112. Neuromodulation

Question 1

Electroconvulsive Tx

• characteristics (4)
• use
• mechanism
• indication
• SE

Answer 1

Non-invasive, seizure-producing, acute use, uses electrical current
Use: pt under general anesthesia, brief pulse through scalp
Mech: unknown; motor seizure like generalized tonic-clonic seizure (but EEG synchronized; chaotic in GTC), may be anticonvulsant or increase hippocampal neurogenesis
Indication: 1st line for severe suicide, catatonia, pt preference (past ECT), pregnancy w/ severe psych illness
2/3rd line refractory conditions: MDD, BPD, Schizophrenia, Catatonia (GOLD STANDARD), Parkinson’s disease, Epilepsy
SE: post-ictal confusion, antero/retrograde memory dysfx, HA, muscle aches, N/V

Question 2

Transcranial Magnetic Stim (TMS)

• characteristics (4)
• indications
• contraindications
• SE

Answer 2

Non-invasive, no seizure, acute, uses magnetic current
Use: MDD (failed one antidepressant)- dorsolateral prefrontal cortex (enhance 5HT output)
CI: implanted/non-removable metallic devices, pacemaker fx
SE: stim site discomfort, HA, muscle ache/twitch (rare: more seizures/mania/skin burns)

Future use: Mania, PTSD, Pain, Tinnitus, Schizo neg sx, Dementia cog enchancement

Question 3

Deep Brain Stimulation (DBS)

• characteristics (4)
• targets

Answer 3

invasive, non-seizure, long-term, electrical current

Use: depression targets (ventral striatum, subgenual prefrontal cortex)