Role Of rTMS Research Articles

Rich-club reorganization of white matter structural network in schizophrenia patients with auditory verbal hallucinations following 1 Hz rTMS treatment

The human brain comprises a large-scale structural network of regions and interregional pathways, including a selectively defined set of highly central and interconnected hub regions, often referred to as the “rich club”, which may play a pivotal role in the integrative processes of the brain. A quintessential symptom of schizophrenia, auditory verbal hallucinations (AVH) have shown a decrease in severity following low-frequency repetitive transcranial magnetic stimulation (rTMS). However, the underlying mechanism of rTMS in treating AVH remains elusive. This study investigated the effect of low-frequency rTMS on the rich-club organization within the brain in patients diagnosed with schizophrenia who experience AVH using diffusion tensor imaging data. Through by constructing structural connectivity networks, we identified several critical rich hub nodes, which constituted a rich-club subnetwork, predominantly located in the prefrontal cortices. Notably, our findings revealed enhanced connection strength and density within the rich-club subnetwork following rTMS treatment. Furthermore, we found that the decreased connectivity within the subnetwork components, including the rich-club subnetwork, was notably enhanced in patients following rTMS treatment. In particular, the increased connectivity strength of the right median superior frontal gyrus, which functions as a critical local bridge, with the right postcentral gyrus exhibited a significant correlation with improvements in both positive symptoms and AVH. These findings provide valuable insights into the role of rTMS in inducing reorganizational changes within the rich-club structural network in schizophrenia and shed light on potential mechanisms through which rTMS may alleviate AVH.

Role of rTMS and Expression Levels of Serum Growth Factors Along with Neurophysiological Markers in Ischemic Stroke Recovery: A Double Blind, Parallel Group, Sham Controlled Randomized Study

Role of rTMS and Expression Levels of Serum Growth Factors Along with Neurophysiological Markers in Ischemic Stroke Recovery: A Double Blind, Parallel Group, Sham Controlled Randomized Study

1318-P: Repetitive Transcranial Magnetic Stimulation: A Potential Treatment for Obesity in Patients with Prader-Willi Syndrome

Prader-Willi Syndrome (PWS) is the most common syndromic type of human obesity. Multiple endocrine abnormalities due to hypothalamic dysfunction as well as cognitive and behavioral disorders occur in PWS. Hypothalamic dysfunction, dysregulated mesocorticolimbic reward system, and impaired prefrontal cortex (PFC) function are implicated in the pathophysiology of hyperphagia and obesity in PWS. All available therapeutic tools have not fully targeted at counteract the mechanisms underlying obesity in PWS. Previously, we demonstrated the safety and efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in inducing weight loss in obesity by modulating the brain dopaminergic system and enhancing the inhibitory activity of the PFC on eating behaviour (Ferrulli et al, DOM 2019) . In this case-report, for the first time, we tested the efficacy and safety of rTMS in a 23-year-old patient with PWS, in whom repeated interventions aimed at inducing weight loss have failed. A 5-week high frequency (18 Hz) rTMS treatment, associated with diet, resulted in a 3.5% weight loss (127.4 vs. 123 Kg, BMI: 50.4 vs. 48.6 Kg/m2, WHR: 1.14 vs. 1.12) . Concerning the metabolic parameters, an improvement in lipid profile has been shown (CHO/HDL/LDL/TG: 212/40/142/152 vs. 190/40/124/131 mg/dL) . While no significant changes emerged in the psychometric assessment of food craving, impulsiveness, quality of life, self-esteem, interestingly, a robust improvement in the Mini-Mental State Examination score (corrected for age and schooling) has been found [from 22 (severe impairment) to 27 (moderate impairment) ]. The improvement in the cognitive status assessed through the Montreal Cognitive Assessment was weaker (17/30 to 19/30) . In view of the urgent need of novel effective interventions for obesity in PWS, these findings support a potential role of rTMS in reducing food drive and behaviors impacting hyperphagia and obesity in PWS, with a possible impact also on cognitive functions. Disclosure A.Ferrulli: None. D.Cannavaro: None. C.Macrì: None. S.Massarini: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Speaker’s Bureau; Eli Lilly and Company, Novo Nordisk. Funding IRCCS Multimedica - Ricerca Corrente

A happiness magnet? Reviewing the evidence for repetitive transcranial magnetic stimulation in major depressive disorder.

First, to conduct a historical review of the evidence for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder and determine a clinical algorithm. Second, to identify opportunities for research. Literature searches were conducted of the MEDLINE database, UpToDate and the Australian National University Library SuperSearch from 1 January 2000 to 30 September 2019. The search terms used were 'transcranial magnetic stimulation', 'major depressive disorder' and 'depression'. There were 24 meta-analyses identified, demonstrating a clear clinical effect. Left high-frequency rTMS had the most evidence. Ideal clinical parameters and study design were explored. Use of rTMS for some patients with depression is justified. Open research questions include the comparative efficacy of right low-frequency and bilateral stimulation, the role of rTMS in medication-naïve patients, and maintenance of effect.

P142 Role of rTMS over primary motor cortex on implicit and explicit motor sequence learning

P142 Role of rTMS over primary motor cortex on implicit and explicit motor sequence learning

Cortical Excitability and Role of rTMS in Cannabis Use Disorder

Cortical Excitability and Role of rTMS in Cannabis Use Disorder

NIBS in addiction: Neurobiological mechanisms and clinical outcomes

Addiction is correlated with the dysfunction of definite neural circuitry involving deep as well as superficial brain regions. Among the deep structures are the midbrain ventral tegmental area (VTA) and the nucleus accumbens of the ventral striatum, connected to each other by means of dopaminergic fibers. This pathway is the neural correlate of normal appetitive behaviour and is part of the reward system. Cortical areas such as the dorsolateral prefrontal cortex (DLPFC) exert an inhibitory control over the appetitive behaviours through descending cortico-striatal projections. Non–invasive brain stimulation (NIBS) of these regulatory cortical areas has been shown to modify symptoms of substance use disorders and behavioural addictions in several recent studies. In particular, repetitive Transcranial Magnetic Stimulation (rTMS) over the left DLPFC was shown to be effective in reducing relapse in abstinent tobacco smokers while it did not consistently reduce craving and consumption in current smokers. Moreover, in cocaine-use disorder, craving, substance consumption and anhedonia were found to be reduced by the application of rTMS over the right and/or left DLPFC. Preliminary data also point to a possible role of rTMS in the treatment of non-substance addictive behaviours, such as gambling disorder. In recent years, another promising NIBS technique, i.e. transcranial direct current stimulation (tDCS) was used to reduce the symptoms of various addictive disorders, with mixed results. In conclusion, the growing evidence of NIBS efficacy for the treatment of addictive disorders does warrant further larger-scale randomized controlled studies.

The possible role of repetitive transcranial magnetic stimulation in dysphagia following brain stem infarctions

Background Dysphagia is a very common manifestation of brain stem infarctions, which is usually severe enough to need special feeding programs including nasogastric tube application. Repetitive transcranial magnetic stimulation (rTMS) can modulate the cortical excitability and enhance the recovery of swallowing dysfunctions. Aim To evaluate the possible therapeutic role of rTMS in accelerating recovery of dysphagia following brain stem infarctions. Patients and methods This study was conducted on 30 dysphagic patients following brain stem infarctions; 15 received real rTMS and 15 received sham rTMS on bilateral supratentorial cortical swallowing areas. Every patient underwent 10 rTMS sessions repeated five times per week for 2 successive weeks. Scheduled dysphagia severity was evaluated using The Dysphagia Outcome and Severity Scale at stroke onset, after the first rTMS session, and then at 7, 30, and 60 days after the last rTMS session (visits 0, 1, 2, 3, and 4, respectively). Results There was significant improvement of dysphagia in patients who received real rTMS compared with those who received sham rTMS during visits 1 and 2. The improvement was maintained through visits 3 and 4, but without significant difference. Conclusion Bilateral application of real rTMS on cortical swallowing areas for patients with dysphagia following brain stem infarctions has a potential rapid maintained improving effect of swallowing functions with decreased burden of aspiration in the early poststroke period until recovery takes place.

The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Functional Indices of Affected Upper Limb in Patients with Subacute Stroke.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet. Objective: This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke. Material and Methods:In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment. Results: Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p<0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. Conclusion: HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

19. Transcraneal magnetic stimulation

Transcranial magnetic stimulation (TMS) a relatively young technique, described 30 years ago as a non-invasive means of stimulating the cerebral cortex, and has proved to be a unique tool for probing brain-behavior relationships. First described as a diagnostic resource, therapeutic role for rTMS in neuropsychiatry has been demonstrated in diverse neuroscience areas. We review studies on the mechanisms of action of rTMS, and present a summary of the news applications of TMS in basic neuroscience. Recent rTMS works has demonstrated its unique role in complementing other tools therapeutics as speech therapy, psychiatry, sleep, dolor, epilepsy, etc. Despite safety concerns and possible side effects, many researchers use rTMS and see a bright future for it.

Is transcranial magnetic stimulation useful in posttraumatic disorders?

Is transcranial magnetic stimulation useful in posttraumatic disorders?

The Role of rTMS in the Treatment of Psychiatric Disorders Other than Major Depression

Repetitive transcranial magnetic stimulation (rTMS) offers a noninvasive, safe, and well-toleratedmethodofneuromodulation.WereviewedexistingliteraturecoveringrTMStreatment of posttraumatic stress disorder (PTSD), schizophrenia, dementia, bipolar disorder, obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Data for PTSD suggest the right dorsolateral prefrontal cortex may be a potential treatment site. rTMS in schizophrenia suggests high-frequency stimulation of the left DLPFC may have some benefit for negative symptoms, and low-frequency stimulation of the primary auditory cortex may assist with auditory hallucinations. The role of rTMS in the diagnosis and treatment of dementia is promising, but further studies are needed. Data for bipolar disorder are inconsistent across the spectrum of mood states. Treatment of OCD by stimulation of the supplementary motor area may have promise. Data are lacking regarding use of rTMS for ASD or ADHD to draw definitive conclusions. [ Psychiatr Ann . 2014; 44(6):293–298.]

Repetitive transcranial magnetic stimulation as treatment for anxiety disorders

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and generally well-tolerated method of focally stimulating brain regions. It has been shown to be efficacious in the treatment for depression, but only to a limited degree. It has also been investigated for the treatment of some anxiety disorders, particularly obsessive–compulsive disorder, post-traumatic stress disorder and panic disorder. While anecdotal reports and open studies have suggested a therapeutic role for rTMS in anxiety disorders, controlled studies, which have varied greatly in terms of rTMS administration, have not shown it to be superior to placebo. Furthermore, reports in animal models of anxiety have not been consistent. Therefore, to date, there is no convincing evidence for the clinical role of rTMS in anxiety disorders. Further research is needed, drawing on advances in our understanding of pathological neurocircuitry in anxiety disorders and the mechanisms of action by which rTMS may alter that neurocircuitry. With advances in neuroimaging technology, this understanding is likely to be more accessible than it has been in the past.

Repetitive Transcranial Magnetic Stimulation in Bulimia Nervosa: Preliminary Results of a Single-Centre, Randomised, Double-Blind, Sham-Controlled Trial in Female Outpatients

Background: Bulimia nervosa (BN) is often associated with depressive symptoms and treatment with antidepressants has shown positive effects. A shared deficient serotonergic transmission was postulated for both syndromes. The left dorsolateral prefrontal cortex was argued to regulate eating behaviour and to be dysfunctional in eating disorders. Methods: Fourteen women meeting DSM-IV criteria for BN were included in a randomised placebo-controlled double-blind trial. In order to exclude patients highly responsive to placebo, all patients were first submitted to a one-week sham treatment. Randomisation was followed by 3 weeks of active treatment or sham stimulation. As the main outcome criterion we defined the change in binges and purges. Secondary outcome variables were the decrease of the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Scale (YBOCS) over time. Results: The average number of binges per day declined significantly between baseline and the end of treatment in the two groups. There was no significant difference between sham and active stimulation in terms of purge behaviour, BDI, HDRS and YBOCS over time. Conclusion: These preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) in the treatment of BN does not exert additional benefit over placebo. A larger number of patients might clarify a further role of rTMS in the treatment of BN.

Slow-Frequency rTMS Reduces Fibromyalgia Pain: Table 1

Evidence suggests that fibromyalgia (FM) is a centrally mediated pain disorder. Antidepressants, including electroconvulsive therapy, provide some symptomatic relief in FM and other pain disorders. Repetitive transcranial magnetic stimulation (rTMS) is a new antidepressant treatment, which may also be useful in treating chronic pain. As part of a larger study, four women with depression, FM, and borderline personality disorder received 1-Hz rTMS applied to the right dorsolateral prefrontal cortex. Subjects rated pain using an 11-point Likert scale. Pretreatment pain averaged 8.2 (7-9.5) and reduced to 1.5 (0-3.5) after treatment (P < 0.009). All had improvement in pain, and two had complete resolution of pain. Only one of the four subjects had an antidepressant response. These preliminary findings suggest a possible role for rTMS in treating FM.

Ein neues Behandlungsverfahren der Depression: Die repetitive transkranielle Magnetstimulation (rTMS)

Recent data suggest that repetitive transcranial magnetic stimulation (rTMS) is effective in treating depressive symptoms to a lesser extent compared with classical electroconvulsive therapy. However, rTMS represents an economical and well tolerable procedure in relation to the expenditure of electroconvulsive therapy with anaesthesia. Usually, rTMS is applicated as an add-on-therapy accompanying psychopharmacological treatment. So far, it has predominantly been used for patients with long-standing and so called treatment-refractory symptoms. However, even in the early phase of a depressive episode rTMS would be possibly more effective. In many cases, the standard procedure-application of up to 10 rTMS-sessions will not be enough to produce therapeutic benefit. Therefore rTMS series including up to 20 sessions are recommended. Long-term studies are needed to clarify the role of rTMS for relapse prevention and to determine the optimal frequency and duration of rTMS in such an indication. Although numerous results of newer studies suggest a moderate antidepressive effect of rTMS, its application in daily clinical routine practice cannot be recommended yet. Larger, accurate designed and controlled studies, especially involving patients of old age, are needed to evaluate the true tolerability and effectiveness of rTMS as a new treatment option for depressive symptoms.