The section also addresses the parameters for brain stimulation and how to determine the right dose. A separate chapter is devoted to low intensity focused ultrasound pulsations LIFUP and temporally interfering TI electric fields, emerging treatments that have the potential to noninvasively stimulate focal locations deep in the brain without surgery or the implantation of hardware.
Transcranial Magnetic Stimulationn (TMS) Therapy
The section on using DBS for treatment-resistant Parkinson's disease PD is thorough, authoritative, and a boon to clinicians assessing the viability and efficacy of treatment options for their PD patients. The new edition retains the amusing, but always informative sidebars highlighting the history of brain experimentation and applications of brain stimulation techniques. Introduction Chapter 2. Basic Electricity Chapter 3.
Electrical Brain Chapter 4.
Electroconvulsive Therapy Chapter 5. Vagus Nerve Stimulation Chapter 6. Transcranial Magnetic Stimulation Chapter 7. Transcranial Direct Current Stimulation Chapter 9. Other Techniques Chapter The Second Edition of Brain Stimulation Therapies for Clinicians by Higgins and George is an up-to-date, and beautifully written examination of this field of therapeutics. It is concise and informative, geared to conveying essential information about this field with clarity.
After reviewing the nature of electricity and electrical signaling in the brain, Higgins and George summarize the current state of knowledge regarding the major forms of therapeutic brain stimulation. This book is of value to any clinician considering a brain stimulation technology for their patients and for clinicians who desire to keep abreast of how the future of neuropsychiatric treatment is being pioneered.
Sackeim, Ph. Doctors Higgins and George have created a sorely needed resource that promises to elevate its readers' understanding of the basic physics, biology, engineering, and physiological principles surrounding neuromodulation therapies. Reading Brain Stimulation Therapies for Clinicians, Second Edition felt like listening to the authors tell me their favorite stories about history and science over beers.
The informal prose often sprinkled with humor see the box on deep penetration! Higgins and George expertly and succinctly covered everything the informed clinician needs to know about brain stimulation in under pages. I particularly appreciated the many large and colorful figures, I plan to use them for teaching my own neuromodulation research trainees because they so effectively illustrate the core concepts and take-home points in a clear and simple manner. I imagine the authors had fun writing this book, and I anticipate many will enjoy reading it!
Some patients have no improvement in symptoms and some actually get worse.
Repetitive transcranial magnetic stimulation rTMS uses a magnet to activate the brain. First developed in , rTMS has been studied as a treatment for depression, psychosis, anxiety, and other disorders. Unlike ECT, in which electrical stimulation is more generalized, rTMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific site in the brain reduces the chance for the types of side effects associated with ECT. But opinions vary as to what site is best.
In , rTMS was approved for use by the FDA as a treatment for major depression for patients who do not respond to at least one antidepressant medication in the current episode. It is also used in other countries as a treatment for depression in patients who have not responded to medications and who might otherwise be considered for ECT. After the trial ended, patients could enter a second phase in which everyone, including those who previously received the sham treatment, was given rTMS. Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be.
The magnetic field is about the same strength as that of a magnetic resonance imaging MRI scan. Generally, the person feels a slight knocking or tapping on the head as the pulses are administered. Not all scientists agree on the best way to position the magnet on the patient's head or give the electromagnetic pulses. More research is underway to determine the safest and most effective uses of rTMS.
Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may contract or tingle during the procedure. Mild headaches or brief lightheadedness may result. It is also possible that the procedure could cause a seizure, although documented incidences of this are uncommon.
Two large-scale studies on the safety of rTMS found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred. Because the treatment is relatively new, however, long-term side effects are unknown. So the pulses are given at a higher frequency than that used in rTMS.
Therefore, like ECT, the patient must be anesthetized and given a muscle relaxant to prevent movement.
Consider non-surgical brain stimulation for severe depression, say experts
MST is in the early stages of testing for mental disorders, but initial results are promising. Like ECT, MST carries the risk of side effects that can be caused by anesthesia exposure and the induction of a seizure. Studies in both animals and humans have found that MST produces.
Deep brain stimulation DBS was first developed as a treatment for Parkinson's disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest. Stimulation is continuous and its frequency and level are customized to the individual. A review of all 22 published studies testing DBS for depression found that only three of them were of high quality because they not only had a treatment group but also a control group which did not receive DBS.
DBS requires brain surgery. The head is shaved and then attached with screws to a sturdy frame that prevents the head from moving during the surgery. Scans of the head and brain using MRI are taken. The surgeon uses these images as guides during the surgery. Patients are awake during the procedure to provide the surgeon with feedback, but they feel no pain because the head is numbed with a local anesthetic and the brain itself does not register pain.
Once ready for surgery, two holes are drilled into the head.
From there, the surgeon threads a slender tube down into the brain to place electrodes on each side of a specific area of the brain. In the case of depression, the first area of the brain targeted by DBS is called Area 25, or the subgenual cingulate cortex. This area has been found to be overactive in depression and other mood disorders. But later research targeted several other areas of the brain affected by depression.
So DBS is now targeting several areas of the brain for treating depression. After the electrodes are implanted and the patient provides feedback about their placement, the patient is put under general anesthesia. The electrodes are then attached to wires that are run inside the body from the head down to the chest, where a pair of battery-operated generators are implanted. From here, electrical pulses are continuously delivered over the wires to the electrodes in the brain.
Although it is unclear exactly how the device works to reduce depression or OCD, scientists believe that the pulses help to "reset" the area of the brain that is malfunctioning so that it works normally again. DBS carries risks associated with any type of brain surgery. For example, the procedure may lead to:. Because the procedure is still being studied, other side effects not yet identified may be possible. Long-term benefits and side effects are unknown. Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge.
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ECT: How it works Before ECT is administered, a person is sedated with general anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. During the procedure: Electrodes are placed at precise locations on the head. Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute. Because the patient is under anesthesia and has taken a muscle relaxant, it is not painful and the patient cannot feel the electrical impulses.
Five to ten minutes after the procedure ends, the patient awakens. He or she may feel groggy at first as the anesthesia wears off. But after about an hour, the patient usually is alert and can resume normal activities.