Your Search Results for: ‘tms’

TMS for medication resistant depression

Walter van den Broek
May 4, 2010
It's been a while since my last post on this blog about transcranial magnetic stimulation (TMS). Myself 'm not impressed by it's efficacy for treatment resistant depression. Especially in treatment resistant depression, whatever that may be, rTMS is probably best avoided for more evidence based form of treatments with proven efficacy. The reason for this post about TMS is a recent publication in the Journal of Clinical Psychiatry. FDA approval for rTMS was based on a large, industry-sponsored, multicenter, double-blind, monotherapy study with 325 patients with "moderately treatment resistant depression" also discussed on this blog here. My opinion on this trial was This more »

rTMS Targeted with MRI Based Neuro-Navigation in Treatment-Resistant Depression

Dr Shock
January 28, 2009
Efficacy of rTMS for treatment resistant depression isn't impressive to say the least. The results of studies show little clinical relevance of the efficacy compared to sham rTMS, many studies have reported limited effect sizes or response rates. A recent study tried to address one of the main concerns that could be responsible for the lack of efficacy namely the way in which the rTMS treatment is targeted over the Dorsolateral Prefrontal Cortex (DLPFC). The localization is done with "the 5 cm measure", this involves the localization of the motor cortical site for optimal stimulation of a hand muscle, usually the abductor more »

Cost effectiveness of ECT versus rTMS

Dr Shock
July 18, 2008
On this blog a lot of posts are about rapid Transcranial Magnetic Stimulation (rTMS), in short Dr Shock is not convinced that rTMS is effective in depression. On Therapeutic Modulation there is an abstract of a recent published study in the Journal of Affective Disorders about the cost effectiveness of rTMS versus electroconvulsive therapy (ECT). Their conclusion: Informal care costs were higher for the rTMS group. Total treatment, service and informal care costs were also higher for the rTMS group. The cost-effectiveness acceptability curves indicated a very small probability that decision-makers would view rTMS as more cost-effective than ECT. more »

rTMS can Improve Working Memory

Dr Shock
May 8, 2008
Columbia University Medical Center has used conventional transcranial magnetic stimulation (TMS) to reduce the deficits in working memory associated with sleep deprivation.On Brain StimulantrTMS can do other things as well, read about 8 Effects of TMS on Brain Function but how does TMS work? more »

rTMS not Effective for Depression

Dr Shock
May 8, 2008
Rapid Transcranial Magnetic Stimulation (rTMS) to the left prefrontal cortex is not more effective than sham rTMS for depression. This was the result of a recent published randomized controlled trial with 4 month follow-up.rTMS is a non-invasive method to stimulate the brain. Weak electric currents are induced in the cortex of the brain by rapidly changing magnetic fields (electromagnetic induction). This way, brain activity can be triggered with minimal discomfort, no need for anesthesia, and no cognitive side-effects. Side effects of rTMS are: discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying more »

Again Open Label Research with rTMS

Dr Shock
April 18, 2008
Another open labeled trial with rTMS. It is a continuation trial after a recent double-blind placebo controlled trial with rTMS.This study is discussed in a recent post on this blog: Finally some good news about rTMS?Considering the outcome on the time point at week 4, Dr Shock is not very impressed by the results. For significant difference with the primary outcome 6 patients had to be excluded from the analysis. The mean difference between active and sham on the severity scales is in the range of 2-3 points, significant but hardly clinical relevant. The NICE guidelines use a difference of more »

rTMS update part 2

Dr Shock
February 14, 2008
Even a Dutch research group published a placebo controlled trial with rTMS. Not that they found rTMS to be significantly better than sham TMS after two weeks of treatment. Both groups had a reduction of 2.5 points on the Hamilton Depression Rating Scale (17-item version) and 1 point in the second week, the decrease never passed 20% in either group. Their point being a continuing improvement in the rTMS and the sham rTMS group during the follow-up of 3 months. This resulted in a significant mean difference of more than 4 points in favor of the rTMS group over the more »

Update on rTMS part 1

Dr Shock
February 10, 2008
The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.This was the conclusion of the authors of the Cochrane library about Transcranial magnetic stimulation for treating depression.Since then (2002) 8 randomized controlled trials were published about rTMS and depressionSearch strategy in PubMed:"Transcranial Magnetic Stimulation/therapeutic use"[Mesh] AND "Depressive Disorder/therapy"[Mesh] AND ("2003/02/12"[PDat] : "2008/02/10"[PDat] AND English[lang] AND Randomized Controlled Trial[ptyp])The most recent randomized controlled trial is already discussed on this blog: At last some good news about rTMS?Considering more »

rapid Transcranial Magnetic Stimulation (rTMS) in Bulimia Nervosa

Dr Shock
February 2, 2008
rTMS for Bulimia Nervosa does not exert additional benefit over placebo. Bulimia Nervosa is a disease strongly influenced by sociocultural influences and psychological factors. In the past this has led to preliminary optimism about efficacy of fluoxetine in this eating disorder. The efficacy was based on the trial effect (Hawthorne Effect). Being in a trial with appointments, rating sessions, diagnostic sessions has effect on well being especially in diseases with a strong origination in sociocultural and psychological factors.Bulimia Nervosa is accompanied by several psychiatric disorders as co morbidity. Some believe that Bulimia Nervosa and Depression share a common aetiology, that more »

Look What rTMS Can Do in the Hands of a Smart Dutch Psychologist

Dr Shock
January 15, 2008
This video is in Dutch but illustrative.No hassle with treatment-resistant depressed patients, no comparison with Electroconvulsive Therapy or any other treatment for that matter. Just plain Personalized Medicine what ever that may be. And a nice website: Brainclinics Diagnostics & Treatment rTMS results (in English)In the Brainclinics Treatment clinic in Nijmegen (The Netherlands) rTMS has been applied over the last year in a practical setting and combined with psychotherapy. In this setting any client with depression is treated (so not only treatment resistive patients). The rTMS treatment is personalized for every client using their individual QEEG on the basis of more »