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transcranial magnetic stimulation (TMS, rTMS)

Indications: - depression [1] - FDA-approved device for persons 15-12 years [6]* - migraine [2] - obsessive compulsive disorder [2] - diagnosis of dementia - reliably & selectively distinguishes - Alzheimer's disease - Lewy body dementia - frontotemporal dementia - Huntington's chorea [5] * repetitive transcranial magnetic stimulation (rTMS) can be effective in depressed patients who don't respond to initial antidepressant drug therapy [7,8] Procedure: 1) application of magnetic fields strong enough to alter cerebral cortex neuron firing patterns 2) applied over left dorsal frontal cortex Clinical trials: - repetitive transcranial magnetic stimulation slowed progression of Alzheimer's disease in phase II trial [9] Notes: - effective in controlled trials.

General

clinical procedure

References

  1. George MS et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: A sham-controlled randomized trial. Arch Gen Psychiatry 2010 May; 67:507. PMID: 20439832
  2. FDA News Release. August 17, 2018 FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm617244.htm
  3. Brooks M FDA Clears 3-Minute Brain Stimulation Protocol for Depression. Medscape - Aug 22, 2018. https://www.medscape.com/viewarticle/901052
  4. Hlavinka E, MedPage Today. Dec 30, 2018 Magnetic Brain Stimulation: 'Huge Amount of Promise' - TMS could still shift the psychiatric treatment paradigm, despite failure in VA trial. https://www.medpagetoday.com/psychiatry/depression/77180 - Yesavage JA, Fairchild JK, Mi Z et al Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans. A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(9):884-893 PMID: 29955803 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2686050
  5. Benussi A, Grassi M, Paslluzzi F et al. Classification accuracy of transcranial magnetic stimulation for the diagnosis of neurodegenerative dementias. Ann Neurol 2020 Jan 10 PMID: 31925823 https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.25677
  6. Bagha S FDA grants clearance to TMS device for MDD in young people. Healio. March 28, 2024 https://www.healio.com/news/psychiatry/20240328/fda-grants-clearance-to-tms-device-for-mdd-in-young-people
  7. Dalhuisen I, van Oostrom I, Spijker J et al rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches. Am J Psychiatry. 2024 Sep 1;181(9):806-814. PMID: 39108161 Clinical Trial.
  8. Papakostas GI, Trivedi MH, Shelton RC et al Comparative effectiveness research trial for antidepressant incomplete and non-responders with treatment resistant depression (ASCERTAIN-TRD) a randomized clinical trial. Mol Psychiatry. 2024 Aug;29(8):2287-2295. PMID: 38454079 PMCID: PMC11412904 Free PMC article. Clinical Trial.
  9. George J Alzheimer's Progression May Be Slowed by Targeted Magnetic Pulses, Study Suggests. In phase II trial, transcranial stimulation led to significant differences versus placebo. MedPage Today November 3, 2024 https://www.medpagetoday.com/meetingcoverage/ctad/112719