2. definition of TMS :
Transcranial magnetic stimulation (TMS) is a procedure that
uses magnetic fields to stimulate nerve cells in the brain to
improve symptoms of depression. Transcranial magnetic
stimulation may be tried when other depression treatments
haven't worked.
With TMS, a large electromagnetic coil is placed against your
scalp near your forehead. The electromagnet used in TMS
creates electric currents that stimulate nerve cells in the
region of your brain involved in mood control and depression
3.
4. Precautions :
Tell your doctor or mental health provider if:
You're pregnant or thinking of becoming pregnant.
You have any metal or implanted medical devices in your
body. Due to the strong magnetic field produced during TMS,
some people who have the following devices cannot have TMS:
Aneurysm clips or coils
Stents
Implanted stimulators
Electrodes for monitoring brain activity
Any magnetic implants
Bullet fragments
Any other metal device or object implanted in your body
5. Result :
If TMS works for you, your depression symptoms may
improve or go away completely. Symptom relief may take
a few weeks of treatment.
TMS may be less likely to work if:
1- Your mental illness causes detachment from reality
( (psychosis)
2- Your depression has lasted for several years
3-Electroconvulsive therapy (ECT) hasn't worked to
improve depression symptoms
It's not yet known if TMS can be used to treat depression
for the long term, or whether you can have periodic
maintenance treatments to prevent depression symptoms
from returning.
6. Deep brain stimulation :
Deep brain stimulation involves implanting electrodes within certain areas of
your brain. These electrodes produce electrical impulses that regulate
abnormal impulses. Or, the electrical impulses can affect certain cells and
chemicals within the brain. The amount of stimulation in deep brain
stimulation is controlled by a pacemaker-like device placed under the skin in
your upper chest. A wire that travels under your skin connects this device to
the electrodes in your brain.
Deep brain stimulation is used to treat a number of neurological conditions,
such as:
Essential tremor
Parkinson's disease
Dystonia
Deep brain stimulation is also being studied as a treatment for epilepsy,
cluster headaches, Tourette syndrome, chronic pain and major depression.
Many candidates for deep brain stimulation are participants in clinical trials.
7.
8. Surgery risks :
Deep brain stimulation involves boring small holes in the skull to implant the
electrodes, and surgery to implant the device that contains the batteries under
the skin in the chest. Complications of surgery may include:
Bleeding in the brain (hemorrhage)
Stroke
Infection
Breathing problems
Nausea
Heart problems
Incision scarring
With deep brain stimulation, surgery isn't a one-time procedure. The batteries
that are implanted in the chest have a limited life span, and when they run out,
your symptoms may quickly return. Replacing the batteries requires another
surgery. It's also possible for a wire connecting the batteries to an electrode to
break or for other malfunctions to occur.
9. Possible side effect after surgery :
Seizure
Infection
Headache
Insomnia
Memory problems
Temporary pain and swelling at the
implantation site
10. Possible side effects of stimulation
Numbness or tingling sensations
Muscle tightness of the face or arm
Speech problems
Balance problems
Lightheadedness
Unwanted mood changes, such as mania and
depression
11. Preparation :
Before surgery, you need to have medical
tests to make sure that deep brain stimulation
is safe for you and is a good option in your
case. You also need brain-imaging studies,
such as an MRI, before the surgery, to map
the areas of your brain where the electrodes
will be implanted.
12. Result :
Deep brain stimulation won't cure your
disease, but it may help lessen your
symptoms. If deep brain stimulation works,
your symptoms will improve significantly, but
they usually don't go away completely. In
some cases, medications may still be needed
for certain conditions. Deep brain stimulation
isn't successful for everyone
13. Vagus nerve stimulation
Vagus nerve stimulation is a procedure that stimulates the vagus nerve
with electrical impulses. Vagus nerve stimulation can be used to treat
epilepsy when other treatments haven't worked. Vagus nerve
stimulation is also a treatment for depression, and it's being studied for
conditions such as multiple sclerosis, migraine and Alzheimer's
disease.
There's one vagus nerve on each side of your body, running from your
brainstem through your neck to your chest and abdomen.
With vagus nerve stimulation, a device is surgically implanted under the
skin on your chest. A wire is threaded under your skin connecting the
device to the left vagus nerve. When activated, the device sends
electrical signals along the vagus nerve to your brainstem, which then
sends signals to certain areas in your brain
14.
15. Risks :
Pain where the cut (incision) is made to
implant the device
Infection
Incision scarring
Difficulty swallowing
Vocal cord paralysis, which is usually
temporary, but can be permanent
16. Side effects :
Voice changes
Hoarseness
Throat pain
Cough
Headache
Chest pain
Breathing problems, especially during exercise
Difficulty swallowing
Abdominal pain or nausea
Tingling or prickling of the skin
17. When vagus nerve stimulation may
be a good option :
The Food and Drug Administration (FDA) has approved vagus
nerve stimulation for people who:
Are 12 and older
Have focal (partial) epilepsy
Have seizures that aren't well controlled with medications
In addition, the FDA has approved vagus nerve stimulation for the
treatment of depression in adults who:
Have chronic, hard-to-treat depression (treatment-resistant
depression)
Haven't improved after trying four or more medications or
electroconvulsive therapy (ECT), or both
Continue standard depression treatments along with vagus nerve
stimulation
18. Result :
Vagus nerve stimulation isn't a cure for epilepsy. Most
people with epilepsy won't stop having seizures
altogether. But many people will have fewer seizures,
as many as 30 to 50 percent fewer. Seizure intensity
may lessen as well.
It can take as long as two years of vagus nerve
stimulation before you notice any significant reduction
in the number of seizures. Vagus nerve stimulation may
also shorten the recovery time after a seizure. People
who've had vagus nerve stimulation to treat epilepsy
generally have an improved quality of life.
Notas do Editor
In TMS therapy, an electromagnet is applied to the left side of the forehead. This induces currents in neurons in the left prefrontal cortex--where brain imaging studies have shown a deficit in activity in depressed patients. It is thought that this can induce activity and blood flow to this area, but also causes changes in areas deeper in the brain (responsible for mood regulation) to which neurons in the cortex connect. Side effects of TMS tend to be mild, especially compared to antidepressants, and the most common complaint is a mild headache
The deep brain stimulation system targets either the subthalamic nucleus or globus pallidus interna regions of the brain involved in muscle movement.
The vagus nerve is comprised of 90% afferent, i.e., sensory nerve fibers, and plays a central role in transmitting information about the functional status of various organs to the brain1. This role also entails the monitoring of the body’s inflammatory processes: When microbial infections occur, the immune cells release pro-inflammatory signals - an accumulation of which can result in systemic inflammation. The vagus nerve thus alerts the brain when there is an excess of molecules such as cytokines. The brain, now notified of a potent infection, reflexively triggers the release of anti-inflammatory substances to avert harmful inflammation2. A serendipitous electrical stimulation of the vagus nerve helped decipher that this attenuation occurs via the efferent fibers that make up the reminder of the vagus nerve. It was thus demonstrated for the first time that the brain can regulate the levels of the Tumor necrosis factor (TNF) via the vagus nerve – a mechanism termed cholinergic anti-inflammatory pathway3.
Electrically stimulating the vagus nerve using pacemaker-like devices to tackle seizures in epileptic patients has been in practice since the 1990’s, and so has been the treatment of depression with vagal nerve stimulation (VNS). These procedures have relied on the fact that the vagus nerve serves as a portal to the brain stem; thus, psychiatric diseases have been the prime target of VNS4.
