123b- Neuromodulation

Question 1

What are the indications for transcranial magnetic stimulation?

Answer 1

• Depression in pts who have failed at least 1 medication
  
  • FDA approved

Nonclinical (research) uses to measure cortical excitability, circuits and connectivity, and for brain mapping

Question 2

Which types of neuromodulation are seizure-inducing?

Answer 2

Electroconvulsive therapy

Deep brain stimulation

Question 3

What are the indications for electroconvulsive therapy?

Answer 3

• 1st line for:
  
  • Catatonia
  • Severe suicidality
  • Severe psychiatric disorders in pregnancy (if medication cannot be tolerated
• 2nd or 3rd line treatment for refractory:
  
  • MDD
  • Bipolar disorder
  • Schizophrenia, schizoaffective disorder
  • Parkinson’s
  • Epilepsy

Question 4

Which type of neuromodulation therapy is surgical?

Answer 4

Deep brain stimulation

(Vs. ECT and TMS which are non-invasive, although ECT does require anesthesia)

Question 5

Which type of neuromodulation is invasive?

Answer 5

Deep brain stimulation

Question 6

List 2 advantages of TMS over ECT

Answer 6

• No memory/cognitive side effects
• No general anethesia required for TMS

Question 7

List some possible side effects of ECT

Answer 7

• Post-ictal confusion
• Anterograde and/or retrograde memory dysfunction
• Headache, muscle ache, nausea/vomiting

Question 8

Electroconvulsive therapy is [more/less] focal than transcranial magnetic stimulation

Answer 8

Electroconvulsive therapy is less focal than transcranial magnetic stimulation

Question 9

Why is ECT underutilized?

Answer 9

• Stigma
• Not widely available
• Expensive

Question 10

[Electroconvulsive therapy/transcranial magnetic resonance] requires anesthesia

Answer 10

Electroconvulsive therapy requires anesthesia

Question 11

What are the indications for Deep Brain Stimulation?

Answer 11

• Essential tremor
• Parkinson’s disease
• Dystonia
• Depression