r tms for depression by dr ajay nihalani
TRANSCRIPT
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rTMS Therapy for Depression
Dr Ajay Nihalani,MD,MRCPsych
www.drnihalanipsychiatristdelhi.in
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• What is magnet Therapy?• How does it work?• What are the side effects?• Does it work?• Magnet therapy in the media.• Tips are MANDATORY
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What is Magnet Therapy?
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Is it the Application of Magnets this way?
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rTMS
• Repetitive Transcranial Magnetic Stimulation
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What is involved in Therapy?
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How does rTMS work?
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• Magnetic stimulation leads to either an increase or decrease in brain activity in targeted brain area.
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Left Front End of Brain
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Brain Perfusion SPECT.
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Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
Fig. 1 Normalized glucose metabolism between medication-resistant depressives (MRD) and healthy controls (HC) under P< 0.05 corrected for multiple comparisons, suggesting a reciprocal limbic-cortical dysregulation in MRD even after depressed symptoms were under control.
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Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
Comparisons of normalized baseline glucose metabolism between rTMS responders and non-responders under a voxel-level uncorrected P< 0.05 (Upper left: Responders > Non-responders; Upper right: Responders < Non-responders; Lower: Responders > Non-Responders [in red], Responders < Non-Responders [in blue], with transverse slices in Axis- Z of − 40 to 40), suggesting patients with less impaired limbic-cortical dysregulation responded better to rTMS.
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Fig. 2 Normalized baseline glucose metabolism between rTMS responders and non-responders, with blue crossings showing an individual global maximum cluster under a cluster-level uncorrected P< 0.05 (Upper: Responders > Non-responders [2756 voxels, P= 0.009, global maximum at Talairach ( xyz) coordinates of 6, 46, 14]; Lower: Responders < Non-responders [1011 voxels, P= 0.087, global maximum at Talairach ( xyz) coordinates of − 34, − 28, − 10]).
Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
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Fig. 4 Pretreatment glucose metabolism relating to depressive symptom improvement following a 2-week add-on rTMS treatment, with blue crossings showing individual global maximum cluster under P< 0.05 corrected for multiple comparisons (Upper, positive correlation [1070 voxels, P= 0.029, global maximum at Talairach ( xyz) coordinates of − 2, 38, 12]; Lower: negative correlation [3751 voxels, P= 0.001, global maximum at Talairach ( xyz) coordinates of − 24, − 44, −
14]). Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolismLi, Cheng-Ta, Journal of Affective Disorders, Volume 127, Issue 1-3, 219-229
Copyright © 2010 Elsevier B.V.
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Fig. 1. Bottom row: Representative consecutive transaxial slices at the level of the basal ganglia parallel to the cantho-meatal line of pre-rTMS treatment neuroSPECT. The pre-treatment study demonstrates decreased perfusion in the right temporal and bilateral infero-frontal regions, as well as non-homogeneous uptake in the caudate nuclei. TOP row: Representative consecutive transaxial slices at the same level of the basal ganglia as the previous study of post-rTMS treatment neuroSPECT. Following treatment, the neuroSPECT study demonstrates marked, general improvement in brain perfusion, including frontal, infero-frontal, and temporal regions, and an increased uptake in the left thalamus.
Right prefrontal rTMS treatment for refractory auditory command hallucinations – a neuroSPECT assisted case studyPsychiatry Research: NeuroimagingVolume 116, Issues 1–2, 30 November 2002, Pages 113–117
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Side effects?
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• APA conference-37% remission• -58% positive response
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Magnetic Therapy in Media
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• Magnet Treatment for Depression Works for Some
• Rigorous Study Finds rTMS Magnet Therapy Can Relieve Depression With Few Side Effects
• May 4, 2010 -- A controversial new treatment for depression, rTMS, helps some patients, a rigorous government-funded study finds
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• Attractive Therapy: Magnetic Brain Stimulation Gaining Favor as Treatment for Depression
• More doctors are turning to repetitive transcranial magnetic stimulation (rTMS) of their patient's brains
• Aug 30 2010
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• Magnetic therapy works where pills fail in major depression
• Malathy Iyer, TNN Sep 9, 2012, 05.31AM IST• (The therapy, which won the…)• MUMBAI: Six months ago, south Mumbai-based executive
Ramesh Joshi's behaviour started worrying his family. He would take two hours to finish a meal. While walking, he would suddenly freeze at a spot. He would stammer if he had to speak more than a couple of lines. The medical diagnosis — major depressive disorder — stunned his
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• Wednesday 10 October 2012News updated at 2:19 AM IST
• Magnetic therapy for depression• London, May 10, 2012, PTI:• Scientists have found a new magnetic therapy
for depression which they claim could soon spell the end for brain-altering, anti-depressant drugs.
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• End of anti-depressants? Magnetic pulse therapy eases depression in third of patients
• By Claire Bates• PUBLISHED: 11:29 GMT, 9 May 2012 | UPDATED:
14:25 GMT, 9 May 2012 • Depression affects one in four of us at some point of
our lives, but controversy still reigns over how to best treat the debilitating condition.
• Now scientists have found that a type of 'magnetic therapy' - which involves no brain-altering drugs or invasive procedures - could be a potent new treatment.
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• Magnetic pulses draw good reviews from doctors treating depression
• Therapy shows positive results for those getting treatment
• April 11, 2012|By Janice Neumann, Special to the Tribune
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