1
|
Kuo J, Block T, Nicklay M, Lau B, Green M. Interventional Mental Health: A Transdisciplinary Approach to Novel Psychiatric Care Delivery. Cureus 2023; 15:e43533. [PMID: 37719598 PMCID: PMC10501497 DOI: 10.7759/cureus.43533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Mental health disorders are among the most common health conditions in the United States. Traditional clinical treatments rely on psychiatric counseling and, in many cases, prescription medications. We propose an innovative model, Interventional Mental Health, which employs a combination of modalities through a multifaceted approach to treat conditions that have exhibited limited responsiveness to traditional methods and individuals afflicted with multiple comorbidities simultaneously. We hypothesize that creating a unique treatment algorithm combining current therapeutic modalities such as Stellate Ganglion Blocks (SGB), Transcranial Magnetic Stimulation (TMS) therapy, and ketamine therapy, within a consolidated timeframe, will yield synergistic outcomes among patients presenting with comorbid post-traumatic stress disorder (PTSD), depression, and/or anxiety.
Collapse
Affiliation(s)
- Jonathann Kuo
- Regenerative and Anti-Aging Medicine, Hudson Health, New York, USA
| | | | | | | | | |
Collapse
|
2
|
Vallejo P, Cueva E, Martínez-Lozada P, García-Ríos CA, Miranda-Barros DH, Leon-Rojas JE. Repetitive Transcranial Magnetic Stimulation in Stroke: A Literature Review of the Current Role and Controversies of Neurorehabilitation Through Electromagnetic Pulses. Cureus 2023; 15:e41714. [PMID: 37575778 PMCID: PMC10414689 DOI: 10.7759/cureus.41714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective method used for the treatment of various neurological diseases, including stroke, epilepsy, and movement disorders. The pathophysiological mechanism for the effect of TMS is not clear. In this literature review, we conducted a detailed search regarding the effect of rTMS on neurotransmission and neuronal plasticity through the modulation of neuronal excitability. Evidence suggests that intramolecular subatomic mechanisms, including genetic changes related to neuronal prevention and death, play an important role. We also discuss the use of rTMS in the rehabilitation of patients with stroke and its main complications, as well as alternative mechanisms related to recovery, emphasizing the findings of available evidence and touching on possible controversies and limitations of the method.
Collapse
Affiliation(s)
- Paula Vallejo
- Medical School, Universidad de Las Américas, Quito, ECU
- Medical Research Department, NeurALL Research Group, Quito, ECU
| | - Emily Cueva
- Medical Research Department, NeurALL Research Group, Quito, ECU
| | | | | | | | - Jose E Leon-Rojas
- Neurological Surgery, Universidad de Las Américas, Quito, ECU
- Medical Research Department, NeurALL Research Group, Quito, ECU
- Research and Development Department, Medignosis, Quito, ECU
| |
Collapse
|
3
|
Tang Q, Li G, Wang A, Liu T, Feng S, Guo Z, Chen H, He B, McClure MA, Ou J, Xing G, Mu Q. A systematic review for the antidepressant effects of sleep deprivation with repetitive transcranial magnetic stimulation. BMC Psychiatry 2015; 15:282. [PMID: 26573324 PMCID: PMC4647580 DOI: 10.1186/s12888-015-0674-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/04/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Sleep deprivation (SD) and repetitive transcranial magnetic stimulation (rTMS) have been commonly used to treat depression. Recent studies suggest that co-therapy with rTMS and SD may produce better therapeutic effects than either therapy alone. Therefore, this study was to review the current findings to determine if rTMS can augment the therapeutic effects of SD on depression. METHODS Embase, JSTOR, Medline, PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials were searched for clinical studies published between January 1985 and March 2015 using the search term "rTMS/repetitive transcranial magnetic stimulation AND sleep deprivation AND depress*". Only randomized and sham-controlled trials (RCTs) involving the combined use of rTMS and SD in depression patients were included in this systematic review. The scores of the Hamilton Rating Scale for Depression were extracted as primary outcome measures. RESULTS Three RCTs with 72 patients that met the inclusion criteria were included for the systematic review. One of the trials reported skewed data and was described alone. The other two studies, which involved 30 patients in the experimental group (SD + active rTMS) and 22 patients in the control group (SD + sham rTMS), reported normally distributed data. The primary outcome measures showed different results among the three publications: two of which showed great difference between the experimental and the control subjects, and the other one showed non-significant antidepressant effect of rTMS on SD. In addition, two of the included studies reported secondary outcome measures with Clinical Global Impression Rating Scale and a self-reported well-being scale which presented good improvement for the depressive patients in the experiment group when compared with the control. The follow-up assessments in two studies indicated maintained results with the immediate measurements. CONCLUSIONS From this study, an overview of the publications concerning the combined use of rTMS and SD is presented, which provides a direction for future research of therapies for depression. More studies are needed to confirm whether there is an augmentative antidepressant effect of rTMS on SD.
Collapse
Affiliation(s)
- Qing Tang
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Guangming Li
- Department of Oncology, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Anguo Wang
- Department of Urology Surgery, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Tao Liu
- Department of Cardiology, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Shenggang Feng
- Department of Nephrology, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Zhiwei Guo
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Huaping Chen
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Bin He
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Morgan A. McClure
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000 Sichuan China
| | - Jun Ou
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
| | - Guoqiang Xing
- Lotus Biotech.com LLC., John Hopkins University-MCC, 9601 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Qiwen Mu
- Department of Radiology & Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China. .,Peking University Third Hospital, 49 Garden North Road, Haidian District, Beijing, 100080, China.
| |
Collapse
|
4
|
Dunlop K, Gaprielian P, Blumberger D, Daskalakis ZJ, Kennedy SH, Giacobbe P, Downar J. MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder. J Vis Exp 2015:e53129. [PMID: 26327307 PMCID: PMC4692428 DOI: 10.3791/53129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.
Collapse
Affiliation(s)
| | | | - Daniel Blumberger
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health
| | - Sidney H Kennedy
- MRI-Guided rTMS Clinic, University Health Network; Department of Psychiatry, University Health Network; Department of Psychiatry, University of Toronto
| | - Peter Giacobbe
- MRI-Guided rTMS Clinic, University Health Network; Department of Psychiatry, University Health Network; Department of Psychiatry, University of Toronto
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, University Health Network; Department of Psychiatry, University Health Network; Toronto Western Research Institute, University Health Network; Department of Psychiatry, University of Toronto;
| |
Collapse
|
5
|
Abstract
Magnetic stimulation delivered via 0.5-mm diameter coils was recently shown to activate retinal neurons; the small coil size raises the possibility that micromagnetic stimulation ( μMS) could underlie a new generation of implanted neural prosthetics. Such an approach has several inherent advantages over conventional electric stimulation, including the potential for selective activation of neuronal targets as well as less susceptibility to inflammatory responses. The viability of μMS for some applications, e.g., deep brain stimulation (DBS), may require suppression (rather than creation) of neuronal activity, however, and therefore we explore here whether (μMS) could, in fact, suppress activity. While single pulses elicited weak and inconsistent spiking in neurons of the mouse subthalamic nucleus (in vitro), repetitive stimulation effectively suppressed activity in ∼ 70% of targeted neurons. This is the same percentage suppressed by conventional electric stimulation; with both modalities, suppression occurred only after an initial increase in spiking. The latency to the onset of suppression was inversely correlated to the energy of the stimulus waveform: larger amplitudes and lower frequencies had the fastest onset of suppression. These findings continue to support the viability of μMS as a next-generation implantable neural prosthetic.
Collapse
Affiliation(s)
- Seung Woo Lee
- Massachusetts General Hospital, Department of Neuro-surgery, Harvard Medical School, Boston, MA 02114 USA ()
| | - Shelley I. Fried
- Boston Veterans Administration Healthcare System, Rehabilitation, Research and Development, Boston, MA 01230 USA and also with Massachusetts General Hospital, Department of Neurosurgery, Harvard Medical School, Boston, MA 02114 USA ()
| |
Collapse
|
6
|
Kedzior KK, Rajput V, Price G, Lee J, Martin-Iverson M. Cognitive correlates of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression--a pilot study. BMC Psychiatry 2012; 12:163. [PMID: 23031294 PMCID: PMC3515465 DOI: 10.1186/1471-244x-12-163] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 09/24/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The aim of the current study was to investigate the cognitive correlates of repetitive transcranial magnetic stimulation (rTMS) in 10 treatment-resistant depression patients. METHODS Patients received forty 20-min sessions of fast-frequency (10 Hz) rTMS of the left dorsolateral prefrontal cortex (DLPFC) over 20 days. Concept-shift ability (accuracy and duration of performance) was assessed daily with a Modified Concept-Shifting Task (mCST) in patients and in eight healthy volunteers. General cognitive functioning test (Repeatable Battery for the Assessment of Neuropsychological Status; RBANS), Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) were applied before the first and after the last rTMS. RESULTS Compared to before rTMS on the first 10 days, the patients performed the mCST significantly more accurately after rTMS on the last 10 days (p < .001, partial eta squared=.78) while the same comparison in healthy volunteers was not statistically significant (p = .256, partial eta squared=.18). A significant improvement in immediate memory on RBANS and reduction in BDI and HAM-D scores were also observed after the last compared to before the first rTMS. CONCLUSION The rTMS is associated with an improvement in selective cognitive functions that is not explained by practice effects on tasks administered repeatedly. TRIAL REGISTRATION Name: "Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of depression, assessed with HAM-D over a four week period."URL: www.actr.org.au REGISTRATION NUMBER ACTRN012605000145606.
Collapse
Affiliation(s)
- Karina K Kedzior
- School of Humanities and Social Sciences, Jacobs University Bremen, Campus Ring 1, Bremen, 28759, Germany
| | - Vikram Rajput
- Clinical Neurophysiology Unit, Graylands Hospital, John XXIII Avenue, Mt Claremont, Perth, 6010, Australia
- Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia
| | - Greg Price
- Clinical Neurophysiology Unit, Graylands Hospital, John XXIII Avenue, Mt Claremont, Perth, 6010, Australia
- Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia
| | - Joseph Lee
- Clinical Neurophysiology Unit, Graylands Hospital, John XXIII Avenue, Mt Claremont, Perth, 6010, Australia
- Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia
| | - Mathew Martin-Iverson
- Clinical Neurophysiology Unit, Graylands Hospital, John XXIII Avenue, Mt Claremont, Perth, 6010, Australia
- Pharmacology & Anaesthesiology Unit, School of Medicine & Pharmacology, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia
| |
Collapse
|