetic stimulation therapy (P < 0.05). Conclusion: This meta-analysis indicates that repetitive transcranial magnetic stimulation has a positive effect on dysphagia after stroke. Compared with low-frequency repetitive transcranial magnetic stimulation, high-frequency repetitive transcranial magnetic stimulation may be more beneficial to the patients. This meta-analysis also supports that repetitive transcranial magnetic stimulation on an unaffected – or bilateral – hemisphere has a significant therapeutic effect on dysphagia.

The effects of repetitive transcranial magnetic stimulation on unilateral neglect of acute stroke patients: A randomised controlled trial.

Rehabilitation of the unilateral neglect of acute stroke patients represents a major challenge. This study aimed to evaluate the effects of repetitive transcranial magnetic stimulation on the functional recovery of stroke patients with unilateral neglect. Twenty patients with stroke were randomly assigned to two groups: a repetitive transcranial magnetic stimulation group (experimental) and a control group. The stroke patients in the experimental group underwent repetitive transcranial magnetic stimulation therapy and comprehensive rehabilitation therapy. The stroke patients in the control group underwent sham magnetic stimulation therapy and comprehensive rehabilitation therapy. The patients in both groups received therapy 5 days per week for 4 weeks. The Motor Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Albert Test (AT), and Star Cancellation Test (SCT) were assessed before and after the 4-week therapy period. The experimental group showed a significant increase in the MVPT, LBT, AT, and SCT values compared with the preintervention values (p < 0.05). Furthermore, the control group showed a significant increase in the MVPT, LBT, and AT results compared with the preintervention results (p < 0.05). A significant difference in the post-training gains for the MVPT (8.9 ± 2.5 vs. 4.8 ± 3.0), LBT (-19.3 ± 7.5 vs. -6.5 ± 9.5), AT (13.1 ± 8.0 vs. 4.0 ± 1.9), and SCT (-13.6 ± 6.9 vs. -4.5 ± 6.9) were observed between the experimental group and the control group (p < 0.05). In addition, the effect size for gains in the experimental and control groups was very large in MVPT and AT (effect size = 3.25 and 2.90), respectively, and the effect size for gains in the experimental and control groups was small in LBT and SCT (effect size = 0.22 and 0.23, respectively). The current study findings indicated that repetitive transcranial magnetic stimulation may be beneficial in decreasing the unilateral neglect of stroke patients.