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P 239. The neurobiological mechanisms of repetitive transcranial magnetic stimulation in depression: A systematic review
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Society Proceedings / Clinical Neurophysiology 124 (2013) e39–e187
and attention in patients after severe TBI. However, effect sizes suggested a positive response to stimulation. doi:10.1016/j.clinph.2013.04.314
P 238. Transcranial direct current stimulation (tDCS) for fatigue in patients with post-polio syndrome—T. Bocci a,b,c, M. Acler d, M. Vergari a, S. Barbieri a, A. Priori a, L. Bertolasi d (a Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants, Milano, Italy, b Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy, c Department of Neuroscience, Unit of Neurology, Pisa University Medical School, Pisa, Italy, d Section of Neurology, Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy) Background: Post-polio syndrome (PPS) develops about 20– 40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Objective: Here, we assessed whether frontal transcranial direct current stimulation (tDCS) improves central fatigue symptoms in patients with PPS. Materials and methods: We enrolled 32 patients with a definitive diagnosis of PPS; 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (1.5 mA, 15 min, daily for five days a week) on clinical scales (Short Form Health Survey, SF-36, Piper Fatigue Scale, PFS, Fatigue Severity Scale, FSS, 101-Point Numerical Rating, PNR-101), Hamilton Rating Scale for Depression, HRSD, Pittsburgh Sleep Quality Index, PSQI) and motor performance (six-min walk test and the endurance test) at baseline (T0) and three weeks later (T1). Results: Scores for the SF-36 sub-items physical functioning, role physical, vitality and social functioning improved significantly more in patients who received tDCS (p). Discussion: Anodal tDCS delivered for 15 min at 1.5 mA over the frontal areas improves fatigue symptoms in patients with PPS. tDCS could be a non-invasive and valuable new tool for managing central fatigue in patients with PPS.
effects of rTMS, or neurobiological predictors of response, in clinical trials of depressed patients, were included. Two of the authors came to consensus on the inclusion of articles. The guidelines for reporting systematic reviews outlined by PRISMA were followed. Results: Our search terms yielded an initial 777 unique articles. Reference lists of relevant articles and 9 relevant reviews were reviewed to identify additional articles meeting inclusion criteria (N = 5). Sixty-seven full-text articles were retrieved and reviewed, with 58 meeting inclusion criteria. There were 21 studies that included a control group and 37 that did not. Only 7 studies investigated the effects of low frequency right sided (LFR) rTMS, whereas 54 studies investigated the effects of high frequency left sided (HFL) rTMS. Three studies investigated the effect of both LFR and HFL. Forty-three studies examined the neurobiological effects after a course of rTMS and 24 studies examined neurobiological predictors of response to rTMS. There were 9 studies that examined neurobiological predictors of response to rTMS, as well as changes various neurobiological factors, after a course of rTMS. Potential neurobiological mechanisms of rTMS included: alterations in brain blood flow and metabolism, neuroendocrine and neurotransmitter levels, and electrophysiology. Moreover, certain genetic polymorphisms appear to mediate the efficacy of rTMS. The laterality of the coil placement and stimulus frequency impacted the neurobiological effects of the treatment. Conclusion: Heterogeneity in study protocols resulted in conflicting findings. However, a convergence of findings from different studies demonstrates that rTMS alters activity in the DLPFC, which may be an important aspect of its antidepressant effects. Well-designed clinical treatment studies that include, multi-modal methods including imaging, genetics and neurophysiology hold the greatest potential for understanding the mechanisms of this emerging treatment for depression. doi:10.1016/j.clinph.2013.04.316
P 239. The neurobiological mechanisms of repetitive transcranial magnetic stimulation in depression: A systematic review—D.M. Blumberger, W. Silverstein, B.H. Mulsant, Z.J. Daskalakis (CAMH, Toronto, Canada)
P 240. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following sequential bilateral non-invasive neuromodulation by theta burst magnetic stimulation—S. Filipovic a, V. Stevanovic a, I. Avramovic a, M. Jelic a, I. Avramovic a, A. Jeremic b, K. Kacar c, S. Milanovic a, L. Konstantinovic b,d, J. Vuksanovic a,e (a University of Belgrade Institute for Medical Research, Department of Neurophysiology, Beograd, Serbia, b Hospital for Rehabilitation “Dr M. Zotovic”, Beograd, Serbia, c Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Beograd, Serbia, d University of Belgrade School of Medicine, Department of Rehabilitation, Beograd, Serbia, e State University of Novi Pazar, Department of Philosophy (Psychology), Novi Pazar, Serbia)
Question: Depression is a prevalent illness and a leading cause of disability worldwide. A significant proportion of depressed patients fail to respond to pharmacotherapy, and as a result, novel therapies for depression have been developed, including rTMS. rTMS has been established as a safe and effective treatment for depression. However, the neurobiological mechanisms through which this treatment exerts its antidepressant effect is still not fully understood. Numerous clinical trials have included various neurobiological measures in attempt to further understand this mechanism of this treatment. However, a synthesis of the findings from the biological measures added to clinical trials of rTMS is lacking. Thus, this review will systematically assess the clinical trial literature investigating the neurobiological mechanisms of rTMS in depressed patients. Methods: Embase (1980–2012) and Medline (1996–2012) were searched under set terms, and duplicates were removed. Primary studies, published in English, evaluating either the neurobiological
Question: In chronic non-fluent aphasia (nfA) patients, inhibitory transcranial magnetic stimulation (TMS) protocols applied over intact right hemisphere (RH) can induce improvement in language functions. Increased activation of preserved left hemisphere (LH) language networks secondary to reduced RH transcallosal inhibition is supposed mechanism. It is unknown whether direct stimulation of LH coupled with inhibition of homologue RH areas might bring similar or even greater effects. Method: Patient was 63-year-old right-handed man who 17 moths earlier suffered an ischemic stroke in left middle cerebral artery territory which caused damage in left fronto-temporo-parietal white matter but with relative sparing of cortex. The stroke caused right hemiparesis and severe nfA (one monosyllabic word phrase length). He had an initial rehabilitation program, including speech and language therapy, during first 2 months following stroke, at a specialized residential rehabilitation facility, followed by a fairly regular
doi:10.1016/j.clinph.2013.04.315
Society Proceedings / Clinical Neurophysiology 124 (2013) e39–e187
and attention in patients after severe TBI. However, effect sizes suggested a positive response to stimulation. doi:10.1016/j.clinph.2013.04.314
P 238. Transcranial direct current stimulation (tDCS) for fatigue in patients with post-polio syndrome—T. Bocci a,b,c, M. Acler d, M. Vergari a, S. Barbieri a, A. Priori a, L. Bertolasi d (a Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants, Milano, Italy, b Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy, c Department of Neuroscience, Unit of Neurology, Pisa University Medical School, Pisa, Italy, d Section of Neurology, Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy) Background: Post-polio syndrome (PPS) develops about 20– 40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Objective: Here, we assessed whether frontal transcranial direct current stimulation (tDCS) improves central fatigue symptoms in patients with PPS. Materials and methods: We enrolled 32 patients with a definitive diagnosis of PPS; 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (1.5 mA, 15 min, daily for five days a week) on clinical scales (Short Form Health Survey, SF-36, Piper Fatigue Scale, PFS, Fatigue Severity Scale, FSS, 101-Point Numerical Rating, PNR-101), Hamilton Rating Scale for Depression, HRSD, Pittsburgh Sleep Quality Index, PSQI) and motor performance (six-min walk test and the endurance test) at baseline (T0) and three weeks later (T1). Results: Scores for the SF-36 sub-items physical functioning, role physical, vitality and social functioning improved significantly more in patients who received tDCS (p). Discussion: Anodal tDCS delivered for 15 min at 1.5 mA over the frontal areas improves fatigue symptoms in patients with PPS. tDCS could be a non-invasive and valuable new tool for managing central fatigue in patients with PPS.
effects of rTMS, or neurobiological predictors of response, in clinical trials of depressed patients, were included. Two of the authors came to consensus on the inclusion of articles. The guidelines for reporting systematic reviews outlined by PRISMA were followed. Results: Our search terms yielded an initial 777 unique articles. Reference lists of relevant articles and 9 relevant reviews were reviewed to identify additional articles meeting inclusion criteria (N = 5). Sixty-seven full-text articles were retrieved and reviewed, with 58 meeting inclusion criteria. There were 21 studies that included a control group and 37 that did not. Only 7 studies investigated the effects of low frequency right sided (LFR) rTMS, whereas 54 studies investigated the effects of high frequency left sided (HFL) rTMS. Three studies investigated the effect of both LFR and HFL. Forty-three studies examined the neurobiological effects after a course of rTMS and 24 studies examined neurobiological predictors of response to rTMS. There were 9 studies that examined neurobiological predictors of response to rTMS, as well as changes various neurobiological factors, after a course of rTMS. Potential neurobiological mechanisms of rTMS included: alterations in brain blood flow and metabolism, neuroendocrine and neurotransmitter levels, and electrophysiology. Moreover, certain genetic polymorphisms appear to mediate the efficacy of rTMS. The laterality of the coil placement and stimulus frequency impacted the neurobiological effects of the treatment. Conclusion: Heterogeneity in study protocols resulted in conflicting findings. However, a convergence of findings from different studies demonstrates that rTMS alters activity in the DLPFC, which may be an important aspect of its antidepressant effects. Well-designed clinical treatment studies that include, multi-modal methods including imaging, genetics and neurophysiology hold the greatest potential for understanding the mechanisms of this emerging treatment for depression. doi:10.1016/j.clinph.2013.04.316
P 239. The neurobiological mechanisms of repetitive transcranial magnetic stimulation in depression: A systematic review—D.M. Blumberger, W. Silverstein, B.H. Mulsant, Z.J. Daskalakis (CAMH, Toronto, Canada)
P 240. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following sequential bilateral non-invasive neuromodulation by theta burst magnetic stimulation—S. Filipovic a, V. Stevanovic a, I. Avramovic a, M. Jelic a, I. Avramovic a, A. Jeremic b, K. Kacar c, S. Milanovic a, L. Konstantinovic b,d, J. Vuksanovic a,e (a University of Belgrade Institute for Medical Research, Department of Neurophysiology, Beograd, Serbia, b Hospital for Rehabilitation “Dr M. Zotovic”, Beograd, Serbia, c Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Beograd, Serbia, d University of Belgrade School of Medicine, Department of Rehabilitation, Beograd, Serbia, e State University of Novi Pazar, Department of Philosophy (Psychology), Novi Pazar, Serbia)
Question: Depression is a prevalent illness and a leading cause of disability worldwide. A significant proportion of depressed patients fail to respond to pharmacotherapy, and as a result, novel therapies for depression have been developed, including rTMS. rTMS has been established as a safe and effective treatment for depression. However, the neurobiological mechanisms through which this treatment exerts its antidepressant effect is still not fully understood. Numerous clinical trials have included various neurobiological measures in attempt to further understand this mechanism of this treatment. However, a synthesis of the findings from the biological measures added to clinical trials of rTMS is lacking. Thus, this review will systematically assess the clinical trial literature investigating the neurobiological mechanisms of rTMS in depressed patients. Methods: Embase (1980–2012) and Medline (1996–2012) were searched under set terms, and duplicates were removed. Primary studies, published in English, evaluating either the neurobiological
Question: In chronic non-fluent aphasia (nfA) patients, inhibitory transcranial magnetic stimulation (TMS) protocols applied over intact right hemisphere (RH) can induce improvement in language functions. Increased activation of preserved left hemisphere (LH) language networks secondary to reduced RH transcallosal inhibition is supposed mechanism. It is unknown whether direct stimulation of LH coupled with inhibition of homologue RH areas might bring similar or even greater effects. Method: Patient was 63-year-old right-handed man who 17 moths earlier suffered an ischemic stroke in left middle cerebral artery territory which caused damage in left fronto-temporo-parietal white matter but with relative sparing of cortex. The stroke caused right hemiparesis and severe nfA (one monosyllabic word phrase length). He had an initial rehabilitation program, including speech and language therapy, during first 2 months following stroke, at a specialized residential rehabilitation facility, followed by a fairly regular
doi:10.1016/j.clinph.2013.04.315