Neuromodulation (ECT and TMS)

Question 1

What is neuromodulation? [1]

Answer 1

Neuromodulaton:
- process of modificaiton, inhibition, stimulation or therapeutic alteration of activity electrically or chemically of the CNS, PNS and brain

Question 2

Describe how ECT is performed today [1]

Answer 2

ECT:
- general anaesthesia
- electrodes placed on brain and electrical currents passed between temples - this causes a seizure typically lasting 30-60 secs
- wakes up in recovery and monitered for an hour / two

Acute treatment regime:
- 12 sessions, twice weekly

Maintence therapy:
- once every 1-4 weeks

Question 3

ECT:
- may only be given either w a patient’s consent or under section [] of the MHA

Answer 3

• may only be given either w a patient’s consent or under section 58A of the MHA

Question 4

What are contraindications for ECT? [5]

Answer 4

Unable to use GA
Risk of intracranial bleed or ICP
Recent MI, stroke of HTN
Pregnancy, AS, AF, cardiac implantable devices
Medications like MAOIs

Question 5

What are ECT complications?
- Common
- Less common
- Rare

Answer 5

Common: reversable short-term memory loss, heaadache, muscle soreness, confusin, dental damage

Less common: Medium-long term cognitive impairment (esp. w bilateral ECT)

Rare: CV complications, prolonged seizures, risks of GA

Question 6

What is TMS? [3]

Answer 6

Transcranial magnetic stimulation
- magnetic coil placed agaisnt scalp to induce electric current within the brain
- modifies level of activity in target regions of brain
- most common approach: bilateral stimulation of left and right dorsolateral prefrontal cortices

Question 7

Indications for TMS? [1]

Contraindications? [2]

Answer 7

Indicated:
* Tx resistant depression

CI:
- Mania / hypomania
- Caution in epilepsy
- ?with ICD

Question 8

What are TMS complications? [+]

Answer 8

Common:
- Headache or scalp discomfort

Less common:
- facial twitching, localised erythema, drowsiness

Other:
- Hypomania, a self limiting partial seizure, vertigo, insomina, increasing hostile thoughts, psychomotor agitation, transient confusion

Question 9

Describe why would use TMS vs ECT? [2]

Answer 9

TMS is lengthier and requires attending more sessions than ECT, though on the other hand is quicker, doesn’t require anaesthesia, and can be administered by a single member of staff in an office whereas ECT requires an ECT suite and a team of nursing, psychiatric and anaesthetic staff.

ECT carries more risks, and notably there’s the risk of cognitive impairment which you don’t have with TMS. On the other hand, the evidence we have is that ECT is more effective