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A retrospective analysis of transcranial magnetic stimulation right dorsolateral prefrontal cortex treatments for patients with generalized anxiety disorder
Brain Stimulation 9 (2016) e1–e9
Contents lists available at ScienceDirect
Brain Stimulation j o u r n a l h o m e p a g e : w w w. b r a i n s t i m j r n l . c o m
ABSTRACTS FROM CLINICAL TMS SOCIETY 1 Treatment of unipolar, non-psychotic major depressive disorder with transcranial magnetic stimulation: Examining acute and long-term efficacy of TMS Kimberly Cress Sugar Land, Texas Background: Transcranial magnetic stimulation (TMS) is noninvasive, non-systemic therapy that uses pulsed magnetic fields to induce localized neuronal depolarization and beneficial effects on the symptoms of MDD. The purpose of this review is to evaluate standardized symptom score outcomes in routine clinical practice and establish long- term efficacy of TMS. Methods: One hundred twenty patients with a primary diagnosis of unipolar MDD who had not received benefit from antidepressant treatment (average of 3.7 in current MDD episode) received TMS treatment. Each patient was assessed using the Beck Depression Inventory scale. Scores were performed prior to and at the end of the acute treatment phase. Long-term results were reported on those patients that returned for assessment. Results: The study population included average age 48.4 years with 69.2% female. Ninety-four patients (78.3%) demonstrated a minimum 50% improvement in the BDI-II symptom score. Eighty-four patients (70.0%) achieved remission with reported symptom scores of ≤13. Long-term data were collected on patients who were available for follow-up and who achieved remission in the acute phase of treatment. There were 71.9% of patients who maintained remission at an average of 14.3 months. At 41.1 months, 90.0% of patients maintained remission. Conclusion: In routine clinical practice, TMS shows significant improvements for treatment of major depression in a treatmentresistant population. In addition, long-term data further demonstrate the efficacy of TMS as a durable treatment option in a treatmentresistant population.
2 A retrospective analysis of transcranial magnetic stimulation right dorsolateral prefrontal cortex treatments for patients with generalized anxiety disorder Kimberly Cress TMS Serenity Center, Sugar Land, Texas Background: TMS therapy is FDA approved for treatment of major depressive disorder, but shows great promise for treatment of generalized anxiety disorder. Our experience in treating patients with GAD with low-frequency, RDLPFC TMS therapy has shown significant improvement of anxiety symptoms. Methods: Seventeen patients with a diagnosis of generalized anxiety disorder were treated with low-frequency, right-sided TMS therapy between 2011 and 2015. Patient diagnoses of GAD were based on DSM-IV and DSM-V criteria. Patients were treated only on the RDLPFC 1935-861X/
with a 1 Hz per second protocol for either 1600 or 2400 pulses. Patients were assessed using the Beck Anxiety Inventory scale. Scores were performed prior to and at the end of the acute treatment phase. Long-term results were reported on those patients who returned for assessment. Results: Ten patients (58.8%) achieved remission. There were 64.7% of patients who showed a response to TMS therapy based on BAI response criteria of 50% improvement of symptoms. Long-term data were collected on 14 patients available for follow-up who achieved remission in the acute phase. There were 57.1% of patients who maintained remission with an average of 11.9 months. Conclusion: In routine clinical practice, TMS shows significant promise for treatment of GAD using low-frequency, right-sided TMS therapy utilizing the Beck Anxiety Scale. RDLPFC TMS therapy data are limited, but support treatment for those who suffer from GAD. Thus, further studies should be considered.
3 Efficacy of deep transcranial magnetic stimulation in patients whose depression is resistant to electroconvulsive therapy Aron Tendler, Elyssa Sisko, Mark DeLuca, Laura DeLuca, Noelia Rodriguez, Sky Corbett-Methot, Jacqulynn Sutton DeBord Advanced Mental Health Care Inc. Objectives: The goal was to further evaluate efficacy of deep transcranial magnetic stimulation (dTMS) for patients with highly treatment resistant severe depression – those who failed electroconvulsive therapy (ECT). The intent was to determine if increased total pulses or different stimulations demonstrate improved response. Background: A previously published study suggests lower rates of response and remission in six patients who previously failed ECT. Methods: A database of two-hundred and fifty dTMS patients’ treatment details was reviewed, for patients who failed a course of ECT. Of the twelve patients who received dTMS, two were excluded from the analysis because they did not undergo an adequate dTMS treatment trial. Three of ten ECT failure patients had bipolar disorder and the remainder MDD. dTMS was administered using the H1 coil to the left dorsolateral prefrontal cortex (LDPFC) at 18 Hz, 120– 150% motor threshold (MT) for 1980 to 6012 total pulses. Patients received dTMS as an augmentation to their antidepressants. Patients were assessed using the Clinical Global Impression (CGI) as the primary outcome measure. Additional outcome measures included Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Patient Health Questionnaire (PHQ). Results: Three patients had no response, four responded, and three fully remitted. Increasing total daily pulses and intensity improved response and remission rates. Conclusions: dTMS treatment with the H1 coil is efficacious even in patients who failed ECT. Further investigation is warranted to determine if increased total pulses and/or stimulation intensity is necessary for improved remission rates.
Contents lists available at ScienceDirect
Brain Stimulation j o u r n a l h o m e p a g e : w w w. b r a i n s t i m j r n l . c o m
ABSTRACTS FROM CLINICAL TMS SOCIETY 1 Treatment of unipolar, non-psychotic major depressive disorder with transcranial magnetic stimulation: Examining acute and long-term efficacy of TMS Kimberly Cress Sugar Land, Texas Background: Transcranial magnetic stimulation (TMS) is noninvasive, non-systemic therapy that uses pulsed magnetic fields to induce localized neuronal depolarization and beneficial effects on the symptoms of MDD. The purpose of this review is to evaluate standardized symptom score outcomes in routine clinical practice and establish long- term efficacy of TMS. Methods: One hundred twenty patients with a primary diagnosis of unipolar MDD who had not received benefit from antidepressant treatment (average of 3.7 in current MDD episode) received TMS treatment. Each patient was assessed using the Beck Depression Inventory scale. Scores were performed prior to and at the end of the acute treatment phase. Long-term results were reported on those patients that returned for assessment. Results: The study population included average age 48.4 years with 69.2% female. Ninety-four patients (78.3%) demonstrated a minimum 50% improvement in the BDI-II symptom score. Eighty-four patients (70.0%) achieved remission with reported symptom scores of ≤13. Long-term data were collected on patients who were available for follow-up and who achieved remission in the acute phase of treatment. There were 71.9% of patients who maintained remission at an average of 14.3 months. At 41.1 months, 90.0% of patients maintained remission. Conclusion: In routine clinical practice, TMS shows significant improvements for treatment of major depression in a treatmentresistant population. In addition, long-term data further demonstrate the efficacy of TMS as a durable treatment option in a treatmentresistant population.
2 A retrospective analysis of transcranial magnetic stimulation right dorsolateral prefrontal cortex treatments for patients with generalized anxiety disorder Kimberly Cress TMS Serenity Center, Sugar Land, Texas Background: TMS therapy is FDA approved for treatment of major depressive disorder, but shows great promise for treatment of generalized anxiety disorder. Our experience in treating patients with GAD with low-frequency, RDLPFC TMS therapy has shown significant improvement of anxiety symptoms. Methods: Seventeen patients with a diagnosis of generalized anxiety disorder were treated with low-frequency, right-sided TMS therapy between 2011 and 2015. Patient diagnoses of GAD were based on DSM-IV and DSM-V criteria. Patients were treated only on the RDLPFC 1935-861X/
with a 1 Hz per second protocol for either 1600 or 2400 pulses. Patients were assessed using the Beck Anxiety Inventory scale. Scores were performed prior to and at the end of the acute treatment phase. Long-term results were reported on those patients who returned for assessment. Results: Ten patients (58.8%) achieved remission. There were 64.7% of patients who showed a response to TMS therapy based on BAI response criteria of 50% improvement of symptoms. Long-term data were collected on 14 patients available for follow-up who achieved remission in the acute phase. There were 57.1% of patients who maintained remission with an average of 11.9 months. Conclusion: In routine clinical practice, TMS shows significant promise for treatment of GAD using low-frequency, right-sided TMS therapy utilizing the Beck Anxiety Scale. RDLPFC TMS therapy data are limited, but support treatment for those who suffer from GAD. Thus, further studies should be considered.
3 Efficacy of deep transcranial magnetic stimulation in patients whose depression is resistant to electroconvulsive therapy Aron Tendler, Elyssa Sisko, Mark DeLuca, Laura DeLuca, Noelia Rodriguez, Sky Corbett-Methot, Jacqulynn Sutton DeBord Advanced Mental Health Care Inc. Objectives: The goal was to further evaluate efficacy of deep transcranial magnetic stimulation (dTMS) for patients with highly treatment resistant severe depression – those who failed electroconvulsive therapy (ECT). The intent was to determine if increased total pulses or different stimulations demonstrate improved response. Background: A previously published study suggests lower rates of response and remission in six patients who previously failed ECT. Methods: A database of two-hundred and fifty dTMS patients’ treatment details was reviewed, for patients who failed a course of ECT. Of the twelve patients who received dTMS, two were excluded from the analysis because they did not undergo an adequate dTMS treatment trial. Three of ten ECT failure patients had bipolar disorder and the remainder MDD. dTMS was administered using the H1 coil to the left dorsolateral prefrontal cortex (LDPFC) at 18 Hz, 120– 150% motor threshold (MT) for 1980 to 6012 total pulses. Patients received dTMS as an augmentation to their antidepressants. Patients were assessed using the Clinical Global Impression (CGI) as the primary outcome measure. Additional outcome measures included Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Patient Health Questionnaire (PHQ). Results: Three patients had no response, four responded, and three fully remitted. Increasing total daily pulses and intensity improved response and remission rates. Conclusions: dTMS treatment with the H1 coil is efficacious even in patients who failed ECT. Further investigation is warranted to determine if increased total pulses and/or stimulation intensity is necessary for improved remission rates.