TMS Improves Brain Plasticity
The article titled “Assessing the mechanisms of brain plasticity by transcranial magnetic stimulation” provides a comprehensive review of the use of transcranial magnetic stimulation (TMS) to measure and modulate brain plasticity, particularly focusing on repetitive TMS (rTMS) protocols like theta-burst stimulation (TBS). The review discusses the application of TMS in various neurological and psychiatric disorders, including major depressive disorder (MDD), and highlights the therapeutic implications of TMS-derived measures of plasticity. Dr. Danish, who is passionate about treatments in mental health that focus on neuroplasticity, understands that enhancing brain plasticity is key to improving outcomes from all forms of treatment, including medications, ketamine, supplements, exercise, mindfulness, and TMS.
Major Findings
Efficacy in Major Depressive Disorder (MDD)
Clinical Improvements: High-frequency rTMS applied to the left prefrontal cortex has been shown to increase cortical excitability and reduce interhemispheric differences in excitability, leading to lasting clinical improvements in patients with MDD. Studies have reported that rTMS can induce a 35% facilitation of motor evoked potentials (MEPs) for up to 60 minutes post-stimulation, which is indicative of long-term potentiation (LTP)-like plasticity.
Personalized Treatment: Functional magnetic resonance imaging (fMRI)-guided personalization of TMS treatment has been found to improve outcomes. For instance, the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which targets the left dorsolateral prefrontal cortex (DLPFC) based on its connectivity with the subgenual anterior cingulate cortex, achieved remission in 90% of patients with treatment-resistant depression.
Dosing and Protocols
Theta-Burst Stimulation (TBS): TBS protocols, including intermittent TBS (iTBS) and continuous TBS (cTBS), are used to induce cortical plasticity. iTBS typically increases cortical excitability, while cTBS decreases it. The SAINT protocol, for example, delivers iTBS at 90% of the resting motor threshold (rMT) in 10 daily sessions over 5 consecutive days.
Safety and Feasibility: Most rTMS treatments allow participants to continue their current medications, which has been shown to be safe and does not increase the risk of adverse events. However, maintaining a steady medication dose is recommended to reduce variability in neurochemical brain states.
Side Effects
Adverse Events: The review indicates that rTMS is generally well-tolerated, with the most common side effects being mild and transient, such as headaches and scalp discomfort. There is no significant increase in adverse events when rTMS is combined with stable doses of antidepressant medication.
Impact of Concurrent Behavioral Tasks
Enhanced Efficacy: Engaging patients in specific behavioral or cognitive tasks during rTMS sessions can enhance the therapeutic efficacy by optimizing brain state. For example, pairing rTMS with cognitive-behavioral therapy (CBT) has shown increased treatment response in disorders like PTSD and OCD.
Individualizing rTMS Protocols
Brain State and Connectivity: The degree of modulation at the brain network level can be quantified using fMRI and quantitative EEG. Individualizing rTMS protocols based on these measures can optimize treatment outcomes. For instance, targeting regions with strong negative functional connectivity with the subgenual cingulate cortex has been associated with better antidepressant responses.
Translational Studies and Future Directions
Animal Models: Translational studies using animal models have provided insights into the mechanisms of TBS-induced plasticity, which can be applied to human studies. These studies help bridge the gap between preclinical research and clinical applications, potentially leading to new diagnostic and therapeutic strategies for neurological disorders.
In summary, the article underscores the potential of TMS, particularly rTMS and TBS, in modulating brain plasticity and improving clinical outcomes in disorders like MDD. Personalized treatment protocols, concurrent behavioral tasks, and the integration of neuroimaging techniques are key factors in enhancing the efficacy of TMS-based therapies.
Getting in Touch with Dr. Danish and his Team
At Philadelphia Integrative Psychiatry, we prioritize staying abreast of the latest research related to TMS and its cognitive benefits to provide the highest quality care safely. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for cognitive impairments or similar conditions, please text or call 610-999-6414 to learn how we can help.
The following blogs by Dr. Danish focus on TMS for a variety of conditions and patient populations:
How TMS Works
Discover just how powerful TMS is for depression.
Find out about accelerated TMS treatment for severe depression that can be completed in under 5 days!
Read about how TMS can lead to neuronal growth and plasticity.
Learn whether patients preparing for TMS should stay on their antidepressants that are not doing enough.
Conditions that TMS can treat
TMS can help treat Fibromyalgia: read more here on this emerging, off-label treatment for Fibromyalgia.
Trichotillomania, or hair pulling disorder, is a difficult to treat disorder, but there is growing evidence that TMS may be beneficial.
Explore the potential of TMS for patients with seizure disorders.
Information & Safety
Understand the safety of TMS for depression during pregnancy.
We look at the safety of TMS in patients with schizophrenia.
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