TMS approved for Depression!

WebMD just published a short blurb on one of their blogs stating that the FDA has cleared TMS for use in depression. They go on to state that there is now an indication for use in patients who have failed a trial of one antidepressant.
Now that this indication has been made, what will the next inidication be???? Stay tuned.

MIT article on tDCS

The MIT Technology Review has a short article about research being done by the NIH. They interview Dr. Wasserman who has done a lot of work on non-invasive neuromodulation. He brings up some good points about the potential uses for tDCS, particularly in a healthy population. Can you imagine the demand for tDCS if high school senior find out that a nine volt battery could boost their SAT scores? Can you imagine the uproar in the Op-Ed pages? I think I can hear it from where I am sitting.....

Forbes article on Vascular Depression and TMS

Forbes Magazine has a write-up about treatments for vascular depression that are up-and-coming. rTMS seems to be the front-runner. I will be excited to read the actual results of the study when they are published.

Neuromodulation Explained

Here is an eloquent explanation of neuromodulation by Alan Wu, a neurologist at UCLA. I had the pleasure of meeting Dr. Wu while I was learning TMS and tDCS techniques at Dr. Alvaro Pascual-Leone's lab at Harvard.

Summary
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising noninvasive cortical stimulation methods for adjunctive treatment of movement disorders. They avoid surgical risks and provide theoretical advantages of specific neural circuit neuromodulation. Neuromodulatory effects depend on extrinsic stimulation factors (cortical target, frequency, intensity, duration, number of sessions), intrinsic patient factors (disease process, individual variability and symptoms, state of medication treatment), and outcome measures. Most studies to date have shown beneficial effects of rTMS or tDCS on clinical symptoms in Parkinson’s disease (PD) and support the notion of spatial specificity to the effects on motor and nonmotor symptoms. Stimulation parameters have varied widely, however, and some studies are poorly controlled. Studies of rTMS or tDCS in dystonia have provided abundant data on physiology, but few on clinical effects. Multiple mechanisms likely contribute to the clinical effects of rTMS and tDCS in movement disorders, including normalization of cortical excitability, rebalancing of distributed neural network activity, and induction of dopamine release. It remains unclear how to individually adjust rTMS or tDCS factors for the most beneficial effects on symptoms of PD or dystonia. Nonetheless, the noninvasive nature, minimal side effects, positive effects in preliminary clinical studies, and increasing evidence for rational mechanisms make rTMS and tDCS attractive for ongoing investigation.

rTMS makes you stronger?

A study by a group out of the University of Cologne in Germany has demonstrated that rTMS over the unaffected motor cortex of patients that have had a stroke will make their use of the affected hand more efficient and quicker.
The paper explains how rTMS is thought to work in a very nice manner and backs it up with a diagram that puts it into very understandable terms. Essentially there is imbalance between the two sides of the brain after a stroke. There are excitatory and inhibitory inputs from both sides of the brain which help us fine tune our movements, making them efficient, accurate and adaptable. Add a prehensile thumb and you start to understand the magnitude of the human brain. Now that we are figuring out how to rebalance a damaged brain the possibilities are becoming apparent. And I am sure that when we look back in twenty years or more at the preliminary data and concepts we will laugh at our shallow understanding of the subject.
Once again, I am amazed by the clinical implications of this. As a physiatrist (Physical Medicine and Rehabilitation specialist that works with stroke patients) I am encouraged and excited by the possibilities that are starting to present themselves. This is a technology that is going to revolutionize stroke rehabilitation; I am unsure if there are other advances that have occurred in this field that are comparable. The advent of clot busting drugs was a milestone, the development and use of advanced imaging techniques as well. Neuromodulation as a therapeutic intervention and as a research tool has staggering possibilities.

Medical Magnetism

The Baltimore Sun has an article on TMS for depression and migraines online today. It starts with the usual TMS success story: someone with treatment resistant depression at the end of their rope is save by enrolling in a trial of TMS.
TMS seems to creeping into the common media. Maybe it is this way with anything cutting edge; at first the claims are too good to be true "Magnets cure everything!". Then they dig a little deeper into the medical literature, interview a few experts, local media picks up a few more success stories and WHAMMO! You have a critical mass of awareness. Is the wave starting to form?
LINK

Post-stroke Depression Treated with TMS

The Archives of General Psychiatry just published a paper from the Department of Psychiatry at University of Iowa about using TMS to treat vascular-related depression. The results were pretty impressive.
Post-stroke depression is a well-known phenomenon, with a large percentage of people that have suffered a stroke showing signs and symptoms of depression. It seems that there is evidence that people with proven vascular disease (one of the side effects of uncontrolled diabetes/cholesterol/hypertension/smoking) have a higher incidence of depression.
These researchers took 90+ patients, with proven vascular disease and depression, and took them off of antidepressants. The divided them into two groups: sham and treatment groups. The treatment group got 12,000 pulses of TMS and the sham got, well, sham treatment with a fake coil. The treatment group a 33% drop on a depression scale while the sham group had a 14% drop, an appropriate placebo effect. The response rate in the placebo group was just under 7% while the response rate in the treatment group was 33%.
In the second experiment the treatment group got 18,000 pulses which resulted in a 42% drop in depression score while the sham group dropped 17%.
Once again, some interesting results that make you scratch your head and wonder if using a three tesla electromagnetic impulse could provide relief of depressive symptoms on par with antidepressants.....
Link

tDCS and aphasia after stroke

One of the most common effects of a stroke is aphasia or the loss of the ability to comprehend and/or produce language. This accounts for much of the morbidity related to strokes.
In a study published by a group in Italy there is some convincing evidence that using tDCS can improve a naming task by 33% +/- 13%. This means that patients could demonstrate twenty to almost fifty percent improvement in naming. When you translate this into real-world recovery from stroke, the results are impressive.
As a tool for rehabilitation, and I am a physiatrist by trade (a rehabilitation doctor that directs the rehab of patients with diagnoses that include stroke), the clinical implications are significant.
PubMed Link

Lack of new posts....

Sorry for the lack of posts recently, with the holidays and the fact I am currently looking for a job my postings have suffered.