A wide range of neuropsychiatric disorders seems to respond to deep brain stimulation--but how does it work, and where will it lead?
A very informative article from SCIENCE on the current state of the art of DBS for neuropsychiatric applications. Read it here; download the PDF here; download or hear the podcast here.
Mar 30, 2009
Rewiring Faulty Circuits in the Brain
Mar 19, 2009
A randomized trial of the anti-depressant effects of low- and high-frequency transcranial magnetic stimulation in treatment-resistant depression
PMID: 19105212
TITLE: A randomized trial of the anti-depressant effects of low- and high-frequency transcranial magnetic stimulation in treatment-resistant depression.
AUTHORS: Paul B Fitzgerald, Kate Hoy, Zafiris J Daskalakis, Jayashri Kulkarni
AFFILIATION: Department of Psychological Medicine, Alfred Psychiatry Research Centre, The Alfred and Monash University, Commercial Rd Melbourne, Vic., Australia.
REFERENCE: Depress Anxiety 2009 26(3):229-34
BACKGROUND: The majority of studies investigating the effectiveness of
repetitive transcranial magnetic stimulation (rTMS) as a treatment for
major depression have focused on high-frequency rTMS to the left
prefrontal cortex (HFL-rTMS). In addition, low-frequency right
prefrontal rTMS (LFR-rTMS) has also been shown to have antidepressant
properties. To date only a small number of studies have directly
compared the efficacy of these two approaches. METHODS: The aim of this
study, therefore, was to investigate further whether LFR-rTMS is as
effective as HFL-rTMS in the treatment of major depression. Twenty-seven
patients were randomized to one of two treatment arms (HFL-rTMS or LFR-
rTMS) for 3 weeks with a possible 1-week extension. Non-responders were
offered the opportunity of crossing over to the other treatment type.
Stimulation parameters for HFL-rTMS were 30 stimulation trains of 5 s
duration at 100% of the resting motor threshold (RMT); for LFR-rTMS,
stimulation was applied in four trains of 180 s duration (30 s inter-
train interval) at 110% of the RMT. Stimulation was provided 5-week days
per week. RESULTS: There were significant improvements seen from
baseline to end point irrespective of group and on all clinical outcome
measures. In addition, there was no deterioration in any of the measures
used to assess cognitive change, and significant improvements were seen
on measures of immediate verbal memory and verbal fluency. CONCLUSIONS
: HFL-rTMS and LFR-rTMS appear to be equally efficacious in treating
major depression. This study adds to the growing literature supporting
LFR-rTMS as an additional viable method of rTMS delivery in the
treatment of depression.
TITLE: A randomized trial of the anti-depressant effects of low- and high-frequency transcranial magnetic stimulation in treatment-resistant depression.
AUTHORS: Paul B Fitzgerald, Kate Hoy, Zafiris J Daskalakis, Jayashri Kulkarni
AFFILIATION: Department of Psychological Medicine, Alfred Psychiatry Research Centre, The Alfred and Monash University, Commercial Rd Melbourne, Vic., Australia.
REFERENCE: Depress Anxiety 2009 26(3):229-34
BACKGROUND: The majority of studies investigating the effectiveness of
repetitive transcranial magnetic stimulation (rTMS) as a treatment for
major depression have focused on high-frequency rTMS to the left
prefrontal cortex (HFL-rTMS). In addition, low-frequency right
prefrontal rTMS (LFR-rTMS) has also been shown to have antidepressant
properties. To date only a small number of studies have directly
compared the efficacy of these two approaches. METHODS: The aim of this
study, therefore, was to investigate further whether LFR-rTMS is as
effective as HFL-rTMS in the treatment of major depression. Twenty-seven
patients were randomized to one of two treatment arms (HFL-rTMS or LFR-
rTMS) for 3 weeks with a possible 1-week extension. Non-responders were
offered the opportunity of crossing over to the other treatment type.
Stimulation parameters for HFL-rTMS were 30 stimulation trains of 5 s
duration at 100% of the resting motor threshold (RMT); for LFR-rTMS,
stimulation was applied in four trains of 180 s duration (30 s inter-
train interval) at 110% of the RMT. Stimulation was provided 5-week days
per week. RESULTS: There were significant improvements seen from
baseline to end point irrespective of group and on all clinical outcome
measures. In addition, there was no deterioration in any of the measures
used to assess cognitive change, and significant improvements were seen
on measures of immediate verbal memory and verbal fluency. CONCLUSIONS
: HFL-rTMS and LFR-rTMS appear to be equally efficacious in treating
major depression. This study adds to the growing literature supporting
LFR-rTMS as an additional viable method of rTMS delivery in the
treatment of depression.
A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression
PMID: 19145228
TITLE: A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression.
AUTHORS: Paul B Fitzgerald, Kate Hoy, Susan McQueen, Jerome J Maller, Sally Herring, Rebecca Segrave, Michael Bailey, Greg Been, Jayashri Kulkarni, Zafiris J Daskalakis
AFFILIATION: Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
REFERENCE: Neuropsychopharmacology 2009 Apr 34(5):1255-62
The aim of this study is to investigate whether repetitive transcranial
magnetic stimulation (rTMS) targeted to a specific site in the
dorsolateral prefrontal cortex (DLPFC), with a neuro-navigational method
based on structural MRI, would be more effective than rTMS applied
using the standard localization technique. Fifty-one patients with
treatment-resistant depression were randomized to receive a 3-week
course (with a potential 1-week extension) of high-frequency (10 Hz)
left-sided rTMS. Thirty trains (5 s duration) were applied daily 5 days
per week at 100% of the resting motor threshold. Treatment was targeted
with either the standard 5 cm technique (n=27) or using a neuro-
navigational approach (n=24). This involved localizing the scalp
location that corresponds to a specific site at the junction of Brodmann
areas 46 and 9 in the DLPFC based on each individual subject's MRI scan
There was an overall significant reduction in the Montgomery-Asberg
Depression Rating Scale scores over the course of the trial, and a
better outcome in the targeted group compared with the standard
localization group at 4 weeks (p=0.02). Significant differences were
also found on secondary outcome variables. The use of neuro-navigational
methods to target a specific DLPFC site appears to enhance response to
rTMS treatment in depression. Further research is required to confirm
this in larger samples, or to establish whether an alternate method
based on surface anatomy, including measurement from motor cortex, can
be substituted for the standard 5 cm method.
TITLE: A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression.
AUTHORS: Paul B Fitzgerald, Kate Hoy, Susan McQueen, Jerome J Maller, Sally Herring, Rebecca Segrave, Michael Bailey, Greg Been, Jayashri Kulkarni, Zafiris J Daskalakis
AFFILIATION: Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
REFERENCE: Neuropsychopharmacology 2009 Apr 34(5):1255-62
The aim of this study is to investigate whether repetitive transcranial
magnetic stimulation (rTMS) targeted to a specific site in the
dorsolateral prefrontal cortex (DLPFC), with a neuro-navigational method
based on structural MRI, would be more effective than rTMS applied
using the standard localization technique. Fifty-one patients with
treatment-resistant depression were randomized to receive a 3-week
course (with a potential 1-week extension) of high-frequency (10 Hz)
left-sided rTMS. Thirty trains (5 s duration) were applied daily 5 days
per week at 100% of the resting motor threshold. Treatment was targeted
with either the standard 5 cm technique (n=27) or using a neuro-
navigational approach (n=24). This involved localizing the scalp
location that corresponds to a specific site at the junction of Brodmann
areas 46 and 9 in the DLPFC based on each individual subject's MRI scan
There was an overall significant reduction in the Montgomery-Asberg
Depression Rating Scale scores over the course of the trial, and a
better outcome in the targeted group compared with the standard
localization group at 4 weeks (p=0.02). Significant differences were
also found on secondary outcome variables. The use of neuro-navigational
methods to target a specific DLPFC site appears to enhance response to
rTMS treatment in depression. Further research is required to confirm
this in larger samples, or to establish whether an alternate method
based on surface anatomy, including measurement from motor cortex, can
be substituted for the standard 5 cm method.
Mar 12, 2009
'A Frontier of Medicine': Brain Surgery for Weight Loss
More on yesterdays story about DBS for obesity here.
Mar 10, 2009
Obese woman has brain surgery for weight loss
Press report on the second patient to get DBS for obesity in the US, read it here. Personally, I am more than a little bit wary about this development ....
A quote from the article:
Poe was awake during the three-hour surgery, in which wires carrying an electrical impulse were inserted into her brain in the region where the stomach is controlled, and linked to two pacemaker devices implanted in her chest. (emphasis added)
The neurosurgeon is quoted as saying:
"This is a frontier of medicine...to be able to generate tiny pulses of electricity in these deep nuclei of the brain, and to see what effect they may have on behavior, including in this case the behavior of eating and the issue of uncontrolled appetite," he said
Mar 3, 2009
OpenStim: The Open Noninvasive Brain Stimulator
An open source rTMS machine ? Read more on this interesting project on the WIKI here.
Smaller, cheaper and more hackable versions of TMS machines are being built. They've put together an open source TMS project that might allow anyone to start an at-home DIY brain hacking lab.
Dial H for Happiness: How Neuroengineering May Change Your Brain
An interesting article on the work of Dr. Bret Schneider at Stanford Medical School and Dr. Ed Boyden at MIT. Read it here.
Mar 2, 2009
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