Transcranial Magnetic Stimulation Therapy Research Articles

TMS Database Registry Consortium Research Project in Japan (TReC-J) for Future Personalized Psychiatry.

The registry project led by the Japanese Society for Clinical Transcranial Magnetic Stimulation (TMS) Research aims to establish a centralized database of epidemiological, clinical, and biological data on TMS therapy for refractory psychiatric disorders, including treatment-resistant depression, as well as to contribute to the elucidation of the therapeutic mechanism of TMS therapy and to the validation of its efficacy by analyzing and evaluating these data in a systematic approach. The objective of this registry project is to collect a wide range of complex data linked to patients with various neuropsychiatric disorders who received TMS therapy throughout Japan, and to make effective use of these data to promote cross-sectional and longitudinal exploratory observational studies. Research utilizing this registry project will be conducted in a multicenter, non-invasive, retrospective, and prospective observational research study design, regardless of the framework of insurance medical care, private practice, or clinical research. Through the establishment of the registry, which aims to make use of data, we will advance the elucidation of treatment mechanisms and identification of predictors of therapeutic response to TMS therapy for refractory psychiatric disorders on a more real-world research basis. Furthermore, as a future vision, we aim to develop novel neuromodulation medical devices, algorithms for predicting treatment efficacy, and digital therapeutics based on the knowledge generated from this TMS registry database.

Randomized Controlled Trial of the Effects of Repetitive Transcranial Magnetic Stimulation and Mirror Therapy on Phantom Limb Pain in Amputees

To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on phantom limb pain (PLP) in amputees, and to compare the therapeutic effect with that of mirror therapy (MT). The study was designed as a randomized controlled trial. The evaluators were blinded, while the subjects and the therapists were unblinded. Subjects were randomly assigned to either the rTMS group or the MT group with a computer-generated random number table. From June 2018 to December 2020, from out of 45 amputee patients screened for the study, 30 who met the inclusion criteria were recruited for the study. All patients were recruited from the Rehabilitation Medicine Center, West China Hospital, Sichuan University. In the end, 4 patients withdrew from the study and 26 patients (12 in the rTMS group and 14 in the MT group) completed the prescribed treatment and evaluation. The rTMS group was given rTMS (1 Hz, 15 min, 5 d/week) for 2 weeks in addition to conventional rehabilitation therapy, while the MT group received MT (corresponding movements of limbs, 15 min, 5 d/week) for 2 weeks in addition to conventional rehabilitation therapy. PLP was evaluated by the Visual Analogue Scale (VAS) and Douleur Neuropathique 4 Questions (DN-4). Subjects were assessed before treatment ( t 0), immediately after the completion of the treatment ( t 1) and 3 months after the completion of the treatment ( t 2). The mean age of the 26 patients was 39.73±12.64. There were 15 males and 11 females. According to the reported description of the characteristics of the PLP by the patients, the characteristics with the highest incidence were tingling, stabbing, numbing, electric shocks and burning in descending order. There was no significant difference in the incidence of PLP characteristics between the two groups ( P>0.05). The two groups had comparable baseline data, showing no significant difference in VAS and DN-4 between the two groups at t 0 ( P>0.05). At t 1 and t 2, the VAS and DN-4 scores were decreased from those of t 0, showing statistically significant difference in both groups ( P<0.01 for both scores). In the rTMS group, there was no significant difference between VAS and DN-4 scores at t 1 and those at t 2 ( P>0.05). In the MT group, the VAS and DN-4 scores at t 2 were significantly lower than those of t 1 ( P<0.05). There was no statistically significant difference between the rTMS group and MT group in the changes in pain measurements, i.e., VAS and DN-4 scores, before and after the intervention ( P>0.05). The 26 patients who completed the experiment showed no dizziness, headache, or other abnormalities during the study. The results of this study indicate that repetitive transcranial magnetic stimulation could improve PLP in amputees, and the improvement effect was comparable to that of mirror therapy.

Differential Effects of rTMS and ECT on the Symptom Dimensions of Reward and Approach/Avoidance in Major Depressive Disorder

Repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) are established depression treatments, but the mechanisms remain unknown. Examining the dimensional effects of each therapy may identify underlying network mechanisms as well as inform clinical decision making.

Case study: Acoustical design for newly renovated behavioral health suite

This presentation addresses requirements and opportunities for the acoustical design of a behavioral design suite. Examples of coordinated design elements will be presented from a recent remodel project for a single suite in the UCSF Langley Porter Psychiatric Hospital and Clinics Mt. Zion relocation. The following will be presented. Unique components: Equipment transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain, used to address depression. TMS therapy treatment equipment has a loud tapping noise that can be highly annoying to occupants of adjacent rooms. Sound isolation and sound-absorbing treatments are important design elements for a room with this equipment. Unique requirements: Patient safety behavioral health suites have unique patient safety requirements that led to the design selection for acoustical tamper-proof ceiling panels and specializd door gaskets at specific room types. Design considerations: Group therapy room group therapy rooms are in-patient areas that can consist of small and large groups, sometimes involving simultaneous group activities among patients and staff. HIPAA requirements, speech intelligibility, and occupant comfort, as well as hospital operations were important considerations for the coordinated acoustical design.

Specific brain network predictors of interventions with different mechanisms for tinnitus patients.

SummaryBackgroundThe aberrant brain network that gives rise to the phantom sound of tinnitus is believed to determine the effectiveness of tinnitus therapies involving neuromodulation with repetitive transcranial magnetic stimulation (rTMS) and sound therapy utilizing tailor-made notch music training (TMNMT). To test this hypothesis, we determined how effective rTMS or TMNMT were in ameliorating tinnitus in patients with different functional brain networks.MethodsResting-state functional MRI was used to construct brain functional networks in patients with tinnitus (41 males/45 females, mean age 49.53±11.19 years) and gender-matched healthy controls (22 males/35 females, mean age 46.23±10.23 years) with independent component analysis (ICA). A 2 × 2 analysis of variance with treatment outcomes (Effective group, EG/Ineffective group, IG) and treatment types (rTMS/TMNMT) was used to test the interaction between outcomes and treatment types associated with functional network connections (FNCs).FindingsThe optimal neuroimaging indicator for responding to rTMS (AUC 0.804, sensitivity 0.700, specificity 0.913) was FNCs in the salience network-right frontoparietal network (SN-RFPN) while for responding to TMNMT (AUC 0.764, sensitivity 0.864, specificity 0.667) was the combination of FNCs in the auditory network- salience network (AUN-SN) and auditory network-cerebellar network (AUN-CN).InterpretationTinnitus patients with higher FNCs in the SN-RFPN is associated with a recommendation for rTMS whereas patients with lower FNCs in the AUN-SN and AUN-CN would suggest TMNMT as the better choice. These results indicate that brain network-based measures aid in the selection of the optimal form of treatment for a patient contributing to advances in precision medicine.FundingYuexin Cai is supported by Key R&D Program of Guangdong Province, China (Grant No. 2018B030339001), National Natural Science Foundation of China (82071062), Natural Science Foundation of Guangdong province (2021A1515012038), the Fundamental Research Funds for the Central Universities (20ykpy91), and Sun Yat-Sen Clinical Research Cultivating Program (SYS-Q-201903). Yu-Chen Chen is supported by Medical Science and Technology Development Foundation of Nanjing Department of Health (No. ZKX20037), and Natural Science Foundation of Jiangsu Province (No. BK20211008).

Transcranial Magnetic Stimulation Therapy of Major Depressive Disorder Improves Heart Rate Variability.

Transcranial magnetic stimulation is typically administered daily for 6 to 9 weeks with gradual resolution of major depressive disorder. However, there is little evidence to guide clinicians when clinical improvement is not forthcoming as the course proceeds. We describe a patient whose depression score remained unchanged after 10 single daily intermittent thetaburst transcranial magnetic stimulation sessions targeting F3 in the dorsolateral prefrontal cortex and our efforts to modify the technique and monitor progress with heart rate variability (HRV) measures. The motor threshold position and intensity were verified to be unchanged from the baseline visit. Stimulation of F3 and treatment target 6 cm anterior to the mapped motor cortex site seemed to slow heart rate and increase HRV equally. We increased the number of daily intermittent thetaburst pulse trains for the remainder of the treatment course, targeting the 6-cm target. Our patient subsequently improved, and we observed concurrent changes in HRV suggestive of enhanced parasympathetic activity. These improvements were found to be durable at 10-week follow-up.

Якість життя як показник ефективності комбінованої терапії з використанням транскраніальної магнітної стимуляції при епілепсії

У статті наводиться аналіз якості життя згідно з опитувальником QOLIE‑31 у 48 пацієнтів з епілепсією, яким здійснювалася ритмічна транскраніальна магнітна стимуляція (рТМС). Аналіз результатів проведеного дослідження з використанням рТМС і мінімальних терапевтичних доз антиепілептичних препаратів показав, що подібна комбінація фармакологічних і фізичних чинників дозволяє контролювати перебіг епілепсії та забезпечує досить високу протисудомну дію. Отримані результати дозволили обгрунтовано доповнити медикаментозне лікування епілепсії проведенням курсу рТМС, домогтися оптимального терапевтичного результату в кожного пацієнта з мінімальним ризиком побічних ефектів, а також поліпшити якість його життя.

Comparison of the effect and treatment sequence between a 2-week parallel repetitive transcranial magnetic stimulation and rehabilitation and a 2-week rehabilitation-only intervention during a 4-week hospitalization for upper limb paralysis after stroke: An open-label, crossover observational study.

BackgroundNEURO® is a 2-week program that combines low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) to treat patients with chronic hemiparesis following stroke. The degree to which each element contributes to the improvement of upper limb function remains unclear. It has been suggested that low-frequency rTMS applied to a healthy cerebrum activates neural activity in the contralateral hemispheric area surrounding the lesion. Intensive OT performed in parallel to rTMS promotes the functional remodeling of the cerebrum to help with rehabilitation.OBJECTIVESHowever, this has not been demonstrated using NEURO®. Therefore, we aimed to compare the effects of the NEURO® and OT-only protocols in patients with hemiparesis following stroke.MethodsThirty-seven patients with upper limb paralysis following stroke were recruited and hospitalized for treatments and randomly divided into two groups. Group A consisted of 16 patients who underwent NEURO® for the first 2 weeks, and Group B consisted of 21 patients who underwent OT-only for the first 2 weeks. After 2 weeks of hospitalization, the treatments of Groups A and B were reversed for the subsequent 2 weeks of treatment. Improvement in upper limb motor function in Groups A and B at 2 and 4 weeks after the start of treatment was evaluated using the Fugl-Meyer Motor Assessment (FMA) and the Wolf Motor Function Test (WMFT).ResultsGroup A, who underwent NEURO® first during their initial 2-week hospitalization, showed significantly greater improvement than that in Group B, who underwent OT-only first (P = .041 for FMA and P < .01 for WMFT). At 4 weeks following the reversal of treatments, Group A who underwent NEURO® and then OT-only showed significantly greater improvement than that in Group B, who underwent OT-only followed by NEURO® (P = .011 for FMA and P = .001 for WMFT).ConclusionOur findings indicate that rTMS facilitates neuromodulation when combined with OT, which leads to more effective rehabilitation than with OT alone (Trial registration: JMACCT (http://www.jmacct.med.or.jp/); trial ID JMA-IIA00215).

A Retrospective Naturalistic Study Comparing the Efficacy of Ketamine and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression.

Depression is a common mental disorder that affects many people worldwide, while a significant proportion of patients remain non-responsive to antidepressant medications. Alternative treatment options such as ketamine therapy and repetitive transcranial magnetic stimulation (rTMS) therapy are offered nowadays. This study aims to describe and compare the acute antidepressive efficacy of both, intramuscular ketamine and rTMS in depression patients seeking help in a naturalistic clinical mental health setting. The clinical records of 24 patients with treatment resistant depression were collected from the clinical base of a real life clinic. Twelve patients were treated with intramuscular ketamine, twice weekly for 8 sessions, and twelve patients were treated with 30 sessions of left dorsolateral prefrontal cortex – intermittent theta-burst stimulation (DLPFC-iTBS). Using three clinical assessments (HDRS, HAM-A, BDI-II), our data reveal that both therapies led to significant improvement in symptoms from pre- to post- treatment, as well as that the two experimental groups did not differ significantly with respect to pre- to post- depressive and anxiety symptoms, indicating that the effect of both experimental groups in our sample was equally effective. Furthermore, our results showed high remission and response rates in both groups, with no statistical differences between the patients of ketamine group and rTMS group in remission and response rates. We show a significant pre- to post- treatment reduction in depressive and anxiety symptoms, with no significant differences between the two experimental groups, indicating that the effect of both therapies was equally effective in our limited sample.

The latest research progress of tinnitus related treatment

Tinnitus is a kind of phantom hearing. The quality of life of millions of people around the world is affected by it. There is no data to prove that drugs can be cured. There is no final conclusion on the clinical treatment of tinnitus. This article focuses on the treatment of tinnitus: Drug Treatment, Traditional Chinese Medicine, Surgical Treatment, Hyperbaric Oxygen Therapy, Acoustic Resonance Therapy, Transcranial Magnetic Stimulation Therapy, Cognitive Behavioral Therapy（CBT）, Tinnitus Retraining Therapy （TRT）, Multiple Compound Sound Therapy, etc. Provide more personalized tinnitus treatment programs for clinical patients.

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

Guidance on Navigating Insurance Plans for TMS-Eligible Patients

Guidance on Navigating Insurance Plans for TMS-Eligible Patients

Structural connectivity changes in the motor execution network after stroke rehabilitation.

Background:Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear.Objective:This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach.Methods:Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes.Results:The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations.Conclusions:This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.

Characteristics of Attention Bias in Patients With Depression Disorder, and the Influence of High Frequency Transcranial Magnetic Stimulation Therapy on the Attention Bias

We propose a general model to entirely describe XPM effects induced by 16QAM channels in hybrid QPSK/16QAM wavelength division multiplexed (WDM) systems. A power spectral density (PSD) formula is presented to predict the statistical properties of XPM effects at the end of dispersion management (DM) fiber links. We derive the analytical expression of phase error variance for optimizing block length of QPSK channel coherent receiver with decision-aided (DA) maximum-likelihood (ML) phase estimation (PE). With our theoretical analysis, the optimum block length can be employed to improve the performance of coherent receiver. Bit error rate (BER) performance in QPSK channel is evaluated and compared through both theoretical derivation and Monte Carlo simulation. The results show that by using the DA-ML with optimum block length, bit signal-to-noise ratio (SNR) improvement over DA-ML with fixed block length of 10, 20 and 40 at BER of 10−3 is 0.18 dB, 0.46 dB and 0.65 dB, respectively, when in-line residual dispersion is 0 ps/nm.

Effect of transcranial magnetic stimulation on treatment effect and immune function.

To explore the effect of transcranial stimulation on the therapeutic effect and immune function of patients with post-stroke depression (PSD). Methods Selection in September 2020–April 2021 on the diagnosis of 70 patients with PSD as the research object, 35 patients were randomly divided into control group and intervention group and control group given conventional treatment, the intervention group in the control group on the basis of the application of transcranial magnetic stimulation treatment, compare the curative effect of two groups of patients after the treatment cycle and the effects on the immune function. Results After treatment, the levels of DA, NE, 5-HT in 2 groups were significantly increased, and those in the observation group were significantly higher than those in the control group (P < 0.05). After 8 weeks of treatment, serum Gly content in 2 groups was significantly increased and Glu content was significantly decreased compared with before treatment. Compared with the control group, serum Gly content in observation group was significantly increased and Glu content was significantly decreased after treatment (P < 0.05). After 8 weeks of treatment, the contents of IL-1β, IL-6 and TNF-α in serum of 2 groups were significantly decreased, compared with the control group, the contents of IL-1β, IL-6 and TNF-α in serum of observation group were significantly decreased (P < 0.05); Before treatment, there was no significant difference in PHQ-9 score and MBI score between the two groups (P > 0.05). After 8 weeks of treatment, PHQ-9 score and MBI score in the two groups were better than before treatment, and the observation group was better than the control group (P < 0.05). Conclusion Transcranial magnetic stimulation therapy can not only effectively promote the synthesis and release of monoamine neurotransmitters in patients with post-stroke depression, regulate the inhibitory/excitatory amino acid neurotransmitters, reduce inflammatory response, improve the clinical treatment effect and enhance the immune function of PSD patients, which has clinical application value.

Changes in brain morphometry after motor rehabilitation in chronic stroke

Purpose Recent studies have revealed structural changes after motor rehabilitation, but its morphological changes related to upper limb motor behaviours have not been studied exhaustively. Therefore, we aimed to map the grey matter (GM) changes associated with motor rehabilitation after stroke using voxel-based morphometry (VBM), deformation-based morphometry (DBM), and surface-based morphometry (SBM). Methods Forty-one patients with chronic stroke received twelve sessions of low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy. MRI data were obtained before and after the intervention. Fugl-Meyer Assessment and Wolf Motor Function Test-Functional Ability Scale were assessed at the two-time points. We performed VBM, DBM, and SBM analyses using T1-weighted images. A correlation analysis was performed between cortical thickness in motor areas and clinical outcomes. Results Clinical outcomes significantly improved after the intervention. VBM showed significant GM volume changes in ipsilesional and contralesional primary motor regions. DBM results demonstrated GM changes contralesionally and ipsilesionally after the intervention. SBM results showed significant cortical thickness changes in posterior visuomotor coordination, precentral, postcentral gyri of the ipsilesional hemisphere and contralesional visuomotor area after the intervention. A combination of threshold p < .05, False Discovery Rate and p < .001 (uncorrected) were considered significant. In addition, cortical thickness changes of the ipsilesional motor areas were significantly correlated with the clinical outcome changes. Conclusions We found GM structural changes in areas involved in motor, visuomotor and somatosensory functions after the intervention. Furthermore, our findings suggest that structural plasticity changes in chronic stroke could occur in the ipsilesional and contralesional hemispheres after motor rehabilitation.

EEG Microstate Analysis of Response to TMS Therapy

Background: Transcranial magnetic stimulation (TMS) is an effective therapy for patients with treatment-resistant depression. TMS likely induces functional connectivity changes in aberrant circuits implicated in depression. Electroencephalography (EEG) “microstates” are topographies hypothesized to represent large-scale resting networks. Canonical microstates have recently been proposed as markers for major depressive disorder (MDD), but it is not known if or how they change following TMS.

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.

Evaluation of fMRI Activation in Hemiparetic Stroke Patients after Rehabilitation with Low-frequency Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy

Purpose: To evaluate activity changes associated with the intervention of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) after stroke using functional magnetic resonance (fMRI). Methods: Seventy stroke patients were scanned while performing finger tapping tasks twice, before and 12 days after the intervention. Recovery of motor functions assessed using Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) for upper extremity at each time point. An fMRI analysis was performed, and a region of interest (ROI) analysis was conducted using percentage signal changes (% SC) to determine the magnitude of activation. Results: FMA and WMFT-FAS were significantly increased from pre-intervention to post-intervention. Intervention related activations were seen in the ipsilesional premotor cortex (PMC) and primary motor cortex (M1), thalamo-cortico regions with the paretic hand movements. With the unaffected hand movements, significant clusters in the contralesional primary somatosensory cortex (S1), superior parietal cortex, and bilateral cerebellum were observed. The ROI-based analysis revealed that ipsilesional M1, contralesional PMC, and supplementary motor area (SMA) showed significantly higher results with the paretic hand movements, a trend toward a significant decrease in the contralesional S1 with the unaffected hand movements from the pre-intervention to post-intervention. Conclusions: Our findings suggest that gains in motor functions produced by the intervention of rTMS and intensive OT in hemiparesis stroke patients may be associated with the ipsilesional hemisphere and contralesional hemisphere as well. Identifying rTMS and OT intervention based on cortical patterns may help to implement rTMS in motor rehabilitation after stroke.

Audio-Guided Mindfulness Meditation During Transcranial Magnetic Stimulation Sessions for the Treatment of Major Depressive Disorder: A Pilot Feasibility Study.

Background: Mindfulness-Based Cognitive Therapy (MBCT) has been shown to enhance the long-term treatment outcomes for major depressive disorder (MDD), and engagement of specific brain activities during brain stimulation may produce synergistic effects. Audio-guided meditation exercises are a component of MBCT that might be combined with standard transcranial magnetic stimulation (TMS) therapy sessions. We developed and pilot-tested a modified MBCT protocol for patients undergoing a standard course of TMS for MDD.Methods: Four MBCT audiotracks with differing durations and types of mental focus were selected. Patients listened to the audiotapes through headphones during daily TMS sessions for 5 consecutive weeks. The primary goal was to evaluate the feasibility and acceptability of the meditation intervention with TMS. Changes in self-rated measures of symptom severity, stress, life satisfaction, and mindfulness were also assessed.Results: Seventeen depressed subjects completed the study and 12 terminated early. Reasons for discontinuation included an inability to meditate in the treatment setting and induction of negative mood states. TMS percussive sensations and clicking sounds hindered the ability of patients to fully concentrate on or hear the voice of the audiotape narrator. Some became overwhelmed or felt increased pressure, anxiety, or aggravation trying to do meditation exercises while receiving TMS.Conclusion: There is a growing interest in combining TMS with other concurrent psychotherapeutic interventions to optimize treatment outcomes. The results highlight numerous feasibility issues with MBCT via guided audiotapes during TMS treatment. Future work should draw on these shortcomings to evaluate the appropriateness of MBCT for depressed patients undergoing neuromodulation.