New Promises and New Expectations from rTMS

SOURCE: Psychiatry and Clinical Psychopharmacology. Conference: 11th International Congress on Psychopharmacology and 7th International Symposium on Child and Adolescent Psychopharmacology. Antalya Turkey. 29(Supplement 1) (pp 360), 2019



ABSTRACT: Transcranial magnetic stimulation (TMS) is a generally well tolerated and reliable procedure that uses magnetic fields to stimulate nerve cells in the brain. TMS uses electromagnetic stimulation to produce transient electric fields in the local cerebral cortex and this process causes depolarization and firing of local neurons. Although the use of TMS in medicine started 30 years ago [Citation1], there has been a significant increase in the studies of this non-invasive brain stimulation technique (neuromodulation) over the last 10 years. TMS has the potential to investigate both the physiology and physiopathological processes of neural structures the, to be used in the treatment of many diseases and with the introduction of navigated transcranial magnetic stimulation to enable the activation/inactivation of functional cortical areas in certain anatomical regions are some of the reasons that explain the researchers’ interest in TMS. The FDA approved the use of TMS in 2008 for depression, migraine headache in 2013 and recently for the treatment of obsessive-compulsive disorder (2018). In recent years TMS has been investigated as a treatment option for various neurological and psychiatric disorders. For example, many neuropsychiatric diseases such as stroke, treatment-resistant epilepsy, multiple sclerosis, tinnitus, conversion disorder, attention deficit and hyperactivity disorder, autism spectrum disorder, dementia, post-traumatic stress disorder, substance use disorders, dystonia and aphasia can be demonstrated [Citation2]. Critical points about their use in these diseases; firstly determining which region of the brain should be stimulated, deciding how to change the function to make it compatible with the normal function of the brain (activation, inactivation), determining the frequency and pattern of stimulus to be applied, detection of the duration and recurrent doses that the application should continue to maintenance the remission. Different combination of these mentioned parameters during treatment applications, allowing rTMS to be used in the treatment of different diseases as alternative therapeutic choice. For example, it is reported that rTMS at low frequencies may cause cortical excitability suppression on target cortical tissue, whereas at frequencies above 5Hz may cause prolonged prolongation of cortical excitability. In addition, alternative modalities such as theta burst stimulation increase the frequency of the stimulus and make the application time shorter. Although Transcranial Magnetic Stimulation has been shown to be effective in treating the symptoms of various neurological and psychiatric disorders, there is a need for further research by comparing with large sample sizes and standard treatments.