Neurostimulation: rTMS Flashcards
what is rTMS
MAGNETIC stimulation applied to the brain with certain FREQUENCIES that are either EXCITATORY or INHIBITORY to target certain areas of the brain
in which conditions in rTMS indicated
grade A or B evidence for: depression, pain, motor stroke
what type of rTMS has evidence in management of depression
stimulation of HIGH FREQUENCY in left DLPFC in depression has definite efficacy with level A recommendation
are there any absolute contraindications to rTMS
yes–> metallic hardwear in head and neck with exception of the mouth
list other contraindications to rTMS, other than metallic heardwear in head/neck
increased ICP
epilepsy or hx seizures
severe CVD
cardiac pacemakers
implanted medication pumps
intracardiac lines
meds that lower seizure threshold
what are adverse effects of rTMS
pain/discomfort and headache that subside quickly
in which patients with depression is rTMS recommended
first line for patients who have failed at least 1 antidepressant
in which phases of treatment (acute efficacy, maintenance efficacy, safety and tolerability) does rTMS have good evidence for tx of MDD/MDE
level 1 for acute efficacy and safety/tolerability
level 3 for maintenance efficacy
how is rTMS thought to work
by altering neurotransmitter transmission, neuronal electrophysiology, blood flow, brain activity in a frequency-dependent manner
what is the most precise method for determining coil placement in rTMS
MRI guidance
–> clinical reality = scalp based nagivation is most common
how is stimulus intensity for rTMS established
based on individually determined resting motor threshold (RMT)–> minimum intensity needed to elicit muscle twitches at relaxed upper and lower extremities
most common stimulus intensity is 110-120% of RMT
how many treatment sessions should be attempted before declaring treatment failure wiht rTMS
at least 20
(treatment efficacy usually peaks at sesison 26-28)
how long do the therapeutic effects of rTMS last
can last up to several months
relapse is common without maintenance treatment
which is more effective, rTMS or ECT
ECT
does rTMS appear to worsen cognition
no
also little evidence of improving cognition
