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B&B Week 8 Flashcards > Lecture 52: Neuromodulation > Flashcards

Lecture 52: Neuromodulation Flashcards

1
Q

What are the different types of neuromodulation?

A
  1. ECT
  2. TMS
  3. Magnetic Seizure Therapy
  4. Vagal Nerve Stimulation
  5. DBS
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2
Q

What is electroconvulsive therapy (ECT)?

A

Electricity is used to induce therapeutic seizure
-first neuromodulatory treatment for severe mental illnesses
-most effective treatment for depression and catatonia
-think of ECT as defibrillation to heart
SAFE PROCEDURE

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3
Q

What are the indications of ECT?

A
  1. MDD
  2. CATATONIA
  3. Schizophrenia
  4. Schizoaffective disorder
  5. bipolar disorder
  6. Neuroleptic malignant syndrome
  7. Severe autism
  8. Status epilepticus (brain is in a state of persistent seizure)
  9. Parkinson’s disease
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4
Q

What are the risks and contraindications of ECT?

A
  1. unstable cardiovascular disease
  2. history of craniotomy
  3. Cognitive impairment (dementia and delirium)
    • because ECT leads to retrograde amnesia
  4. Problems with anesthesia (pseudocholinesterase deficiency)
  5. Uncontrolled seizure disorder
  6. Borderline personality disorder
  7. Active substance abuse
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5
Q

What is the most effective ECT regimen?

A

Maintenance ECT with pharmacotherapy likely most effective at preventing relapse

  • you want to maintain ECT sessions…don’t discontinue
  • 15-30 minutes for one treatment
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6
Q

What is the MOA of ECT?

A

Releases all of the neurotransmitters (monoamines) ACUTELY

  • monoaminergic, glutaminergic and GABAergic neurotransmitter INCREASE
  • antidepressant effect may be mediated by BDNF
  • can conceptualize as brain defibrillization (restoration of corticothalamic rhythms)
  • unknown how ECT exerts a therapeutic effect lol
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7
Q

What do you see in DLPFC after ECT?

A

You see less connectivity

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8
Q

You see less connectivity

A

Catatonia

Mood disorders

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9
Q

Where do you want to place the electrode for ECT?

A

Right hemisphere

-because most of us are left brain dominant

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10
Q

What is Transcranial Magnetic Stimulation (TMS)?

A
  • uses magnetic field to induce electric current (Faraday’s laws)
  • used to stimulate an area cortex
  • subconvulsive therapy involving application of rapidly ALTERNATING magnetic fields to deliver focal stimulation to the cortex
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11
Q

What is the difference between TMS and ECT?

A

TMS does not have as many side effects, doesn’t induce seizures, no memory loss

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12
Q

When we go into sleep, what happens in connectivity?

A

Brain connectivity decreases
-massimini et al found that TMS will induce a lot of cortical activity when patient is awake while cortical activity not as pronounced when patient is asleep

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13
Q

Where do you place TMS for treatment of depression?

A

DLPFC

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14
Q

How do you treat depression with TMS?

A

TMS over the DLPFC

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15
Q

What is TMS used for?

A 
Depression
Anxiety
Schizophrenia
Pain Syndromes
Tinnitus
ADHD
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16
Q

How long is the treatment?

A

Everyday for 6 weeks…

17
Q

What is the efficacy of TMS?

A

Approved by FDA to treat depression after one failed antidepressant trial

18
Q

What is magnetic seizure therapy?

A

A focal convulsive therapy utilizing high tesla focal TMS

  • used as an alternative to ECT
  • requires anesthesia/muscle relaxants
  • associated with more focal seizures, less post-ictal confusion, fewer memory side effects, shorter recovery time
  • likely not as effective of ECT
19
Q

What is vagal nerve stimulation?

A

Nerve stimulation applied to left vagus nerve used to treat EPILEPSY
Also treats DEPRESSION
-takes 2 years for effect
-few to no side effects (hoarse voice, breathing problems, difficulty swallowing)
FDA approved after 4 or more antidepressant failures

20
Q

What is MOA of vagal nerve stimulation?

A

Activation of monoaminergic cell bodies

21
Q

Can you do vagal nerve stimulation with ECT?

A

Yes, but can’t do others

22
Q

What is deep brain stimulation?

A

Stimulates the subthalamic nuclei of basal ganglia

  • used to treat OCD
  • treatment of depression?
  • treatment for essential tremor and epilepsy?
23
Q

What is MOA of DBS?

A

Involves “neural jamming”
“poking and hoping” lmaoooo
Install electrodes in brain to generate stimulation

24
Q

What area is implicated in depression?

A

Area 25 of the anterior cingulate
The more activity the more depression
If you decrease activity (using DBS, antidepressant or CBT), then depression gets better
-jury is still out on this guy

25
Q

What are the different ways to treat psychiatry patients?

A
  1. medications
  2. psychotherapy
  3. neuromodulation

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