TMS Flashcards
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TMS is a
non-invasive technique used in CN to alter the normal workings of neural pathways
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How does TMS work?
- High intensity MF next to scalp surface
- Indues eletrical current
- Current alters membrane potential of neurons
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The current serves to alter the membrane potential of neurons in the area…
Thus altering the rate and probability of which they will fire
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If the frequency at which the TMS stimulation is pulsed…
Is greater than 1 Hz, it is known as receptive TMS
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Whether the stimulation induces an excitatory or inhibitory effect….
Is contigent on whether the pulse is slow or repetitive
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What are the studies?
O’Reardon et al., 2007
McNamara et al., 2001
Reid et al., 1998
Berlim et al., 2014
O’Reardon et al., 2007
Method
- Large scale study
- Patients reported resistance to Anti’Ds
- PFC TMS for 6 weeks
O’Reardon et al., 2007
Findings (2)
- Decreased in S-R depressive symptoms
- TMS group 2x as likely to be in remission at 6 weeks compared to control
McNamara et al., 2001
Method
- Meta-analysis of 5 RCTs investigating TMS and depression
McNamara et al., 2001
Findings
Highly significant (p<0.001) beneficial effect of TMS compared to control
Reid et al., 1998
- No withdrawals, few temporary side effects of TMS in treating depression
Reid et al., 1998
2 side effects
Transient headache
Discomfort at stimulation site
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However, it has remained elusive….
As to how long these beneficial effects last
Berlim et al., 2014
Method
Meta-analysis of 29 RCT’s
Berlim et al., 2014
Findings
~1/5 of patients remained in remission following the sessions
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Studies?
Barwood et al., 2011
Li et al., 2015
Barwood et al., 2011
Method
Inhibitory rTMS to 6 Aphasia patients over 10 days
Barwood et al., 2011
Findings
Improvements reported in picture naming, sentence complexity and receptive lanuage 2 months post-stimulation COMPARED TO SHAM COIL
Barwood et al., 2011
The mechanisms from which the improvements occurred…
Were from the downregulation of overactivity in the brain region associated with the deficits
Barwood et al., 2011
Criticism of the study
Small sample size – unclear whether findings can be further replicated
Li et al., (2015)
Meta analysis of 4 RCT’s indicated a significant effect of rTMS in strengthening picture naming skills only
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Finishing sentence
Further investigation may be required to validate the benefits of TMS in a larger range of skills
There is some evidence to suggest that TMS can be used in cognitive enhancement,
For example, phonological STM
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Studies (4)
Kirschen et al., 2006
Luber et al., 2007
Osaka et al., 2007
Luber & Lisbany, 2014
