Neuromodulation : journal of the International Neuromodulation Society
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Review Practice Guideline
Transcranial Magnetic Stimulation for Pain, Headache, and Comorbid Depression: INS-NANS Expert Consensus Panel Review and Recommendation.
While transcranial magnetic stimulation (TMS) has been studied for the treatment of psychiatric disorders, emerging evidence supports its use for pain and headache by stimulating either motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC). However, its clinical implementation is hindered due to a lack of consensus in the quality of clinical evidence and treatment recommendation/guideline(s). Thus, working collaboratively, this multinational multidisciplinary expert panel aims to: 1) assess and rate the existing outcome evidence of TMS in various pain/headache conditions; 2) provide TMS treatment recommendation/guidelines for the evaluated conditions and comorbid depression; and 3) assess the cost-effectiveness and technical issues relevant to the long-term clinical implementation of TMS for pain and headache. ⋯ After extensive literature review, the panel provided recommendations and treatment guidelines for TMS in managing neuropathic pain and headaches. In addition, the panel also recommended more outcome and cost-effectiveness studies to assess the feasibility of the long-term clinical implementation of the treatment.
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The methodology used for the application of repetitive transcranial magnetic stimulation (TMS) is such that it may induce a placebo effect. Respectively, adverse events (AEs) can occur when using a placebo, a phenomenon called nocebo. The primary aim of our meta-analysis is to establish the nocebo phenomena during TMS. Safety and tolerability of TMS were also studied. ⋯ TMS is a safe and well-tolerated intervention. Nocebo phenomena do occur during TMS treatment and should be acknowledged during clinical trial design and daily clinical practice.
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Randomized Controlled Trial
Transcranial Static Magnetic Field Stimulation Over the Temporal Cortex Modulating the Right Ear Advantage in Dichotic Listening.
Transcranial static magnetic field stimulation (tSMS) has proposed a new, promising, and simple non-invasive brain stimulation method. While several studies gained certain evidence about tSMS effects in the motor, somatosensory, and visual domains, there is still a controversial debate about its general effectiveness. In the present study, we investigated potential tSMS effects on auditory speech processing as measured by a dichotic listening (DL) task. ⋯ The preliminary results of the present exploratory study demonstrate the ability of tSMS to modulate human brain activity on a behavioral as well as physiologic level. Furthermore, tSMS effects on acoustic processing may have clinical implications by fostering potential approaches for a treatment of speech-related pathologies associated with hyperexcitability in the AC.
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Aging is associated with a decline in cognitive and motor performances, which are a part of geriatric syndromes. Since aging is associated with morphological changes in the cerebellum and cerebellar morphology is a good predictor of cognitive and motor performances, so the study of cerebellar role in age-related decline in performance is necessary. Cerebellar transcranial direct current stimulation (ctDCS) has been proposed to study and facilitate the cerebellar function. However, lobule-specific dosing has not been investigated in healthy aging. This is important because the same electrode montage across different individuals for ctDCS (called the "one-size-fits-all" approach) can lead to inter-individual differences in the lobule-specific dosing of the electric field (EF). These differences can be due to the inter-individual variability and age-related changes in the cerebellar structure. To investigate such lobule-specific dosing differences in healthy aging, we modeled the lobular EF distribution across groups of 18 to 89 years for a commonly used "one-size-fits-all" ctDCS montage. ⋯ We found that cerebellar shrinkage and increasing thickness of the highly conductive CSF during healthy aging can lead to the dispersion of the current away from the lobules underlying the active electrode. We concluded that an individualized ctDCS approach for dosimetry is critical when ctDCS is used as an adjuvant treatment for active aging to address age-related lobule-specific cerebellar geriatric syndromes effectively. Future work is necessary to investigate age-related effects of lobule-specific ctDCS on the large-scale cognitive and motor networks using functional neuroimaging that is expected due to the cerebellum's extensive reciprocal connectivity with the cerebral cortex.
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Repetitive transcranial magnetic stimulation (rTMS) can cause potentially useful changes in brain functional connectivity (FC), but the number of treatment sessions required is unknown. We applied the continual reassessment method (CRM), a Bayesian, adaptive, dose-finding procedure to a rTMS paradigm in an attempt to answer this question. ⋯ The CRM can be adapted for rTMS dose finding when a reliable outcome measure, such as FC, is available. The minimum effective dose needed to produce a criterion increase in FC in our hippocampal network of interest at 87.5% efficacy was estimated to be greater than four sessions. This study is the first demonstration of a Bayesian, adaptive method to explore a rTMS parameter.