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Electrical brain activity following magnetic stimulation as recorded with high-resolution Q EEG

Electrical brain activity following magnetic stimulation as recorded with high-resolution Q EEG. www.biomag-hus.fi/tms. rTMS. First TMS capable of delivering a pulse every three seconds (as diagnostic aids for neurologists.) New machines which can give up to 50 stimuli per second (rTMS)

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Electrical brain activity following magnetic stimulation as recorded with high-resolution Q EEG

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  1. Electrical brain activity following magnetic stimulation as recorded with high-resolution QEEG www.biomag-hus.fi/tms

  2. rTMS • First TMS capable of delivering a pulse every three seconds (as diagnostic aids for neurologists.) • New machines which can give up to 50 stimuli per second (rTMS) • A non-invasive technique, free of serious side effects, easily modifying activity of specific brain areas

  3. How does rTMS work for brain electrical activity? rTMS gives short pulses of magnetic energy to Limbic system structures

  4. How does rTMS work for brain electrical activity? Small electric charges can cause the neurons to fire or to become active

  5. Ilmoniemi et.al.(1997) were able to measure with QEEG just seconds after electromagnetic pulse Nashaat et.al (2001), Nikulin et.al (2003), Kommsi et.al (2004) have used ongoing rTMS and QEEG Monitoring

  6. Brain electrical activity changes with rTMS • Acute rTMS induces changes in regional activity throughout the brain • Stimulation intensity is important • Low frequency has a tendency to decrease • High frequency has a tendencyto increase

  7. Resynchronization effects • Normal brain function requires synchronized activity of interconnected brain areas • rTMS may help ‘reset’ the normal synchrony between brain regions (Garcia-Toro et.al. 2001, Avery 2004)

  8. GABA and QEEG • GABA increases functional connectivity on QEEG (Benzodiazepine effect) • GABA decreases with stress • GABA decreases in plasma and in brain (MRS) of depressed patients • ECT increases GABA level in depressed patients. • rTMS: increase ?

  9. State marker improves after treatment • Trait marker doesn’t improve after treatment

  10. ‘State markers’of QEEG being: • Ratio of Alpha waves • Ratio of Delta waves • Hemispheric asymmetry • Alpha/Delta ratio of the frontal area

  11. Acute drug effect in QEEG • Tricyclic Antidepressant drugs: Alpha, Theta, Delta • Antipsychotic drugs :Theta and Delta waves • Antianxiety drugs :beta • Cognitive activator drugs : Alpha • SSRI drugs: Alpha (Itil 1989)

  12. The Response to drug treatment in depression • Delta waves: good response, • Alpha and Beta waves: good response, • Unchanged QEEG: bad response. (Kendler)

  13. The Distribution of Brain waves in QEEG after 10 sessions of rTMS(preliminary findings)

  14. According to HAM Scores

  15. HAM Scores and QEEG after 10 sessions of rTMS “An interpretation” • All patients showed 30-50% treatment response • In Alpha increases group, HAM improvement wasgreater • In no changes group, HAM improvement was minimal • More verification, and MEG studies, are necessary

  16. Pregnancy and rTMS Case Study (I) • One case (I.D., 32 years) • She had serious non-psychotic Chronic Major Depression. • She used antiepileptic and antidepressant drugs. • She became pregnant during treatment. • She wanted to continue the pregnancy.

  17. Pregnancy and rTMS Case Study (II) • Firstly, we stopped her using the antidepressant drugs • We applied 40 sessions of rTMS to her. • Every session was 25 Hz. and 1000 pulses. • Now,she has a healthy baby. • Afterbirth, rTMS was continued.

  18. Frequency of seizures • We applied rTMS at approximately 15,000 sessions in two years • In every session, rTMS was applied at 25 Hz • In most cases, 1000 pulses were applied in every session • Grandmal seizures were observed only in 3 cases.(3 /15,000)

  19. 25 Hz, 1 Pulses, 50% Power

  20. 25 Hz, 1 Pulses, 100% Power

  21. 25 Hz, 3 Pulses, 100% Power

  22. 5 Hz, 10 Pulses, 50% Power, Duration 1.8 sec

  23. 5 Hz, 10 Pulses, 75% Power, Duration 1.8 sec

  24. 5 Hz, 10 Pulses, 100% Power, Duration 1.8 sec

  25. 25 Hz, 50 Pulses, 50% Power, Duration 1.9 sec

  26. 25 Hz, 50 Pulses, 75% Power, Duration 1.9 sec

  27. 25 Hz, 50 Pulses, 100% Power, Duration 1.9 sec

  28. 20 B T A2 A T A T

  29. 21 B T A3 A T

  30. 22 B T A4 A T

  31. 34 A7 B T A T

  32. 42 B T A9 A T

  33. 32 B6 B T A T

  34. 40 B8 B T A T

  35. 49 B9 A T

  36. 63 BT B11 A T

  37. 94 B17 B T A T

  38. 12 B T C3 A T

  39. 61 B T C4 A T

  40. 71 B T C5 A T

  41. 111 B T C8 A T

  42. 130 B T C11 A T

  43. 11 E2 B T A T

  44. 36 B T E6 A T

  45. 95 E9 B T A T

  46. 98 E10 B T A T

  47. 116 B T E11 A T

  48. Scientific Inspiration • One day, in 1990 at a London Hospital in an elevator, a passenger was giggling. A magnetic stimulation had been appliedto his head. It wasa neuro-diagnostic motor test, for thumb jerk • Dr. Mark George observed and was astonished by this situation. He suspected that magnetic fields could move much more than the thumb. • The story of magnetic therapy in psychiatry started like this.

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