A novel concurrent TMS-fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation

Major depressive disorder (MDD) is a severe mental disorder associated with high morbidity and mortality rates, which remains difficult to treat, as both resistance and recurrence rates are high. Repetitive transcranial magnetic stimulation (TMS) of the left dorsolateral prefrontal cortex (DLPFC) provides a safe and effective treatment for selected patients with treatment-resistant MDD. Little is known about the mechanisms of action of TMS provided to the left DLPFC in MDD and we can currently not predict who will respond to this type of treatment, precluding effective patient selection. In order to shed some light on the mechanism of action, we applied single pulse TMS to the left DLPFC in 10 healthy participants using a unique TMS-fMRI set-up, in which we could record the direct effects of TMS. Stimulation of the DLPFC triggered activity in a number of connected brain regions, including the subgenual anterior cingulate cortex (sgACC) in four out of nine participants. The sgACC is of particular interest, because normalization of activity in this region has been associated with relief of depressive symptoms in MDD patients. This is the first direct evidence that TMS pulses delivered to the DLPFC can propagate to the sgACC. The propagation of TMS-induced activity from the DLPFC to sgACC may be an accurate biomarker for rTMS efficacy. Further research is required to determine whether this method can contribute to the selection of patients with treatment resistant MDD who will respond to rTMS treatment

Changing Housing for Elderly People and Co-ordination Issues in Europe

The inter-sectoral policy systems of housing for elderly people in the EU-countries change with the implementation of ageing in place and by general processes of modernisation of society and welfare state. For implementation of the innovations the relevance of co-ordination between the sector housing, care and social services depends on the state of development of the sectors in a country. However, modernisation threatens co-ordination by decentralisation, privatisation and transfer of choices and responsibilities to the individual. This paper is an international comparative study describing how countries of the European Union are dealing with the topic of co-ordination. Nowadays especially policy actors at the regional and local level have the responsibility for inter-sectoral co-ordination. Looking at the practices of these actors the development of a shared vision on ageing in place seems to be very important. Central government should facilitate this approach and control the results. The term 'managed co-operation' describes very well this new way of management of co-ordination