CANMAT neuromodulation

Question 1

List the types of neuro modulation and their recommendation level

Answer 1

ECT 1st line under specific circumstances
rTMS 2nd L
VNS 3rd L (better for maintenance not acute)
DBS investigational

Question 2

Which of the neuromodulation techniques has cognitive umpairement?

Answer 2

Only ECT

Question 3

Are there absolute # to ECT? to rTMS? what are they

Answer 3

not ECT

rTMS#: Sz, ferromagnetic materials, pacemakers, increased ICP, CVD, pregnancy (not recommended)

Question 4

What medical condition was VNS approved for?

Answer 4

refractory epilepsy

Question 5

What medical condition was DBS approved for?

Answer 5

Parkinsons

Question 6

What are the indications for ECT as 1st line

Answer 6

acute SI
psychotic features
treatment resistant depression
medication intolerance
previous response
patient preference
catatonia
rapidly deteriorating physical status
pregnancy plus any of the above

Question 7

What 1st line indications of ECT actually have level 1 evidence

Answer 7

acute SI
Dep with psychotic features
Treatment resistant dep

Question 8

What is the best studied brain area and type for rTMS?

Answer 8

high frequency left DLPC
located 5 cm anterior to motor cortical site (abd pol brevis) in parasaggital line betwen BA 9 and 46
90-120% of motor threshold,

Question 9

What is the response rate for ECT?

Answer 9

80-90% in general

50-60% in true Tx resistant depression

Question 10

What is the response and remission rate for rTMS?

Answer 10

25% and 17%

Question 11

What is the response and remission rate for VNS?

Answer 11

30% and 15% in an open trial

Question 12

What is the response and remission rate for DBS?

Answer 12

60% and 35%

Question 13

What is the location(s) of DBS?

Answer 13

subcallosal cingulate gyrus= BA 25
NA
ventral caudate=ventral striatum region

Question 14

hypomania can occur after?

Answer 14

ECT, VNS, DBS