Effects of repetitive transcranial magnetic stimulation on clinical, social, and cognitive performance in postpartum depression

Background: This randomized, placebo-controlled, double-blind pilot study evaluated the impact of repetitive transcranial magnetic stimulation (rTMS) on clinical, cognitive, and social performance in women suffering with postpartum depression. Methods: Fourteen patients were randomized to receive 20 sessions of sham rTMS or active 5 Hz rTMS over the left dorsolateral prefrontal cortex. Psychiatric clinical scales and a neuropsychological battery were applied at baseline (pretreatment), week 4 (end of treatment), and week 6 (follow-up, posttreatment week 2). Results: The active rTMS group showed significant improvement 2 weeks after the end of rTMS treatment (week 6) in Hamilton Depression Rating Scale (P = 0.020), Global Assessment Scale (P = 0.037), Clinical Global Impression (P = 0.047), and Social Adjustment Scale-Self Report-Work at Home (P = 0.020). Conclusion: This study suggests that rTMS has the potential to improve the clinical condition in postpartum depression, while producing marginal gains in social and cognitive function

Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen’s MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction p=0.05, favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration

Prospective, placebo-controlled, randomized, double-blind study to assess the safety and efficacy of using Deep Transcranial Magnetic Stimulation (dTMS) in smoking cessation

Introdução: A Organização Mundial da Saúde considera a epidemia do tabaco uma das maiores ameaças à saúde pública que o mundo já enfrentou. A Estimulação Magnética Transcraniana usa pulsos magnéticos para modular a atividade cerebral. Estudos iniciais sugerem que este método possa ajudar no tratamento de dependências químicas, incluindo o tabagismo, ao estimular o córtex pré-frontal e a ínsula bilateralmente. O principal objetivo deste estudo é avaliar eficácia e segurança da Estimulação Magnética Transcraniana Profunda (EMTp) no tratamento do tabagismo. Metodologia: Trata-se de um ensaio clínico duplo-cego, randomizado, placebo (sham) controlado. O protocolo envolveu 21 sessões distribuídas por 12 semanas de tratamento. Foram usadas ferramentas de avaliação de abstinência: Escala Minnesota de Abstinência de Nicotina e Questionário de Fissura por Tabaco; de humor: Hamilton para depressão e ansiedade; e testes cognitivos. A redução ou cessação do tabagismo foi monitorada por autorrelato de consumo, confirmada por monoximetria de ar expirado (cessação se CO 3 ppm) e cotinina sanguínea (cessação se nível sérico menor que 25 ng/mL). Resultados: No conjunto Intenção de Tratar (n=100), a taxa de cessação em cada braço, ativo e sham, foi de 14%, não havendo diferença estatística entre eles (p= 1,000; IC 95%: 5,8% a 26,7%). Em ambos os grupos houve redução similar no consumo de cigarros e nos biomarcadores. Os instrumentos de avaliação de abstinência e humor não apontaram diferença significativa entre os grupos. Na avaliação cognitiva observou-se efeito positivo no grupo ativo, sem relação com a cessação do tabagismo. Não houve eventos adversos graves. Os efeitos colaterais relatados foram os esperados para este método de tratamento. Conclusão: O tratamento ativo com EMTp não foi eficaz para a cessação do tabagismo. A tendência de efeito encontrada na melhora cognitiva deve ser melhor investigada futuramente. O método de EMTp foi seguro na nossa casuísticaIntroduction: The World Health Organization considers the tobacco epidemic one of the greatest threats to public health the world has ever faced. Transcranial Magnetic Stimulation modulate brain activity using magnetic pulses. Early studies suggest that it may help treat chemical dependencies, including smoking, by stimulating the prefrontal cortex and insula bilaterally. The main objective of this study is to evaluate efficacy and safety of the Deep Transcranial Magnetic Stimulation (dTMS) on smoking treatment. Methodology: This is a double-blind, randomized, sham-controlled clinical trial. The treatment protocol involved 21 sessions spread over 12 weeks of treatment. Withdrawal assessment tools: Minnesota Nicotine Withdrawal Scale and Tobacco Craving Questionnaire; mood scales: Hamilton for Depression and Anxiety, besides cognitive evaluation. Smoking reduction or cessation was monitored by self-report consumption, confirmed by exhaled air monoximetry (cessation value: less than 3 parts per million - ppm) and blood cotinine (cessation value: less than 25 ng/mL). Results: In the Intention to Treat set (n=100), the cessation rate in both groups was 14%, with no statistical difference between the groups (p=1.000; 95% CI: 5.8% to 26.7%). In both groups there was a similar reduction in cigarette consumption and in biomarkers. Abstinence and mood scales scores showed no significant statistical difference between groups. In the cognitive assessment, a positive effect was observed in the active group, unrelated to smoking cessation. There were no serious adverse events. The reported side effects were as expected for this treatment method. Conclusion: Active dTMS treatment was not effective for smoking cessation. The effect trend found on cognitive improvement should be further investigated. The dTMS was safe in this clinical tria

Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen’s MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction p=0.05, favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration