Tuesday, August 14, 2007

rTMS for Bipolar Disorder

An article about Brainsway and their trials on using rTMS for Bipolar disorder.

Brainsway Ltd. (TASE:BRIN) reports positive
interim results in the clinical trial of its Deep TMS transcranial magnetic
stimulation device for the treatment of bipolar disorder on patients who did not
respond to any medications.
The findings are based on the interim report by
the chief researcher on the nine patients in the study at the Shalvata
Psychiatric Hospital in Israel. The effect of Deep TMS on the patients was
measured using different methods for measuring depression, such as the Hamilton
Depression Rating Scale (HDRS), and self questionnaires.
The study found that all the patients
responded positively to the treatment, compared with previous treatments using
antidepressants. There were no complaints or side effects, except for slight
headaches that some patients felt after the treatment and which quickly passed.
The chief researcher at Shalvata said that the study was the first evidence
that Deep TMS was an effective treatment for bipolar disorder, with the caveat
that this was only the beginning.
Brainsway also reported the results of a
study on the effectiveness and safety of the use of Deep TMS for the treatment
of major depression in cases where patients did not respond to medications.
These findings are based on a preliminary report by the chief researcher on 54
patients participating in the trial at Shalvata.
Published by Globes Israel business news - www.globes.co.il - on August 8, 2007

Zap the Brain to cut Alcohol Craving

Scientists at Harvard and in Brazil have just published a study that shows using low voltage current delivered through a pair of saline-soaked sponges to specific sites on the head can cut down an alcoholics craving for alcohol.

Prefrontal cortex modulation using transcranial DC stimulation reduces alcohol craving: A double-blind, sham-controlled study.

Previously studies have shown that high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) can cut down smoking and cocaine craving. They postulated that by using tDCS to apply "subthreshold neuronal membrane depolarization" as a result of electrical current flow they could mimic the effects of rTMS. They had previously shown that tDCS delivered to both sides of the brain could reduce the craving for smoking and a craving for alcohol has been shown to increase activity in the DLPFC, so they juiced up some volunteers.

The study design was double-blind, sham-controlled, cross-over study that stimulated the brain using two mirror-image montages: one placed the active anode over the left DLPFC and the one that placed it over the right. The third was a sham control. They used validated scales to measure alcohol craving as well as side-effect questionnaires for tDCS. 13 subjects were examined at baseline and then went through the different protocols. The stimulation used 2mA for 20 minutes. They were shown videos, both before stimulation or sham stimulation, as well as after, that exposed them to alcohol cues for five minutes. After the exposure they were questioned about their craving for alcohol.

After the subjects were exposed to alcohol cues there was an 8% increase in their craving. There was a decrease in cravings after both left and right anode stimulation of 20-27%! To make things even more interesting cravings could not be increased by alcohol cues after the stimulation with active electrodes but it could be increased in the sham group.

Their conclusion is that "...both anodal left/cathodal right and anodal right/cathodal left DLPFC stimulation significantly decreased craving as compared to sham stimulation." They then go on to suggest the possible mechanisms for the changes including alteration of activity in the dopamine pathways.

"One potential advantage of developing tDCS as an alternative therapeutic strategy is the fact that the effects of tDCS are immediate.""...a single treatment that can transiently block craving levels quickly would be highly desirable compared to drug treatment therapies that are typically more long-lasting and lead to tonic effects and thus can-not capture craving variations."

Side-effects were very mild.

Tuesday, August 7, 2007

Better rTMS studies? Where are we headed??

Browsing Pub Med for TMS related subjects and came across an article whose authors include Dr. Pascual-Leone and Dr. Fregni, both from Harvard. They did a meta review of TMS (and incidentally a both prolific researchers looking at rTMS, tDCS etc..) and it's effects on depression from articles published in the last year and it seems that there is an improved effect of TMS on depression in these papers versus earlier studies.
Is this a result of improving science behind the use of TMS, more accurate TMS protocols, more studies????
Anyone have any thoughts on the subject????

Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent vs. the earlier rTMS studies.

Autism and TMS

It seems that there is some evidence that the effects of autism can be altered by TMS. This is news to me, I am going to have to do a little Pub Med sleuthing to see what the word on the scientific street is.
It would make sense that by altering an already skewed balance of hyper and hypo excitability you would be able to alter the balance of the brain activity.
Turns out there is a total dearth of science regarding TMS as a treatment for autism. A PubMed search only gave me one article that was in a journal of scientific hypotheses.
Here is the article from about.com