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Can you tell me about TMS and where this treatment is offered in the United States or Canada?



Answered by: Sarah Lisanby

Transcranial magnetic stimulation (TMS) refers to the use of magnetic fields to stimulate the brain. The magnetic fields induce small electrical currents in the brain, which can activate neuronal circuits. Repeatedly activating functional networks in the brain can alter the functioning of those networks. As a noninvasive means of changing brain function, TMS has been studied for its utility in the dual roles of studying the brain and potentially treating brain-based disorders.

TMS has demonstrated utility in studying brain function in ways that move beyond correlational relationships that can be revealed by imaging to testing causal relationships. By stimulating different brain regions with TMS, it is possible to test hypotheses about the function of those brain regions, and advance our knowledge of brain behavior relationships. For example, we recently reported on the use of TMS, guided by functional magnetic resonance imaging (fMRI) to test the role on specific brain circuits that confer resilience to sleep deprivation (Luber et al. 2008).

The therapeutic potential of TMS is under study. Specifically, TMS is under study for the treatment of a range of psychiatric and neurological disorders, including depression, schizophrenia, anxiety disorders, Parkinsonís Disease, and stroke, just to name a few. As the time of this writing, TMS is not presently approved by the Food and Drug Administration (FDA), therefore TMS is considered experimental. Individuals can access TMS in the context of approved research studies, but FDA prohibits advertising or marketing of non-approved off-label treatment. It is wise to consult with your physician before making a decision as to whether TMS, or any other procedure, is right for you.

Studies have examined the potential use of TMS for depression, with some encouraging results. Several meta-analyses have provided supporting evidence for a modest antidepressant effect of TMS applied to the left dorsolateral prefrontal cortex when applied daily for 4 to 6 weeks. A recently completed randomized controlled trial of over 300 patients with unipolar depression found a significantly higher response rate with active TMS than with a placebo condition (sham TMS) (OíReardon et al. 2007).

A number of universities across the US and other countries are conducting research with TMS. For a listing of TMS research centers, see www.ists.unibe.ch/Centers.html.

For more information about TMS programs at Columbia, see the following links:

www.brainstimulation.columbia.edu

www.columbiapsychiatry.org/cs/bss.html



References:

Luber B, Stanford AD, Bulow P, Nguyen T, Rakitin BC, Habeck C, Basner R, Stern Y, Lisanby SH: Remediation of Sleep-Deprivation-Induced Working Memory Impairment with fMRI-Guided Transcranial Magnetic Stimulation. Cereb Cortex. 2008 Jan 17.

O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007 Dec 1;62(11):1208-16.

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Sarah Lisanby, M.D.
Founding Chief, Brain Stimulation and Therapeutic Modulation Division 

Dr. Lisanby was the founding Chief of the Columbia Brain Stimulation and Therapeutic Modulation Division and Professor of Clinical Psychiatry. Dr. Lisanby is now the Chair of Psychiatry at Duke University. Her research focuses on the use of emerging electromagnetic means of modulating brain function to study and treat psychiatric disorders. These techniques include transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), magnetic seizure therapy (MST), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and electroconvulsive therapy (ECT).

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