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: 3.44). 05/2012; 28(1). DOI: 10.1016/j.eurpsy.2012.02.006
Source: PubMed


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.

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    • "The TMS procedure using H-coil is called deep TMS, and it is used for the treatment of refractory depression and is being studied to treat other conditions, such as autism and schizophrenia (Bersani et al., 2012). "
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    DESCRIPTION: Transcranial magnetic stimulation (TMS) was introduced as a novel method of brain stimulation in 1985, and now it is widely used in research of cortical excitability, neuronal connectivity and plasticity, and also is applied to the treatment of various neurological and psychiatric conditions. This review is written with the purpose of introducing the brief conspectus and area of therapeutic application of TMS. The techniques, equipment and treatment modalities of TMS are continuously developing, and its area of therapeutic application is being extended. For determining the form of the optimal therapeutic application of TMS in various clinical conditions, more data from controlled studies should be obtained.
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    • "Such stimulation of more widespread brain structures could increase the activity of brain regions linked to cognitive functioning, such as working memory (Harvey et al., 2015). Therefore, the clinical improvement after DTMS could be concurrent or even secondary to improvements in cognitive functioning (Bersani et al., 2013b). Although still limited, the evidence so far suggests that DTMS might in fact improve various cognitive domains, such as sustained attention, visuospatial memory, cognitive planning, and working memory (Levkovitz et al., 2009; Minichino et al., 2012). "
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    ABSTRACT: Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systematic literature review and a quantitative meta-analysis. Seventeen studies on 'DTMS or H-coil' and 'depression' were identified on Medline, PsycInfo, and Google Scholar (until November 2014). Data from nine open-label studies were meta-analysed using a random-effects model with inverse-variance weights. The outcome measures were the standardised paired mean difference (Cohen's d) in depression scores on Hamilton Depression Rating Scale (HDRS), response, remission, and dropout rates after acute DTMS treatment compared to baseline. There was a large antidepressant effect after 20 acute, high-frequency DTMS sessions compared to baseline according to HDRS change scores (overall mean weighted d=2.04, 95% confidence interval: 1.53-2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were 60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in four studies with 68 patients on concurrent antidepressants compared to two studies with 26 patients who received DTMS as a monotherapy. These results are based on data from a low number of open-label studies. High-frequency DTMS appears to have acute antidepressant effects after 20 sessions in mostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants might enhance the efficacy of DTMS. Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 08/2015; 187. DOI:10.1016/j.jad.2015.08.033 · 3.38 Impact Factor
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    • "Recently, h-shaped coils for so called ''deep TMS'' were introduced as a potential means for the treatment of psychiatric disorders such as depression (Harel et al., 2014; Levkovitz et al., 2007). It was demonstrated that these coils modulate cortical excitability to a maximum depth of up to 6 cm (Bersani et al., 2013; Roth, Amir, Levkovitz, & Zangen, 2007), thus allowing for a direct stimulation of deeper brain structures like the cingulum. However, these coils are not used in the routine application yet. "
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    ABSTRACT: With the advent of non-invasive brain stimulation (NIBS), a new decade in the study of language has started. NIBS allows for testing the functional relevance of language-related brain activation and enables the researcher to investigate how neural activation changes in response to focal perturbations. This review focuses on the application of NIBS in the healthy brain. First, some basic mechanisms will be introduced and the prerequisites for carrying out NIBS studies of language are addressed. The next section outlines how NIBS can be used to characterize the contribution of the stimulated area to a task. In this context, novel approaches such as multifocal transcranial magnetic stimulation and the condition-and-perturb approach are discussed. The third part addresses the combination of NIBS and neuroimaging in the study of plasticity. These approaches are particularly suited to investigate short-term reorganization in the healthy brain and may inform models of language recovery in post-stroke aphasia.
    Brain and Language 01/2015; · 3.22 Impact Factor
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