Contents
1: An Introduction to the Basic Principles of TMS and rTMS
1.1 Introduction
1.2 Overview of TMS Technology
1.3 Overview of Repetitive TMS (rTMS) Technology
1.4 Sham Stimulation
1.5 Noise
References
2: The History of TMS and rTMS Treatment of Depression
2.1 Introduction
2.2 Early Attempts to Develop TMS-Like Approaches
2.3 The Development of Modern TMS
References
3: The Mechanism of Action of rTMS
3.1 Introduction
3.2 Effects of rTMS Assessed in the Motor Cortex
3.2.1 Effects on Motor Cortical Excitability
3.2.2 Effects on Motor Cortical Inhibition and Facilitation
Silent Period (SP)
Paired Pulse Inhibition and Facilitation (ppTMS)
3.2.3 Effects of rTMS on Motor Cortical Plasticity
3.3 Effects of rTMS Assessed with EEG
3.4 Neuroimaging Studies of the Effect of rTMS
3.4.1 Imaging of rTMS Effects
3.4.2 Imaging of rTMS Effects in Depression
3.4.3 Studying Brain Effects of rTMS with Near-Infrared Spectroscopy
3.5 Studying Brain Effects of rTMS with Electroencephalography
3.6 Effects of rTMS on BDNF
3.7 Conclusions
References
4: Acute rTMS Treatment for Depression
4.1 rTMS in Depression: High-Frequency Stimulation
4.1.1 Meta-Analysis
4.1.2 rTMS Versus ECT
4.1.3 Network Meta-Analysis and Umbrella Reviews
4.1.4 Real-World Data
4.1.5 Summary
4.2 Low-Frequency Right-Sided rTMS
4.3 Bilateral rTMS
4.4 Other Approaches to Standard rTMS Treatment Delivery
4.5 Issues with the Conduct of Clinical Trials of rTMS
4.6 Conclusions
References
5: Clinical Indications and Patient Selection
5.1 Stage of Illness and Treatment Resistance
5.1.1 Clinical Recommendations
5.2 Illness Type: Unipolar and Bipolar Depression
5.2.1 Clinical Recommendations
5.3 Elderly Patients with Depression
5.3.1 Clinical Recommendations
5.4 Adolescent Depression
5.4.1 Clinical Recommendations
5.5 Pregnant or Breastfeeding Patients
5.5.1 Clinical Recommendations
5.6 Comorbid Anxiety
5.6.1 Clinical Recommendations
5.7 Depression with Psychotic Symptoms
5.7.1 Clinical Recommendations
5.8 Concurrent Illness: Neurological Disease
5.8.1 Clinical Recommendations
5.9 Other Factors
References
6: Practical Issues in Treatment Provision
6.1 Introduction
6.2 Selection of Treatment Type and Parameters
6.2.1 Considerations with High-Frequency Stimulation Left-Sided rTMS
6.2.2 Use of Low-Frequency Right-Sided rTMS
6.2.3 Sequential Bilateral rTMS
6.2.4 Overall Clinical Recommendations
6.3 Treatment Scheduling and Duration
6.3.1 Less Intense Approaches
6.3.2 More Intense Approaches
6.3.3 Missing Sessions
6.3.4 Treatment Duration
Clinical Recommendations
6.4 Concurrent Treatments
6.4.1 Potential Moderation of Efficacy
6.4.2 Safety Considerations
Clinical Recommendations
References
7: Switching, Continuing, or Ending Treatment
7.1 Introduction
7.2 How Long Is Long Enough?
7.2.1 Patients Showing Improvement
7.2.2 Clinical Recommendations
7.2.3 Nonresponders
7.3 Novel Options
7.3.1 Clinical Recommendations
7.4 Clinical Decision-Making and the Measurement-Based Care Approach
References
8: The Use of Deep Transcranial Magnetic Stimulation in Depression
8.1 Introduction
8.2 Clinical Application of dTMS
8.3 Safety of dTMS
8.4 Not All Deep TMS Involves the Use of an H-Coil
8.4.1 Expanding Applications of dTMS
8.5 Conclusion and Clinical Recommendations
References
9: Theta-Burst Stimulation (TBS)
9.1 Introduction
9.2 TBS and Its Effects on Brain Function
9.3 TBS in Depression
9.3.1 Preliminary Clinical Trials
9.3.2 TBS in Bipolar Depression
9.3.3 The Three-D Trial
9.3.4 Other TBS Studies in Depression
9.4 Use of Accelerated or Intensive Protocols
9.5 Safety of Theta-Burst Stimulation
9.6 Practical Implementation
9.7 Clinical Recommendation
References
10: Accelerated and Intensive rTMS Treatment Protocols
10.1 Introduction
10.2 Twice-Daily rTMS
10.2.1 Summary and Clinical Recommendations
10.3 Intensive or Accelerated rTMS
10.4 Summary and Clinical Recommendations
References
11: Localization and Targeting of rTMS Treatment of Depression
11.1 Introduction
11.2 Selection of a Stimulation Target
11.2.1 Anatomical Localization
11.2.2 Functional Localization
11.3 Is There Just One Optimal Target?
11.4 How Do We Localize Treatment to the DLPFC?
11.5 How Do We Keep the Coil at the Target?
11.6 Is Being Highly Targeted Optimal?
11.7 Donât Forget About Coil Orientation
11.8 Clinical Application and Recommendations
References
12: Treatment Intensity, the Resting Motor Threshold and rTMS Treatment Dosing
12.1 Dosing and Motor Threshold
12.2 Assessment of the Resting Motor Threshold (RMT)
12.3 Issues with RMT Assessment
12.4 Factors Affecting the RMT
12.5 Clinical Recommendations
References
13: Maintenance and Continuation Treatment
13.1 Introduction
13.2 Rates of Relapse Following rTMS Treatment
13.3 Approaches to Minimize Relapse
13.4 Medication Treatment
13.5 Psychotherapy
13.6 Maintenance rTMS Treatment
13.6.1 Standard Maintenance
13.6.2 Clustered Maintenance
13.7 Other Options: Intermittent Treatment
13.8 Repeated rTMS Treatment
13.9 Summary and Clinical Recommendations
References
14: rTMS Associated Adverse Events, Safety and Monitoring
14.1 Introduction
14.2 Contraindications
14.3 Adverse Events
14.3.1 Syncope
14.3.2 Seizure Induction
14.4 Other Potential Safety Concerns
14.4.1 Impairment of Cognition
14.4.2 Hearing Impairment
14.4.3 Potential Histotoxicity or Other Brain Changes
14.5 Pregnancy, Breastfeeding
14.6 Children and Adolescents
14.7 Safety of Operators
References
15: Side Effects of rTMS Treatment
15.1 Introduction
15.2 Site or Regional Pain
15.3 Headache
15.4 Other Transient Side Effects
15.5 Psychiatric Complications
15.6 Other Considerations
References
16: The Use of rTMS in Other Psychiatric Disorders
16.1 Introduction
16.2 Obsessive-Compulsive Disorder (OCD)
16.2.1 Summary
16.3 Mania
16.3.1 Summary
16.4 Post-traumatic Stress Disorder
16.4.1 Summary
16.5 Panic Disorder and Generalized Anxiety Disorder
16.5.1 Summary
16.6 Schizophrenia
16.6.1 Prefrontal Stimulation in Schizophrenia
16.6.2 Negative Symptoms
16.6.3 Cognition
16.6.4 Summary
16.6.5 Temporoparietal Cortex rTMS and Auditory Hallucination
16.6.6 Summary
16.7 Disorders of Addiction
16.7.1 Summary
16.8 Chronic Pain
16.8.1 Summary
References
17: Equipment and rTMS Program Setup
17.1 TMS Equipment
17.2 MagVenture
17.3 Magstim
17.4 Neuronetics
17.5 Brainsway
17.6 Nexstim
17.7 Neurosoft
17.8 Others
17.9 Treatment Program Establishment
17.10 Patient Information and Consent
Index