Transcranial magnetic stimulation in depression--lessons from the multicentre trials

Looking at novelties and advances in medicine in particular in the treatment of major depressive disorder no principally new antidepressant treatment strategy has been established in clinical routine in the last fifty years. However, regarding the considerable issue of treatment resistance in depression, new therapeutic strategies are urgently required. In this context, repetitive transcranial magnetic stimulation above the dorsolateral prefrontal cortex has been proposed as a potential new treatment option for depression; furthermore, in October 2008 a first rTMS-device (NeuroStar TMS Therapy System™) was approved by the FDA for the treatment of treatment resistant major refractory depression in adults. Yet, despite now nearly two decades of research in this field, no final answer concerning its validity for antidepressant treatment in the clinical practice is given. Numerous studies with small sample sizes and heterogeneous designs have been performed in this field yielding to different results. These were subjected to meta-analyses, assessing the antidepressant effect of rTMS, which are briefly summarized in this article. Further, multicentre-trials with larger numbers of patients were performed, which are presented and critically discussed here in more detail. This short review shall thus provide an overview of the current status of knowledge concerning rTMS in depression and it also provides some recommendations for future research in this field

A chronometric exploration of high-resolution ‘sensitive TMS masking’ effects on subjective and objective measures of vision

Transcranial magnetic stimulation (TMS) can induce masking by interfering with ongoing neural activity in early visual cortex. Previous work has explored the chronometry of occipital involvement in vision by using single pulses of TMS with high temporal resolution. However, conventionally TMS intensities have been high and the only measure used to evaluate masking was objective in nature. Recent studies have begun to incorporate subjective measures of vision, alongside objective ones. The current study goes beyond previous work in two regards. First, we explored both objective vision (an orientation discrimination task) and subjective vision (a stimulus visibility rating on a four-point scale), across a wide range of time windows with high temporal resolution. Second, we used a very sensitive TMS-masking paradigm: stimulation was at relatively low TMS intensities, with a figure-8 coil, and the small stimulus was difficult to discriminate already at baseline level. We hypothesized that this should increase the effective temporal resolution of our paradigm. Perhaps for this reason, we are able to report a rather interesting masking curve. Within the classical-masking time window, previously reported to encompass broad SOAs anywhere between 60 and 120 ms, we report not one, but at least two dips in objective performance, with no masking in-between. The subjective measure of vision did not mirror this pattern. These preliminary data from our exploratory design suggest that, with sensitive TMS masking, we might be able to reveal visual processes in early visual cortex previously unreported

Experimental constraints on the ω\omega-nucleus real potential

In a search for $\omega$ mesic states, the production of $\omega$-mesons in coincidence with forward going protons has been studied in photon induced reactions on $^{12}$C for incident photon energies of 1250 - 3100 MeV. The $\pi^0 \gamma$ pairs from decays of bound or quasi-free $\omega$-mesons have been measured with the CBELSA/TAPS detector system in coincidence with protons registered in the MiniTAPS forward array. Structures in the total energy distribution of the $\pi^0 \gamma$ pairs, which would indicate the population and decay of bound $\omega~^{11}$B states, are not observed. The $\pi^0 \gamma$ cross section of 0.3 nb/MeV/sr observed in the bound state energy regime between -100 and 0 MeV may be accounted for by yield leaking into the bound state regime because of the large in-medium width of the $\omega$-meson. A comparison of the measured total energy distribution with calculations suggests the real part $V_0$ of the $\omega~^{11}$B potential to be small and only weakly attractive with $V_0(\rho=\rho_0) = -15\pm$ 35(stat) $\pm$20(syst) MeV in contrast to some theoretical predictions of attractive potentials with a depth of 100 - 150 MeV.Comment: 13 pages, 8 figure

Measurement of polarisation observables in Ks0Σ+K^0_s\Sigma^+ photoproduction off the proton

The reaction $\gamma \, p \rightarrow K^0_S\,\Sigma^+$ is studied in the photon energy range from threshold. Linearly polarised photon beams from coherent bremsstrahlung enabled the first measurement of photon beam asymmetries in this reaction up to $E_\gamma = 2250$ MeV. In addition, the recoil hyperon polarisation was determined through the asymmetry in the weak decay $\Sigma^+ \rightarrow p \pi^0$ up to $E_\gamma = 1650$ MeV. The data are compared to partial wave analyses, and the possible impact on the interpretation of a recently observed cusp-like structure near the $K^*$ thresholds is discussed.Comment: 6 pages, 5 figures. References [8,9,10,11] which were not on the original submission are now include

Age-related changes in Serum Growth Hormone, Insulin-like Growth Factor-1 and Somatostatin in System Lupus Erythematosus

BACKGROUND: Systemic lupus erythematosus is an age- and gender-associated autoimmune disorder. Previous studies suggested that defects in the hypothalamic/pituitary axis contributed to systemic lupus erythematosus disease progression which could also involve growth hormone, insulin-like growth factor-1 and somatostatin function. This study was designed to compare basal serum growth hormone, insulin-like growth factor-1 and somatostatin levels in female systemic lupus erythematosus patients to a group of normal female subjects. METHODS: Basal serum growth hormone, insulin-like growth factor-1 and somatostatin levels were measured by standard radioimmunoassay. RESULTS: Serum growth hormone levels failed to correlate with age (r(2 )= 3.03) in the entire group of normal subjects (i.e. 20 – 80 years). In contrast, serum insulin-like growth factor-1 levels were inversely correlated with age (adjusted r(2 )= 0.092). Of note, serum growth hormone was positively correlated with age (adjusted r(2 )= 0.269) in the 20 – 46 year range which overlapped with the age range of patients in the systemic lupus erythematosus group. In that regard, serum growth hormone levels were not significantly higher compared to either the entire group of normal subjects (20 – 80 yrs) or to normal subjects age-matched to the systemic lupus erythematosus patients. Serum insulin-like growth factor-1 levels were significantly elevated (p < 0.001) in systemic lupus erythematosus patients, but only when compared to the entire group of normal subjects. Serum somatostatin levels differed from normal subjects only in older (i.e. >55 yrs) systemic lupus erythematosus patients. CONCLUSIONS: These results indicated that systemic lupus erythematosus was not characterized by a modulation of the growth hormone/insulin-like growth factor-1 paracrine axis when serum samples from systemic lupus erythematosus patients were compared to age- matched normal female subjects. These results in systemic lupus erythematosus differ from those previously reported in other musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, fibromyalgia, diffuse idiopathic skeletal hyperostosis and hypermobility syndrome where significantly higher serum growth hormone levels were found. Somatostatin levels in elderly systemic lupus erythematosus patients may provide a clinical marker of disease activity in these patients

Photoproduction of eta mesons from the neutron: cross sections and double polarization observable E

Photoproduction of $\eta$ mesons from neutrons} \abstract{Results from measurements of the photoproduction of $\eta$ mesons from quasifree protons and neutrons are summarized. The experiments were performed with the CBELSA/TAPS detector at the electron accelerator ELSA in Bonn using the $\eta\to3\pi^{0}\to6\gamma$ decay. A liquid deuterium target was used for the measurement of total cross sections and angular distributions. The results confirm earlier measurements from Bonn and the MAMI facility in Mainz about the existence of a narrow structure in the excitation function of $\gamma n\rightarrow n\eta$. The current angular distributions show a forward-backward asymmetry, which was previously not seen, but was predicted by model calculations including an additional narrow $P_{11}$ state. Furthermore, data obtained with a longitudinally polarized, deuterated butanol target and a circularly polarized photon beam were analyzed to determine the double polarization observable $E$. Both data sets together were also used to extract the helicity dependent cross sections $\sigma_{1/2}$ and $\sigma_{3/2}$. The narrow structure in the excitation function of $\gamma n\rightarrow n\eta$ appears associated with the helicity-1/2 component of the reaction