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Objective:To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for schizophrenia by meta-analysis, and provid evidence support for clinical treatment of schizophrenia. Methods:Randomized controlled trials of rTMS and schizophrenia were searched on Embase, PubMed, Cochrane Library, CNKI, Wanfang and VIP. The quality of the included literature was controlled and meta-analysis was performed with Stata 15.1 software. Results:Seventeen studies were enrolled, including 486 patients in the stimulation group and 436 in the control group. rTMS was effective in treating patients with schizophrenia (OR=3.32, 95% CI 1.93-5.70, Z=4.35, P=0.000); rTMS treatment was effective for overall condition and negative symptoms of patients with schizophrenia (SMD=-0.33, 95% CI -0.58--0.08, Z=2.61, P=0.009; SMD=-0.41, 95% CI -0.65--0.17, Z=3.31, P=0.001), and ineffective for positive symptoms (P=0.755). There was no significant difference in adverse reactions between the two groups (P=0.732). Subgroup analysis revealed that only high frequency (10 Hz) stimulation and treatment for 4 weeks could achieve therapeutic effects. Conclusion:rTMS is effective in treating negative symptoms of patients with schizophrenia and has high therapeutic safety, but it is ineffective for positive symptoms.
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Resumen Introducción: La estimulación magnética transcraneal (EMT) es una opción potencial de tratamiento para la sintomatología de trastorno del espectro autista. Objetivos: Determinar la eficacia de la EMT en modalidad theta-burst intermitente (ETBi) sobre la corteza pre frontal dorso lateral izquierda (CDLPF) en el manejo de comportamientos patológicos asociados con TEA. Pacientes y Métodos: Paciente masculino de 10 años de edad diagnosticado con TEA con (ADOS) Autistic Diagnostic Observation Schedule, presenta una historia familiar de una hermana menor con TEA. Tanto el estudio de Resonancia Magnética encéfalo (IRM) y IRM funcional (IRMf) con paradigma emocionales se efectuaron antes del tratamiento de ETBi, inmediatamente después de tratamiento ETBi, y después de 6 meses de tratamiento con ETBi. Resultados: La prueba de ATEC reporto mejoría en las escalas de comunicación, cognición, social y comportamiento, 83%,81%,72% y 52% respectivamente. La puntuación total mejoro un 66% inmediatamente después de tratamiento y 55% en un periodo de 6 meses. La IRMf revelo la activación de la corteza frontal, parietal y occipital antes del tratamiento con ETBi y persistiendo la mejoría por 6 meses. Conclusión: ETBi una técnica de neuromodulación no invasiva bien tolerado que requiere un tiempo de administración menor que el tratamiento estándar.
Abstract Background: Transcranial magnetic stimulation (TMS) is a potential treatment option for autism spectrum disorder (ASD) symptomatology. Objectives: To determine the efficacy of the TMS intermittent theta-burst stimulation (iTBS) protocol over the left dorsolateral prefrontal cortex (DLPFC) in the management of pathological behaviors associated with ASD. Patient/Methods: A 10-year-old male diagnosed with ASD by the Autism Diagnostic Observation Schedule (ADOS) presented with a family history of ASD with a younger sister diagnosed with the same disorder. Both magnetic resonance imaging (MRI) and functional MRI (fMRI) scans for emotional paradigms were performed before the iTBS treatment, immediately after the iTBS treatment, and after 6 months of iTBS treatment. Results: The ATEC reports revealed improvement in communication, cognition, sociability, and behavior scales by 83%, 81%, 72%, and 52%, respectively. The overall score improved by 66% immediately after the treatment and by 55% lasting over a 6-month period. The fMRI revealed the activation of the frontal, parietal, and occipital cortex before iTBS treatment, and a better integration and activation of the frontal, temporal, and occipital cortex after iTBS treatment and persisted after 6 months. Conclusions: iTBS is a well-tolerated, non-invasive neuromodulation technique that requires relatively less administration than the standard treatment.
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Objective • To investigate the effects and safety of accelerated repetitive transcranial magnetic stimulation (rTMS) on suicide ideation in depressive patients and to examine whether intensive rTMS has a rapid remission of suicidal ideations or not. Methods • A total of 14 depression out patients with severe suicidal ideations were enrolled in the study. All the participants were treated with rTMS (5 Hz) on the left dorsolateral prefrontal cortex. rTMS was delivered 3-4 times daily for 3 d (total 10 sessions, 20 000 stimuli). The participants were taking antidepressants at a fixed effective dose during rTMS treatment. Scale for Suicidal Ideation (SSI), Hamilton Depression Scale-17 (HAMD17) and Clinical Global Impression-Severity of Illness (CGI-SI) were assessed at baseline and 4 d, 2 weeks and 4 weeks after baseline. Results • rTMS of 5 Hz was safe and well-tolerated. The SSI scores decreased significantly at all follow-up timepoints after rTMS treatment (F=15.788, P=0.000), and the SSI score decreased the most significantly the day after the end of rTMS therapy. The effect of anti-suicide ideation could be maintained after 4 weeks. There was a significant correlation between the degree of decrease of suicidal ideation and the decrease of HAMD17 score (t=5.658, P=0.000), but not related with CGI-SI (t=-1.058, P=0.295). accelerated rTMS treatment improved depressive symptoms significantly, and the total effective rate reached 78.57% after 4 weeks from the baseline. Conclusion • accelerated rTMS treatment may have the potential to quickly reduce suicide ideation in depressive patients, with good safety. The degree of decrease in suicide ideation is related to the antidepressant effect of rTMS, and its efficacy can be maintained.
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Substance addiction is a chronic and recurrent disorder and may be related to complex neural circuits. However, there is no optimally effective treatment for substance addiction currently. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, safe and easy-to-operate neuro-electrophysiological technique, which is becoming an emerging therapeutic option for many mental disorders. The effect of rTMS on substance addiction is closely related to the stimulation of neural circuits. However, the mechanism is still unknown. The review summarizes recent research progress on the application of rTMS and its application combined with other therapies in substance addiction, as well as the regulation of rTMS on substance addiction-related neural circuits.
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At present, a considerable proportion of patients with obsessive-compulsive disorder (OCD) cannot be effectively relieved by standard drug and psychotherapy, so researchers have turned their attention to new directions of physiotherapy. Repetitive transcranial magnetic stimulation (rTMS), as an adjuvant therapy for refractory OCD, is a non-invasive nerve stimulation technique. Many studies have shown that rTMS is effective in the treatment of OCD. However, there were also disputes in the selection of stimulation targets, parameter settings and so on. This article systematically combs the setting and application of standard rTMS in the treatment of OCD, and comprehensive therapeutic effect of rTMS, and then discusses the deficiency of treatment so far, in order to put forward the future development direction and promote clinical treatment progress.
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Neurologic symptoms that develop unconsciously and are incompatible with known pathophysiologic mechanisms or anatomic pathways belong to Conversion Disorder (CD). CD diagnosis is based on the clinical history and the exclusion of physical disorders causing significant distress or social and occupational impairment. In a subgroup of CD, called functional weakness (FW), symptoms affecting limbs may be persistent, thus causing a permanent or transient loss of limb function. Physiotherapy, pharmacotherapy, hypnotherapy and repetitive transcranial magnetic stimulation (rTMS) have been proposed as treatment strategies for FW-CD. Herein, we report a 30 year-old male, presenting with lower limb functional paraparesis, having obtained positive, objectively, and stable effects from a prolonged r-TMS protocol associated to a multidisciplinary approach, including psychological and sexuological counseling, and monitored by gait analysis. We postulate that our rTMS protocol, combined with a multidisciplinary approach may be the proper treatment strategy to improve FW-CD.
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Humans , Male , Brain , Conversion Disorder , Counseling , Diagnosis , Drug Therapy , Extremities , Gait , Hypnosis , Lower Extremity , Neurologic Manifestations , Paraparesis , Transcranial Magnetic StimulationABSTRACT
BACKGROUND: To investigate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on motor symptoms especially freezing of gait (FoG), and nonmotor symptoms in Parkinson disease (PD). METHODS: In this randomized, double-blind, sham-controlled study, fifteen PD patients were enrolled. For 10 days, 5 Hz, both motor cortices and dorsolateral prefrontal cortex (DLPFC) were stimulated. The motor symptoms and FoG were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) part III, FoG questionnaire (FoG-Q), variable parameters of FoG, and kinematic gait analysis. Nonmotor symptoms were evaluated by the Korean version of non-Motor Symptoms Scale (K-NMSS), 39-item Parkinson disease questionnaire (K-PDQ39), Mini-Mental Status examination (K-MMSE), Montreal Cognitive Assessment (K-MoCA), and Frontal assessment battery (FAB). RESULTS: Finally, 12 patients (real:8, sham:4) data were analyzed. FoG-Q and UPDRS part III were improved (p=0.002, 0.022) and variable parameters of FoG was improved after 10 days stimulation in real treatment group. In addition, their effects maintained until 6 weeks from the baseline. In nonmotor symptoms, K-NMSS and K-PDQ 39 were improved until 6 weeks in real treatment group (p=0.002, 0.002), however no changes were shown in cognitive function test. CONCLUSIONS: The high frequency rTMS was effective for FoG, in addition to motor and a few nonmotor symptoms in PD.
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Humans , Freezing , Gait , Parkinson Disease , Prefrontal Cortex , Transcranial Magnetic Stimulation , WeatherABSTRACT
BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has potential as a noninvasive neuromodulation treatment method for various neuropsychiatric disorders, and repeated sessions of rTMS are more likely to enhance the therapeutic efficacy. This study investigated neurophysiologic and spatiodynamic changes induced by repeated 1-Hz rTMS of the temporal cortex using transcranial magnetic stimulation (TMS) indices and fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: Twenty-seven healthy subjects underwent daily 1-Hz active or sham rTMS of the right temporal cortex for 5 consecutive days. TMS indices of motor cortical excitability were measured in both hemispheres daily before and after each rTMS session, and 2 weeks after the last stimulation. FDG-PET was performed at baseline and after the 5 days of rTMS sessions. RESULTS: All subjects tolerated all of the sessions well, with only three of them (11.1%) reporting mild transient side effects (i.e., headache, tinnitus, or local irritation). One-Hz rTMS decreased motor evoked potential amplitudes and delayed cortical silent periods in the stimulated hemisphere. Statistical parametric mapping of FDG-PET data revealed a focal reduction of glucose metabolism in the stimulated temporal area and an increase in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri. CONCLUSIONS: Repeated rTMS sessions for 5 consecutive days were tolerated in all subjects, with only occasional minor side effects. Focal 1-Hz rTMS of the temporal cortex induces cortico-cortical modulation with widespread functional changes in brain neural networks via long-range neural connections.
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Brain , Evoked Potentials, Motor , Glucose , Headache , Positron-Emission Tomography , Salicylamides , Tinnitus , Transcranial Magnetic StimulationABSTRACT
A multi-institutional study using our protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) showed significant improvement of motor function of the affected upper limb in poststroke patients. The response to the treatment was not influenced by age or time after stroke onset. Our protocol is a safe, feasible, and potentially useful neurorehabilitative intervention for upper limb hemiparesis after stroke. The extent of the improvement seems to be influenced by the baseline severity of upper limb hemiparesis. The results suggest that patients with Brunnstrom stage 4 or 5 upper limb hemiparesis are best suited for this protocol. Botulinum toxin type A (BoNT-A) has been reported to be an effective treatment for limb spasticity after stroke. However, the spasticity reduction after BoNT-A injection alone does not ensure an improvement in the active motor function of the affected limb. Our proposed protocol of a BoNT-A injection, followed by home-based functional training seems to have the potential to improve the active motor function of the affected upper limb after stroke.
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OBJECTIVE: To investigate the effects of continuous repetitive transcranial magnetic stimulation (rTMS) on pain response in spinal cord injured rat. METHOD: Forty Sprague-Dawley rats (200~250 grams, female) were used. Thoracic spinal cord (T9) was contused using New York University (NYU) spinal cord impactor. Ten gram weight rod was dropped from a height of 25 mm to produce spinal cord contusion model with moderate injury. The animals were randomly assigned to two groups: one exposed to real magnetic stimulation (real-rTMS group) and the other not exposed to magnetic stimulation (sham-rTMS group). rTMS was applied for 8 weeks. To assess the effect of continuous rTMS on below-level pain responses after spinal cord injury (SCI), the hindpaw withdrawal response for thermal stimuli, cold stimuli and mechanical stimuli were compared between two groups. RESULTS: Behavioral response for pain showed that hindpaw withdrawal response for cold stimuli was reduced significantly from 4 weeks after SCI in real-rTMS group compared with sham group (p<0.05). CONCLUSION: These results suggest that continuous rTMS may have beneficial effects on attenuation of cold allodynia after SCI, and it might be an additional non-invasive therapeutic method in patients with chronic neuropathic pain after SCI.
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Animals , Humans , Rats , Cold Temperature , Hyperalgesia , Magnetics , Magnets , Neuralgia , New York , Rats, Sprague-Dawley , Salicylamides , Spinal Cord , Spinal Cord Injuries , Transcranial Magnetic StimulationABSTRACT
Objective: To examine the therapeutic effects of dual dorsolateral prefrontal repetitive transcranial magnetic stimulation (rTMS) on auditory hallucinations experienced by schizophrenic patients. Methods: A double-blind randomized controlled study was conducted. Totally 25 schizophrenic patients met DSM-Ⅳ criteria for schizophrenia and had anditory hallucination with stable antipsychotic drugs treatment were recruited. Subjects were grouped into active treatment subgroup and sham subgroup randomly. Measurements including the Positive and Negative Symptom Scale (PANSS) for clinical symptom and the Treatment Emergent Symptom Scale (TESS) for side-effects were evaluated Results: Totally 25 subjects completed the trial. The treatment efficiency of active treatment group was higher than that of sham group (75% vs. 31%) .No overt side effects of rTMS were observed. Conclusion: It is effective for rTMS to treat schizophrenia with auditory hallucination at 1Hz. rTMS may be a new selection of schizophrenia treatment.
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@#Objective To explore the effect of repetitive transcranial magnetic stimulation(rTMS)on spinal cord injured rats.Methods Weight-drop spinal cord injury model was made at thoracic 10 segments with NYU impactor device.Stimulated group received daily superthreshold rTMS continued for 4 weeks.BBB locomotor scores were recorded weekly.Growth associated protein 43(GAP43)and 5-hydroxytryptamine(5-HT)were detected with immunofluorescence staining in the area of rostral and caudal to the lesion.Results The BBB scores in stimulation group improved compared with that in the control(P<0.01).GAP43 and 5-HT markers increased in the stimulation group(P<0.01),and they increased in the rostral than in the caudal areas(P<0.01).Conclusion rTMS can improve the locomotor function of incomplete spinal cord injury rats,which may result from the increase of expression of GAP43 and 5-HT.
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Objective : To describe the effect of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) on unilateral spatial neglect (USN) in 22 right-handed stroke patients with right hemispheric damage and the corresponding change of regional cerebral blood flow (rCBF) before and after rTMS, speculating on the neural basis for recovery from USN. Methods : The time of onset to the initiation of rTMS was 70 to 220 days (mean : 128.3 days), on chronic stage in all patients. The therapeutic schedule consisted of 7 sessions of 1 Hz-rTMS delivered every other day for two weeks, with 14 sessions in two patients. Each session consisted of one train of 500 pulses applied over P5 (10/20 EEG system) at 90% motor threshold using a figure-eight-shaped coil. Assessment was made using the Japanese edition of the Behavioural Inattention Test (BIT) and a computed visual search task at four times as well as a cold-xenon CT (Xe-CT) at two times. Results : rTMS induced a significant improvement of USN patient performance in cancellation tasks and the BIT figure copy task as well as in visual search reaction time, an improvement which lasted 2 weeks after rTMS. Xe-CT showed a significant increase in rCBF in the right cerebellum after rTMS. Conclusions : It is conceivable that low-frequency rTMS may be useful for improving USN and it is a promising therapeutic tool. Also, the cerebellum, by forming a neural network with the parietal and frontal lobe, may play an important role in patient recovery from spatial neglect.
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@#Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on the spinal segmental excitability after spinal cord injury in adult rats.MethodsT 10 spinal cord injury models were made with weight-drop method.8 weeks later,rTMS were applied to the experimental group at 0.5 Hz suprathreshold stimulation,500 pulses daily for 4 weeks.Spinal cord injury rats without stimulation and normal rats were used as controls.At different time points,electronic evoked F-wave were measured.The ratio of F-wave amplitude to M-wave amplitude(F/M)were compared among these groups.Immunohistochemistry was used to detect the expression of 5-hydroxytryptamine(5-HT)in the rostral and caudal lesion segments.ResultsThe ratio of F/M increased significantly(P<0.01)8 weeks after spinal cord injury compared with baseline ratio and regressed significantly(P<0.01)after 4 weeks of rTMS.Expression of 5-HT in grey matter around lesion was decreased after spinal cord injury and increased significantly(P<0.01)both in the rostral and caudal lesion segments in rTMS treatment group.ConclusionThe increased spinal segmental excitability after spinal cord injury can be regressed by rTMS,which may be resulted in increased expression of 5-HT.