SM_112b: Neuromodulation

Question 1

Electroconvulsive therapy is most effective in treatment of ____

Answer 1

Electroconvulsive therapy is most effective in treatment of catatonias

Question 2

TMS is ___ and has ___ cognitive side effects

Answer 2

TMS is noninvasive and has few cognitive side effects

Question 3

DBS is indicated for ____, ____, and ____

Answer 3

DBS is indicated for essential tremor, Parkinson’s disease, and dystonia

Question 4

VNS is indicated for ____

Answer 4

VNS is indicated for epilepsy

Question 5

TMS is indicated for ____, ____, and ____

Answer 5

TMS is indicated for migraines, major depressive disorder, and OCD

Question 6

ECT is ____, ____, used for ____, and functions by ____

Answer 6

ECT is noninvasive, acute, used for seizure, and electrical current

Question 7

Mechanism of ECT is ____ and motor seizure is indistinguishable from ____, but seizure induced during ECT is ____

Answer 7

Mechanism of ECT is unknown and motor seizure is indistinguishable from GTC seizure, but seizure induced during ECT is synchronized / coherent

Question 8

General indications for ECT are ____ and ____

Answer 8

General indications for ECT are treatment-refractory conditions (2nd or 3rd line) and severe conditions (acute risk of morbidity / mortality)

Question 9

Reasons to consider ECT first include ____, ____, ____, and ____

Answer 9

Reasons to consider ECT first include severe suicidality, catatonia / NMS, pregnancy and severe psychiatric illness, and patient preference (usually previous ECT)

Question 10

ECT diagnostic indications include ____, ____, ____, ____, ____, and ____

Answer 10

ECT diagnostic indications include

• Major depressive disorder (especially if psychotic features or in geriatric patients)
• Bipolar disorder
• Schizophrenia / schizoaffective disorder
• Catatonia
• Parkinson’s Disease
• Epilepsy / super-refractory status epilepticus

Question 11

Describe common adverse effects of ECT

Answer 11

ECT common adverse effects

• Post-ictal confusion
• Anterograde memory dysfunction
• Retrograde memory dysfunction
• Headache
• Muscle ache
• Nausea / vomiting

(very safe though!)

Question 12

TMS is ____, ____, used for ____, and acts by ____

Answer 12

TMS is noninvasive, acute, used for nonseizure, and acts by magnetic field

Question 13

TMS is to assess ____, ____, ____, and ____

Answer 13

TMS is to assess cortical excitability, circuits and connectivity, brain mapping, and virtual lesions (Wada test)

Question 14

rTMS is used for patients with depression who ____ and ____

Answer 14

rTMS is used for patients with depression who have failed at least one antidepressant medication and are currently not on any antidepressant therapy

Question 15

TMS acts by ____, leading to ____

Answer 15

TMS acts by depolarizing neurons in superficial cortex, leading to local and trans-synaptic changes in brain activity

(normalizes subgenual ACC and DLPFC and default mode network connectivity)

Question 16

TMS has rare complications of ____, ____, and ____

Answer 16

TMS has rare complications of seizure, mania / hypomania, and skin burns

(contraindicated in people with implanted / nonremovable metallic objects in/around head and used with caution in people with pacemakers or ICDs)

Question 17

DBS is acts by ____

Answer 17

DBS is acts by jamming the system and blocking information flow via high frequency stimulation