medigraphic.com
ISSN 0185-3325 (Print)
Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2002, Number 4

<< Back Next >>

Salud Mental 2002; 25 (4)

La aplicaciones de la estimulación magnética transcraneal en psiquiatría

Jiménez-Genchi A, González-Olvera J, Graff GA

Language: Spanish
References: 67
Page: 32-41
PDF size: 376.51 Kb.


ABSTRACT

Transcranial magnetic stimulation (TMS) is a novel and promising procedure for studying the brain mechanisms of human behavior. This paper presents a brief review about current uses of TMS for study and treatment of psychiatric disorders.
Magnetic stimulation has been known since the nineteenth Century, almost twenty five years after the first description of direct electrical stimulation of human brain.
Although the first magnetic stimulator was designed more than one hundred years ago, its use was sporadic and almost limited to peripheral nerves. It is, scarcely ten years ago, that it has been used to stimulate the brain.
Nowadays, magnetic stimulators consist in a system of high voltage capacitors, which generate brief pulses of high-intensity current in a ring or eight-shaped electromagnetic coil placed on the scalp. The magnetic field produced in the coil induces electric currents in underlying brain tissue and therefore neuronal depolarization. In contrast with brain electrical stimulation (e. g., electroconvulsive therapy) TMS can be focal and noninvasive. As TMS knowledge has developed, several determinant issues have arisen, among them, stimulation frequency and stimulation intensity.
Magnetic stimulation with one single pulse is known as single TMS and rhythmic stimulation with several pulses is called repetitive TMS (rTMS). At least in motor cortex, rTMS with high frequencies seems to increase neuronal excitability while rTMS with low frequencies decreases it.
Movement in contralateral muscles to the stimulated cerebral hemisphere was the first striking effect of TMS, which, nowadays is used to measure motor threshold (MT). TMS intensity is expressed as a percentage of MT.
Beyond the possibility to assess integrity of motor pathways in neurological disorders, TMS research is being applied to some other brain functions such as emotion generation. In healthy volunteers, rTMS on left and right prefrontal regions has produced brief states of sadness and happiness, respectively. These findings propose TMS use for testing models of emotion modulation.
Based on neuroanatomic knowledge of depression and rTMS effects on mood and cortical excitability, it has been tested on treatment-resistant depressed patients. Results are encouraging. Some studies have reported a mood improvement similar to that obtained with electroconvulsive therapy, offering such advantages as lack of side effects on cognition and no need for anesthesia. Several research groups have replicated the antidepressant effect of TMS on resistant non-psychotic depression; nevertheless, because of inherent features of the procedure, these findings are not definitive yet . Perhaps the major source of bias is the lack of a simulated maneuver, which allows to separate response to the active procedure, from placebo effect. Frequency and intensity TMS parameters of antidepressive efficacy are not totally defined and its mechanism of antidepressive action is unknown. Left prefrontal region has been the most frequently stimulated but little is known about antidepressant effect with TMS on different regions. Future TMS studies on depression must offer clearer definitions for treatment resistance. Its use as an augmentation strategy seems a warranted research area.
Probably, in the next few years these aspects will be clarified and the place of TMS in depression management will be defined. Also, TMS has shown to have therapeutic effects on mania, obsessive compulsive disorder, post-traumatic stress disorder and schizophrenia. Furthermore, results from these studies show clearly its usefulness in researching neuronal circuits involved in the physiopathology of these and some other psychiatric disorders. Combination of TMS with neuroimaging techniques has allowed to conclude that TMS has effects on cortical and subcortical activity, and this is a fast growing area. As a whole, TMS is a very safe procedure. Safety studies have shown TMS has no adverse effects on cognitive functions and changes in hormonal, immune and auditive functions are brief and reversible. Unfortunately, it can produce seizures. Nowadays, there are security profiles to avoid the seizure risk; and therefore conditions that contraindicate its use have been identified. Although TMS role for the treatment of psychiatric disorders is uncertain, there is no doubt about its usefulness for noninvasive study of normal and abnormal brain functioning.


REFERENCES

  1. AMASSIAN VE, HENRY, K, DURKIN, H, CHICE S, CRACCO IB y cols.: Human immune functions are differentially affected by left-sided vs. right-sided magnetic stimulation of temporo-parietal cortex. Neurology, 44:A 133, 1994.

  2. AVERY DH, CLAYPPOLE K, ROBINSON L, NEUMAIER JF, DUNNER DL, y cols.: Repetitive transcranial magnetic stimulation in the treatment of medicationresistant depression: Preliminary data. J Nerv Ment Dis, 187:114-117, 1999.

  3. BARKER AT, JALINOUS, FREESTON I: Non invasive magnetic stimulation of the human motor cortex. Lancet, 1:1106-1107, 1985.

  4. BARTHOLOW R: Experimental investigations into the functions of the human brain. Am J Med Sci, 67:305- 313, 1874.

  5. BELMAKER RH, GRISARU N: Does TMS have bipolar efficacy in both depression and mania? Biol Psychiatry, 43:755, 1998.

  6. BICKFORD RG, FREMMING BD: Neural stimulation by pulsed magnetic fields in animals and man. 6th Int Conf Med Electr Biol Eng, Tokio, 7-6, 1965.

  7. BOHNING DE, SHASTRI A, MCCONELL KA, NAHAS Z y cols.: A combined TMS/fMRI study of intensitydependent TMS over motor cortex. Biol Psychiatry, 45:385-394, 1999.

  8. CADWELL, J: Principles of magnetoelectric stimulation. En: Chokroverty S (ed.). Magnetic Stimulation in Clinical Neurophysiology. Butterworth, Stoneham, 13- 32, 1989.

  9. COHRS S, TERGAU F, RIECH S, KASTNER S y cols.: High-frequency repetitive transcranial magnetic stimulation delays rapid eye movement sleep. NeuroReport, 9:3439-3443, 1998.

  10. CONCA A, KOPPI S, KONIG P, SWOBODA W, KRECKE N: Transcranial Magnetic stimulation: A novel antidepressive strategy? Neuropsychobiol, 34:204-207, 1996.

  11. COUNTER SA, BORG E, LOFQVIST L: Acoustic trauma in extracranial magnetic stimulation. Electroenceph Clin Neurophysiol, 78:173-184, 1991.

  12. D’ARSONVAL A: Dispositifs pour la mesure des courants alternatifs de toutes fréquences. C R Soc Biol (París) 3:450-457, 1896.

  13. DEVINSKY O, DUCHOWNY MS: Seizures after convulsive therapy: a retrospective case survey. Neurology, 33:921-925, 1983.

  14. FAUTH C, MAYER BU, PROSIEGEL M, ZIHL J, CONRAD B: Seizure induction and magnetic brain stimulation after stroke (letter). Lancet, 339:87-89, 1992.

  15. FIGIEL GS, EPSTEIN C, MCDONALD WM, AMAZON- LEECE J, FIGIEL L, SALDIVIA A, GLOVER S: The use of rapid rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neurosci, 10:20-25, 1998.

  16. FLEISCHMANN A, STEPPEL J, LEON A, BELMAKER RH: The effect of transcranial magnetic stimulation compared with electroconvulsive shock on rat apomorphine- induced stereotypy. Eur Neuropsychopharmacol, 4:449-450, 1994.

  17. FLEISCHMANN A, STERNHEIM A, ETGEN AM, LI C, GRISARU N, BELMAKER RH: Transcranial magnetic stimulation downregulates beta-adrenoreceptors in rat cortex. J Neural Transm, 103:1361-1366, 1996.

  18. GEORGE MS, KETTER TA, POST RM: Prefrontal cortex dysfunction in clinical depression. Depression, 2:59- 72, 1994.

  19. GEORGE MS, LISANBY SH, SACKEIM HA: Transcranial magnetic stimulation. Applications in neuropsychiatry. Arch Gen Psychiatry, 56:300-311, 1999.

  20. GEORGE MS, NAHAS Z, MOLLOY M, SPEER AM, OLIVER NC, LI B, ARANA GW, RISCH SC, BALLENGER JC: A controlled trial of daily transcranial magnetic stimulation (TMS) of the left prefrontal cortex for treating depression. Biol Psychiatry, 48:962-970, 2000.

  21. GEORGE MS, NAHAS Z, SPEER AM, KIMBRELL TA y cols.: Transcranial magnetic stimulation: A new method for investigating the neuroanatomy of depression. En: Ebert D, Ebmeier KP (eds.). New Models Depression, Basilea, 94-122, 1998.

  22. GEORGE MS, SPEER AM, MOLLOY M, NAHAS Z y cols.: Low-frequency daily left prefrontal rTMS improves mood in bipolar depression: a placebo controlled case report. Hum Psychopharmacol, 13:271- 275, 1998.

  23. GEORGE MS, WASSERMANN EM, WILLIAMS WA, CALLAHAN A y cols.: Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. NeuroReport, 6:1853-1856, 1995.

  24. GEORGE MS, WASSERMANN EM, WILLIAMS WE, KIMBRELL TA y cols.: Mood improvements following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebocontrolled crossover trial. Am J Psychiatry, 154:1752- 1756, 1997.

  25. GEORGE MS, WASSERMAN EM, WILLIAMS WA, STEPPEL J y cols.: Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation of the prefrontal cortex. J Neuropsychiatry Clin Neurosci, 8:172-180, 1996.

  26. GREENBERG BD, GEORGE MS, DEARING J, BENJAMIN J, SCHLAEPFER T y cols.: Effect of prefrontal repetitive transcranial magnetic stimulation (rTMS) in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry, 154:867-869, 1997.

  27. GREENBERG BD, ZIEMANN U, HARMON A, MURPHY DL, WASSERMANN EM: Decreased neuronal inhibition in cerebral cortex in obsessive-compulsive disorder on transcranial magnetic stimulation. Lancet, 352:881- 882, 1998.

  28. GRISARU N, AMIR M, COHEN H, KAPLAN Z: Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study. Biol Psychiatry, 44:52- 55, 1998.

  29. GRISARU N, CHUDAKOV B, YAROVSLAVSKY Y, BELMAKER RH: TMS in mania: a controlled study. Am J Psychiatry, 155:1608-1610, 1998.

  30. GRISARU N, YAROVSLAVSKY U, ABARBANEL J, LAMBERG T, BELMAKER RH: Transcranial magnetic stimulation in depression and schizophrenia. Eur Neuropsychopharmacol, 4:287-288, 1994.

  31. GRUNHAUS L, DANNON P, SCRIEBER S: Effects of transcranial magnetic stimulation on severe depression: similarities with ECT. Biol Psychiatry, 43:76, 1998.

  32. HOFFMAN R, BOUTROS N, BERMAN R, KRYSTAL J, CHARNEY D: Transcranial magnetic stimulation and hallucinated voices. Biol Psychiatry, 43:93, 1998. 33. HOFLICH G, KASPER S, HUFNAGEL A, RUHRMAN S, MOLLER HJ: Application of transcranial magnetic stimulation in treatment of drug-resistant major depression: a report of two cases. Hum Psychopharmacol, 8:361-365, 1993.

  33. HOMBERG V, NETZ J: Generalized seizures induced by transcranial magnetic stimulation of motor cortex (letter). Lancet, 2:1223, 1989.

  34. JAHANSHAHI M, RIDDING MC, LIMOUSIN P, PROFICE P y cols.: Rapid rate transcranial magnetic stimulation – a safety study. Electroenceph Clin Neurophysiol, 105:422-429, 1997.

  35. KANDLER R: Safety of transcranial magnetic stimulation. Lancet 335:469-470, 1990.

  36. KOLBINGER HM, HOFLICH G, HUFNAGEL A, MOLLER HJ, KASPER S: Transcranial magnetic stimulation (TMS) in the treatment of major depression: a pilot study. Hum Psychopharmacol, 10:305-310, 1995.

  37. KLEIN E, KREININ I, CHRISTYAKOV A, KOREN D y cols.: Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry, 56:315-320, 1999.

  38. JELLINEK DA, BRADFORD R, BAILEY I: The role of motor evoked potentials in the management of hysterical paraplegia: case report. Paraplegia, 30:300-302, 1992.

  39. LOO C, MITCHELL P, SACHDEV P, MCDARMONT B, GANDEVIA S: rTMS: A sham-controlled trial in medication-resistant depression. Biol Psychiatry, 43:95, 1998.

  40. LORBERBAUM JP, WASSERMANN EM: Safety concerns of TMS. En: MS George MS, Belmaker RH (eds.). Trancranial Magnetic Stimulation in Neuropsychiatry. American Psychiatric Press, 141-161, Washington, 1999.

  41. MARTIN JD, GEORGE MS, GREENBERG BD, WASSERMANN EM y cols.: Mood effects of prefrontal repetitive high-frequency TMS in healthy volunteers. CNS Spectrums, 2:53-68, 1997.

  42. MCCANN UD, KIMBRELL TA, MORGAN CM, ANDERSON T y cols.: Repetitive transcranial magnetic stimulation for post-traumatic stress disorder. Arch Gen Psychiatry, 55:276-279, 1998.

  43. NAHAS Z, BOHNING DE, MOLLOY MA, OUSTZ JA, RISCH SG, GEORGE MS: Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of an anxious depression in pregnancy: A case report. J Clin Psychiatry, 60:50-52, 1999.

  44. NAHAS Z, SPEER AM, MOLLOY M, ARANA GW, y cols.: Preliminary results concerning the roles of frequency and intensity in the antidepressant effect of daily left prefrontal rTMS. Biol Psychiatry, 43:94, 1998.

  45. NOBLER MS, SACKEIM HA, PROHOVNIK I, MOELLER JR y cols.: Regional cerebral blood flow in mood disorders, III: treatment and clinical response. Arch Gen Psychiatry, 51:884-897, 1994.

  46. NOBLER MS, TENEBACK CC, NAHAS Z, BOHNING DE y cols.: Structural and functional neuroimaging of ECT and TMS. Depress Anxiety, 12:144-56, 2000.

  47. PADBERG F, HAAG C, ZWANZGER P, THOMA H, KATHMAN N y cols.: Rapid and slow transcranial magnetic stimulations are equally effective in medication-resistant depression: a placebo-controlled study. CINP abstracts, 21:103, 1998.

  48. PASCUAL-LEONE A, CATALA MD, PASCUAL AP: Lateralized effect of rapid-rate transcranial magnetic stimulation of the prefrontal cortex on mood. Neurology, 46:499-502, 1996.

  49. PASCUAL-LEONE A, COHEN LG, SHOTLAND LI, y cols.: No evidence of hearing loss in humans due to transcranial magnetic stimulation. Neurology, 42: 647-651, 1992.

  50. PASCUAL-LEONE A, HOUSE CM, REEVES K, SHOTLAND LI y cols.: Safety of rapid-rate transcanial magnetic stimulation in normal volunteers. Electroenceph Clin Neurophysiol 89:120-130, 1993.

  51. PASCUAL-LEONE A, RUBIO B, PALLARDO F, CATALA MD: Beneficial effect of rapid-rate transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in drug resistant depression. Lancet, 348:233-238, 1996.

  52. PASCUAL-LEONE A, VALLS-SOLE J, WASSERMANN EM, BRASIL-NETO JP, HALLET M: Response to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain, 117:847-858, 1994.

  53. PRIDMORE S: Substitution of rapid transcranial magnetic stimulation treatments for electroconvulsive therapy treatments in a course of electroconvulsive therapy. Depress Anxiety, 12:118-23, 2000.

  54. PRIDMORE S, FILHO JAF, NAHAS Z, LIBERATOS C, GEORGE MS: Motor threshold in transcranial magnetic stimulation: a comparison of a neurophysiological and a visualization of movement method. J ECT, 14:25-27, 1998.

  55. POLSON MJR, BARKER AT, FREESTON IL: Stimulation of nerve trunks with time varying magnetic fields. Med Biol Eng Comput, 20:243-244, 1982.

  56. PURI BK, DAVEY NJ, ELLAWAY PH, LEWIS SW: An investigation of motor function in schizophrenia using transcranial magnetic stimulation of the motor cortex. Br J Psychiatry, 169:690-695, 1996.

  57. ROSS DE, HOMAN RW, BUCK R: Differential hemispheric lateralization of primary and social emotions: Implications for developing a comprehensive neurology for emotions, repression and the subconscious. Neuropsychol Behav Neurol, 7:1-19, 1994.

  58. ROTH BJ, SAYPOL JM, HALLET M, COHEN LG: A theoretical calculation of the electric field induced in the cortex during magnetic stimulation. Electroenceph Clin Neurophysiol, 81:47-56, 1991.

  59. SZUBA M, KNIGHT D, KASTENBERG J, O’REARDON J y cols.: Acute effects of TMS on serum TSH in major depression. Electroenceph Clin Neurophysiol 107:97P, 1998.

  60. TENEBACK CC, NAHAS Z, SPEER AM, MOLLOY M y cols.: Changes in prefrontal cortex and paralimbic activity in depression following two weeks of daily left prefrontal TMS. J Neuropsychiatry Clin Neurosci, 4:426- 435, 1999.

  61. TRIGGS WJ, MCCOY KJM, GREER R, ROSSI F, BOWERS D y cols.: Effects of left frontal transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold. Biol Psychiatry, 45:1440-1446, 1999.

  62. UENO S, TASHIRO T, HARADA K: Localized stimulation of neural tissue in the brain means of paired configuration of time varying magnetic fields. J Appl Phys, 64:5862-5864, 1988.

  63. VALLS-SOLE J, PASCUAL-LEONE A, WASSERMANN EM, HALLET M: Human motor evoked responses to paired transcranial magnetic stimuli. Electroenceph Clin Neurophysiol, 85:355-364, 1992.

  64. WASSERMAN EM, GRAFMAN J, BERRY C, HOLLNAGEL C y cols.: Use and safety of a new repetitive transcranial magnetic stimulator. Electroenceph Clin Neurophysiol 101:412-417, 1996.

  65. WASSERMANN EM, COHEN LG, FLITMAN SS, CHEN R, HALLET M: Seizures in healthy people with repeated “safe” trains of transcranial magnetic stimuli (letter). Lancet, 347:825, 1996.

  66. WASSERMANN EM: Risk and safety of repetitive transcranial magnetic stimulation: report and recommendations from de International Workshop on the Safety of Repetitive Transcranial Stimulation June 5-7, 1996. Electroenceph Clin Neurophysiol, 108:1-16, 1998.

  67. ZIEMANN U, PAULUS W, ROTHENBERGER A: Decreased motor inhibition in Tourette’s disorder: evidence from transcranial magnetic stimulation. Am J Psychiatry, 154:1277-1284, 1997.




2020     |     www.medigraphic.com