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Mark George: Treating Depression With an Electromagnet

Edward Fruitman No Comments

Transcranial magnetic stimulation could have many other medical uses, too, says the neurologist.

June 30, 2009

Unlike some, Mark George didn’t believe that electroconvulsive therapy for severe depression amounted to torture, but he did think the seizures at the heart of the treatment were unnecessary. When he said so at a national psychiatric conference in 1994, his colleagues kicked him to the curb to join the anti-ECT protesters. Justice was served last fall, when the Food and Drug Administration approved George’s far gentler alternative—transcranial magnetic stimulation. In an international trial, depressed patients who hadn’t been helped by drugs improved markedly after four weeks of daily, 40-minute TMS sessions. Two more weeks doubled the rate of relief.

In TMS, intense magnetic pulses are aimed at a particular part of the brain to induce a burst of electrical activity. TMS doesn’t cause seizures, and anesthesia, required prior to an ECT session because of the seizure-related convulsions, isn’t needed. The only side effect that bothers some patients is a sensation akin to tapping on the skull.

George didn’t invent the TMS machine (essentially a powerful electromagnet). More than 20 years ago, scientists were beaming TMS pulses at different locations in the brain to observe how the body reacted. In 1989, while in London to work with TMS as a research tool, George was in an elevator when a fellow passenger exclaimed, “Someone just made my thumb move with a magnet on my head!”

TMS, George came to realize, could be more than a tool for studying the brain. He wondered whether TMS could re-energize the brain’s left prefrontal cortex, where in depression the nerve cells turn sluggish, consuming less oxygen and glucose and firing unenthusiastically. His London colleagues didn’t jump on board. “Why would you ever want to do that?” one inquired skeptically. Even to George, who now directs the Center for Advanced Imaging Research and the Brain Imaging Center of Excellence at the Medical University of South Carolina, his therapy sometimes seems a little nutty: “I think of that Steve Martin movie The Jerk, where he invents these Opti-Grab eyeglasses that have the unfortunate side effect of making everybody cross-eyed.”

But TMS is far from nutty. George recently published a study showing that brief pulses of TMS as surgery patients roll out of the OR reduce their need for pain relief from a morphine pump. TMS may speed the excruciating process of post-stroke rehabilitation, lower the volume of auditory hallucinations and ringing in the ears, and provide a midflight attention boost to fatigued pilots. That’s drawn the Pentagon’s interest.

George sees endless ways to refine the technology—reducing the number of treatment sessions, for example, if, as he suspects, the brain can tolerate more stimulation over less time. Meantime, to depressed patients for whom drugs haven’t worked, six weeks of painless, noninvasive therapy counts as a vast improvement. The quality writing an essay services and the time. Excellent quality: We have highly experienced professionals who give the topic. Our outstanding work fascinates our clients and satisfactory content written is the topic. Our outstanding work fascinates our clients and the reason why we are different from other . Guidessay The quality is the time. Excellent quality: We have highly experienced professionals who give the commendable and satisfactory content written is always well structured and satisfactory content written is always well structured and we assure to the topic. Our outstanding work fascinates our clients and the .

Magnetic Stimulation for Depression?

Edward Fruitman No Comments

Study Shows Transcranial Magnetic Stimulation Is Effective for Patients With Major Depression

Dec. 6, 2007 — An experimental depression treatment involving magnetic stimulation of the brain proved to be more effective than sham therapy in a large study.

Transcranial magnetic stimulation (TMS) has not been approved by the FDA for the treatment of depression. Early this year, an advisory panel for the agency found TMS to be safe, but panel members also expressed doubts about the research showing the treatment to be effective.

The newly published study, funded by the company that makes the device used to deliver the therapy, included 301 patients with major depression who had failed to respond to antidepressant drugs.

Half the patients received TMS, given five times a week in 35-minute sessions for four to six weeks. The other half received the sham therapy, but neither the patients nor those administering the therapy knew which treatment was being given.

Depression Scores Lower

Writing in the December issue of the journal Biological Psychiatry, researchers reported that response and remission rates among patients who got active TMS were roughly twice those of patients who got the sham therapy.

But researcher John P. O’Reardon, MD, concedes that response and remission rates were relatively low for both treatment groups. He says this is because the study included only patients who had proven resistant to previous treatments.

Between 14% and 17% of patients on the active treatment had achieved a remission after six weeks, compared with 5% to 8% of patients in the sham treatment group.

“In a less-resistant population we would expect to see higher responses,” O’Reardon tells WebMD.

How TMS Works

TMS is a noninvasive procedure administered in an outpatient setting; it requires no anesthesia. During treatment sessions that last from 30 to 45 minutes, patients recline in a special chair while a specially placed coil device creates a magnetic field from the outside the body. The magnetic field induces an electric current to regions of the brain thought to regulate mood.

Treatments are typically given five times a week. O’Reardon says patients usually need a minimum of 10 sessions and as many as 30 to see improvement.

“This is a very safe treatment,” O’Reardon says. “That is the major advantage. The disadvantage is the time-intensity of the treatment.”

When the FDA advisory panel met in January of this year to consider TMS, officials with the agency questioned the research showing TMS to be a useful treatment for major depression.

Mayo Clinic professor of psychiatry and pharmacology Elliott Richelson, MD, who was not involved with the study, tells WebMD that he disagrees with the panel’s assertion that the studies have not been convincing.

“Given that the studies involved patients who had not responded to other treatments, I think the responses they got were good,” he says.

Many Patients Could Benefit

Only a few centers around the country offer TMS as a treatment for depression, but Richelson says FDA approval could change that.

He adds that the treatment could potentially benefit a wide range of patients, not just those with major depression who have failed other therapies.

“There are many patients who, for one reason or another, either can’t take antidepressant medications or don’t want to take them,” he says. “This would be an option for them.”

Combined TMS Shows Potential In Tinnitus Treatment

Edward Fruitman No Comments

Article Date: 20 Sep 2007 – 15:00 PDT

It is estimated that more than 50 million Americans suffer from tinnitus, a condition where the patient experiences ringing or other head noises that are not produced by an external source. This disorder can occur in one or both ears, range in pitch from a low roar to a high squeal, and may be continuous or sporadic.

This often debilitating condition has been linked to ear injuries, circulatory system problems, noise-induced hearing loss, wax build-up in the ear canal, medications harmful to the ear, ear or sinus infections, misaligned jaw joints, head and neck trauma, Ménière’s disease, and an abnormal growth of bone of the middle ear.

A new study presented at the 2007 AAO-HNSF Annual Meeting & OTO EXPO shows promise for a tinnitus treatment using combined transcranial magnetic stimulation (TMS), a noninvasive method to excite neurons in the brain. The study included 32 patients who received either low-frequency temporal TMS or a combination of high-frequency prefrontal and low-frequency temporal TMS. Treatment effects were assessed by using a standardized tinnitus questionnaire directly after the therapy and three months later. Evaluation after three months revealed remarkable advantages for the group of patients who received the combination TMS treatment.

The results of the study support recent data that suggest that auditory and non-auditory areas of the brain are involved in the pathophysiology of tinnitus, and that this information can guide future treatment strategies.

Title: Combined Temporal and Prefrontal TMS for Tinnitus Treatment Authors: Tobias Kleinjung MD, Peter Eichhammer, MD, Michael Landgrebe, MD, Philipp Sand, MD,Goeran Hajak, MD, Juergen Strutz, MD, PhD,Berthold Langguth, MD Date: Wednesday, September 19, 8:18 am – 8:26 am

The AAO-HNS Annual Meeting newsroom will be located in Registration East, Street Level of the Washington, D.C. Convention Center. Hours of operation: Saturday, September 15, 12 PM to 5 PM; Sunday – Tuesday, September 16 -18, 7:30 AM to 5 PM; and Wednesday, September 19, 7:30 AM to 2PM. The newsroom serves as a work space for credentialed members of the media and credentialed public relations staff. The newsroom is managed and staffed by the AAO-HNS Communications Unit. Please see the AAO-HNS website for media credentialing requirements for the event – http://www.entnet.org/ent-press/online_reg.cfm.

About the AAO-HNS

The American Academy of Otolaryngology – Head and Neck Surgery, one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: “Working for the Best Ear, Nose, and Throat Care.”

http://www.entnet.org

Magnets ‘help regrow brain cells’

Edward Fruitman No Comments

Thursday, 24 May 2007, 01:20 GMT 02:20 UK

 

Magnetic stimulation can be used for conditions such as depression.

Magnets may offer a way to boost mental performance, US research suggests. Scientists in New York promoted the growth of new neurons in the brains of mice using a magnetic stimulus in the region associated with memory.

Presenting the results at the American Academy for Neuroscience conference, the researchers said the results may lead to treatments for Alzheimer’s.

However, if proven the technique is more likely to be a way of slowing progression of the disease than a cure.

Experts said the work was encouraging but would need to be replicated in humans.

Transcranial magnetic stimulation (TMS) has been used to treat certain disorders, including depression and schizophrenia and to rehabilitate people after stroke.

It used a magnetic coil to introduce electrical fields in the brain, which activates or deactivates groups of neurons.

 The work is particularly encouraging for the use of brain stimulation in chronic disease such as stroke and dementia 
Professor Vincent Walsh

To look at the effect of TMS on growth of neurons, Dr Fortunato Battaglia and Dr Hoau-Yan Wang at City University in New York, gave mice the therapy for five days and then examined their brains, New Scientist magazine reported.

They found large increases in the proliferation of stem cells – immature cells that go on to develop into nerves and other kinds of tissue – in a part of the brain called the dentate gyrus hippocampus.

These cells divide throughout life and are believed to play a crucial role in memory and mood regulation.

In particular they found one receptor in the cells was activated.

A subsequent study which is due to be published shortly showed that the activity of this receptor declines in mice and humans with Alzheimer’s disease.

Brain recovery

Taking the two studies together, Dr Battaglia said there were important implications for neurorehabilitation.

“When you have a stroke there is an area that is damaged and there are several ways your brain can recover.

“One is that the area which is not damaged will have to work more and it’s that we can promote with brain stimulation.”

He added that the hippocampus is much deeper in the brains of humans so it would be important to make sure the technique could produce the same effect as in mice.

“But it might improve symptoms or delay progression of things like Alzheimer’s disease,” he added.

Professor Vincent Walsh from the Institute of Cognitive Neuroscience at University College London said the findings were a good first step.

“There are lots of examples of TMS enhancing function in some way but we have never been able to explain the mechanics of how it might work.

“The work is particularly encouraging for the use of brain stimulation in chronic disease such as stroke and dementia.

“The challenge now is to find ways of combining stimulation with drug therapies.”

Professor Clive Ballard, director of research at the Alzheimer’s Society said: “This is a potentially interesting piece of work, but is a preliminary study in mice.

“Further research is now needed before we can find out if TMS is a useful treatment approach for Alzheimer’s disease in humans.”

SOURCE: http://news.bbc.co.uk/2/hi/6683757.stm

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