Clinical Off-Label Use of Deep Transcranial Magnetic Stimulation in Psychiatric Conditions
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Clinical Off-Label Use of Deep Transcranial Magnetic Stimulation in Psychiatric Conditions Brandon J. Cornejo1,2,3,* Holly McCready2,3 Sarah Rabin2 Shannon Boyce1 Laura Dennis2,3 Address 1 Achieve TMS, 1675 SW Marlow Ave., Suite 206, Portland, OR, 97225, USA 2 Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR, 97239, USA *,3 Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA Email: [email protected]
* This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Keywords Repetitive transcranial magnetic stimulation I Deep TMS I Neuromodulation I Off-label dTMS
Abstract Purpose of review Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation approach to psychiatric treatment that is FDA approved for the management of major depressive disorder (MDD) and obsessive compulsive disorder (OCD). Standard TMS appears to exert biological effects by inducing current in the cortex more shallowly than deep TMS (dTMS); it may be that this modality of treatment differs from standard TMS. Given the potential difference in the manner in which dTMS stimulates the targeted brain regions, it is reasonable to review and summarize the various off-label and experimental applications of this variation of TMS. Recent findings Deep TMS has demonstrated promise in treating mood disorders including bipolar depression and PTSD, but it is clear that more work is needed to clarify the utility of dTMS compared with rTMS. Future work may help delineate the role dTMS plays in addressing a wide spectrum of psychiatric illnesses. In addition, direct fundamental work is needed to characterize any effectiveness of dTMS in schizophrenia, anxiety, and autism spectrum disorder. Summary Overall, neuromodulation holds promise for treating a variety of psychiatric conditions but more extensive works aimed at understanding the mechanisms and applicability are sorely needed. Continued efforts in understanding the unique application of
Hot Topic dTMS may pave the way for future methodologies that could enhance treatment options for both mood and thought disorder.
Introduction Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation approach to psychiatric treatment wherein magnetic fields are projected through the skull and into the cerebral cortex [1, 2•]; rTMS stimulation can produce changes in cortical excitability [3, 4]. Deep TMS (dTMS) is a variation of standard rTMS that can modulate cortical excitability up to a maximum depth of 6.5 cm into the cortex; this may not only modulate cerebral activity but also the activity of deeper neuronal circuits [5, 6]. Consequently, this form of TMS has been used in both medical and research applications. From a clinical standpoint, dTMS is currently FDA-approved for the treatment of major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) [7, 8•, 9]. The aim of this review is to discuss and sum
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