One specific portion while the machine turned on provided relief. The contrast/brightness of my vision was noticeably improved, and I was thinking very oddly, which turned out to be clear thinking which I had forgotten the feeling of. I was able to do math in my head much more quickly and I had a general feeling of content and happiness. The happiness I felt what I can only imagine I used to feel like before my depression got so awful, or possibly how I should be feeling all of the time and that I’ve never truly felt happy in my life.

When that portion was over, everything went away very quickly and I was excited for the next scanning portion to begin so that I could feel it again. The succeeding portions did offer any of the same feelings or effects, and I was asking the technician to put me back in and he said nobody had ever felt that way about the MRI machine before. I researched and found that I wasn’t the only one who had a relieving experience while having an MRI scan performed. I’m betting that it’s only applicable to a select few people with a specific problem, or possibly only for those who truly have depression, as I’ve read research that the majority of people diagnosed with depression just have chronic stress; additionally, I read an article about how the placebo effect is becoming more and more effective, furthering the suspicion that the majority of people don’t necessarily have depression, by definition. I certainly wasn’t susceptible to the placebo effect with my MRI scan since I went in to be checked for tumors and possible pressure on my frontal lobe; my sensations initiated and stopped as the machine became active and then deactivated and did not return, as hoped, in succeeding rounds of the scan intervals.

There’s a good chance that people in the control groups are not very aware of themselves–I have an oddly powerful sense of proprioception, know my body very well, and astounded the neuropsychologist with my motorfunctions. There’s also the chance that they aren’t positioning the magnets for TMS in the proper position, orientation, or with the proper calibration. I would love to be part of ongoing research since I’m articulate and can describe my symptoms and sensations with abundant information and provide accompanying hypotheses to physicians so that they can better understand the problem. I think I could fine-tune the location, orientation, and calibration of TMS systems if given the opportunity–”0.5mm to the left…3mm lower…adjust yaw 5 degrees counter-clockwise…decrease power output…increase frequency”, etc. I think it has great potential for a niche of people since not everyone is physiologically the same: like extra ribs, extra chromosomes, missing finger/toe, and so on. As it turns out, I suffer from undocumented side-effects from abundant medications I’ve tried, and am often told “no, that’s not from the medication”…then a few years later, my symptoms become documented as a known side-effect of the medication when all the while I was told “no, you’re wrong because the documentation doesn’t agree with you”.

It’s unfortunate that I’m not given opportunities to offer my services (beyond a mere clinical trial of “yes/no”) in exchange for some worthwhile treatment. I can be contacted by yahoo mail under my posted name if any researchers are willing to include me in their projects for some in-depth discussion of hypotheses and some stringent and exhaustive trials. I’ll sign all waivers if it means getting an improved version of TMS treatment and furthering the research, guided by my feedback.

http://www.ant-neuro.com/events/neuromeeting2009/

Greetz

Georges

georges

Thanks for Your marvelous blog. I enjoy it very much. As an EBM afficionado I think it is good to be critical on the efficacy of new neurostimulating procedures be it rTMS, cTMS or even more general “new” therapeutic hype such as neurofeedback. We do not want to invest in expensive machinery when it offers nothing more then a mere placebo effect but, on the other hand, therapy rsistent depression being a very serious problem, we would not want to dispatch prematurely people to last resort very expensive interventionist neurosurgical procedures such as NVS and especially DBS treatment if rTMS (or ECT) could eventually in some form be beneficial after all.

What has always struck me on rTMS is the disparity in reported results. Some centers claim “wonderfull” effects (Pascuall-Leone , Boston) while others overtly find the results less then clinically impressive.

Could it be that rTMS has become to broad an umbrella and that the new procedures differ to much to be compared with vintage rTMS ? For instance: in most rTMS devices the motor point (hot spot) is looked for and then the coil is advanced 5 cm in a parasagittal plane in order to stimulate BA 46 and 9 (DLPFC). Neuronavigation methods however (on patient NMR mapped referenced landmarks) showed that in 22 testcases this procedure only directed the coil on correct target (DLPFC) in only 7 (30%). Thus 70% received rTMS but in what is supposed to be “off target” cortical networks . That is a substantial difference and could jeopardise the clinical outcome. Maybe we should postpone our judgements until results from neuronavigated rTMS (RCT like) are available. Also a slight twist of the wrist holding the coil can put it off target (subdural or even on bone ..). Seeing neuronavigated rTMS at work has given me more insight in the technical problems that rTMS has to deal with. In older people or people with slifgt corticosubcortical atrophy it is very easy to be off traget alltogether. Robot controlled neuronavigated rTMS can solve those issues.It is indeed more expensive and time consuming but has advantages over neurosurgery. I really look forward to clinical outcome studies (will be presented in France at the beaune Neuromeeting in jan 2009 by groups from Ulm and Paris. Especially in therapy resistent depression. Let’s hope the outcome of what I call “augmented” rTMS is more inspiring !
Will keep You posted

Dr. G. Otte