Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: A comprehensive review.

Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
European Psychiatry (Impact Factor: 3.29). 05/2012; DOI: 10.1016/j.eurpsy.2012.02.006
Source: PubMed

ABSTRACT Deep transcranial magnetic stimulation (TMS) is a technique of neuromodulation and neurostimulation based on the principle of electromagnetic induction of an electric field in the brain. The coil (H-coil) used in deep TMS is able to modulate cortical excitability up to a maximum depth of 6cm and is therefore able not only to modulate the activity of the cerebral cortex but also the activity of deeper neural circuits. Deep TMS is largely used for the treatment of drug-resistant major depressive disorder (MDD) and is being tested to treat a very wide range of neurological, psychiatric and medical conditions. The aim of this review is to illustrate the biophysical principles of deep TMS, to explain the pathophysiological basis for its utilization in each psychiatric disorder (major depression, autism, bipolar depression, auditory hallucinations, negative symptoms of schizophrenia), to summarize the results presented thus far in the international scientific literature regarding the use of deep TMS in psychiatry, its side effects and its effects on cognitive functions.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant literature was identified through a search on Medline and PubMed; search terms included tinnitus, brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemic-neurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways. Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical localizationism, could be better explained by an holistic or associationist approach considering psychic functions and tinnitus as emergent properties of partially overlapping large-scale neural networks.
    Neural Plasticity 01/2014; 2014:817852. · 2.86 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. deep transcranial magnetic stimulation (dTMS) has been shown to be efficacious and relatively safe for major depressive disorder (Mdd). however, its clinical utility as an augmenting strategy for treatment-resistant depression (Trd) remains unexplored. Methods. in an open label trial, 17 outpatients with severe Trd received 4 weeks of daily high fre-quency dTMS over the left dorsolateral prefrontal cortex. depressive and anxious symptoms, suicidality and quality of life (qol) were measured at baseline (i.e., in the week prior to the start of the dTMS treatment) and at week 5 (i.e., in the week following the end of the dTMS treatment). Primary outcome measures were rates of response and remission at week 5 using an intention-to-treat approach. Results. response and remission rates at week 5 were 70.6 and 41.2%, respec-tively. also, depression, anxiety, and suicidality ratings were significantly improved by week 5 (with hedges' g estimates ranging from 0.6 to 1.72), as well as four of the five qol domain scores (i.e., global, psychological, environmental and social). Finally, two patients dropped out of the study at week 1 because of significant scalp discomfort during stimulation. Conclusions. our study suggests that dTMS, when used as an augmenting strategy for antidepressants in severe Trd, is efficacious, safe and relatively well tolerated. however, controlled studies with larger samples are needed to confirm and expand our preliminary findings.
    The World Journal of Biological Psychiatry 07/2014; · 3.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transcranial magnetic stimulation (TMS) is a noninvasive method of brain stimulation used to treat a variety of neuropsychiatric disorders, but is still in the early stages of study as addiction treatment. We identified 19 human studies using repetitive TMS (rTMS) to manipulate drug craving or use, which exposed a total of 316 adults to active rTMS. Nine studies involved tobacco, six alcohol, three cocaine, and one methamphetamine. The majority of studies targeted high-frequency (5–20 Hz; expected to stimulate neuronal activity) rTMS pulses to the dorsolateral prefrontal cortex. Only five studies were controlled clinical trials: two of four nicotine trials found decreased cigarette smoking; the cocaine trial found decreased cocaine use. Many aspects of optimal treatment remain unknown, including rTMS parameters, duration of treatment, relationship to cue-induced craving, and concomitant treatment. The mechanisms of rTMS potential therapeutic action in treating addictions are poorly understood, but may involve increased dopamine and glutamate function in corticomesolimbic brain circuits and modulation of neural activity in brain circuits that mediate cognitive processes relevant to addiction, such as response inhibition, selective attention, and reactivity to drug-associated cues. rTMS treatment of addiction must be considered experimental at this time, but appears to have a promising future.
    Annals of the New York Academy of Sciences 07/2014; · 4.38 Impact Factor


Available from
May 22, 2014