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Anthony Barker and his colleagues at the University of Sheffield were the first to develop a TMS device, introducing a new neuromodulatory technique in neuroscience. Initially, TMS was used mainly in studies on motor conductivity through investigating the temporal aspects and amplitude of the evoked motor responses after stimulating the motor cortex.
The potential of repetitive TMS in the treatment of psychiatric disorders was suggested for the first time relatively soon after the development of the first TMS device in 1985. Major depression is a common disorder with millions of sufferers around the world and a lifetime prevalence of about 13% in men and 21% in women (Blazer, Kessler, McGonagle & Swartz, 1994)). The early reports of rTMS as an antidepressant treatment modality consisted of pilot studies with a small number of subjects. After 15 years of research, the general consensus is that rTMS treatment in depression has potential, but has not yet fully lived up to initial expectations.
In this section, a comprehensive overview of rTMS in the treatment of depression will be provided. The behavioral effects of rTMS have been found to depend on the frequency, intensity and duration of stimulation (e.g. Progress in the development of technical aspects of TMS devices and advancing insights have led to a continuing progression of experimental and innovative protocols.
The stimulation frequency refers to the number of pulses delivered per second, as can be programmed on the TMS device. Although the vast majority of studies have focused on low frequency stimulation applied to the right and high frequency stimulation applied to the left prefrontal cortex, it is to be noted that in a few studies parameters have varied from these traditional sites. These aforementioned studies demonstrate evidence that active HF-rTMS and LF-rTMS are more effective in the treatment of depression as compared to sham. A second variant is the sequential stimulation protocol in which within one session both HF-rTMS and LF-rTMS are applied.
A third option is the unilateral combination of high and low frequency stimulation in a protocol referred to as ‘priming’ stimulation. Together, these studies suggest that clinical efficacy may be improved by means of more precise targeting methods. Despite the fact that the majority of the studies target the DLPFC, some authors have argued that it has never been experimentally proven that the DLPFC is the most effective target for rTMS treatment of depression.
For rTMS to be effective, the magnetic field has to induce currents in the neurons of the cortex.
The variety of protocols discussed above indicate that rTMS is an active field of research. With rTMS the goal is to modulate brain activity, with a resultant reduction of depressive symptoms. Knowledge of neurobiological mechanisms to date is derived from neuroimaging studies, studies on neurotransmitter and neuroendocrinologic systems and from gene expression research. The combination of rTMS with neuroimaging research provides a unique opportunity to elucidate the underlying mechanisms of rTMS in the treatment of depression.
As discussed in the “Protocols” section, in most depression protocols rTMS is applied over the left or right DLPFC. One neuroimaging study has directly compared the effects of high frequency stimulation applied to the left side with low frequency stimulation applied to the right (Fitzgerald et al., 2007). Event related potentials (ERPs), and especially late ERPs, are related to cognitive processes such as attention, stimulus evaluation and early visual detection. These findings demonstrate specific and selective alterations induced by repeated rTMS, which are distinct from those induced by other antidepressant treatments.
Apart from altering rCBF in stimulated regions and connected networks, rTMS also has an effect on the neuroendocrinologic (Post & Keck, 2001) and neurotransmitter systems (Ben-Shachar, Belmaker, Grisaru & Klein, 1997; Strafella, Paus, Barrett & Dagher, 2001).
A few years later rTMS induced changes in dopamine were investigated for the first time in human subjects.
In the study performed by Keck and colleagues (Keck et al., 2002), an rTMS-induced effect on dopamine was found by using intracerebral microdialysis, but no effects on norepinephrine and serotonin were found.
Another possible mechanism through which rTMS exerts its antidepressant effect involves the modulation of GABA and glutamate, which, respectively, are the main inhibitory and excitatory neurotransmitters. Another candidate as a mechanism for the rTMS treatment effect in depression is the modulation and release of neurotrophins.
In the above-mentioned studies, several likely candidates associated with (and perhaps responsible for) an rTMS-induced antidepressant response were discussed. As a new and dynamic field, rTMS is the topic of a considerable research and innovative developments are numerous.
In addition to the ‘traditional’ LF and HF frequency studies, a newly developed theta-burst stimulation (TBS) protocol has been proposed; referred to as ‘patterned TMS’. Until recently, this rapid delivery of pulses as happens in a TBS protocol was not possible due to technical limitation of older stimulators. In response to limitations of currently used coils, a new type of coil ‘the H-coil’ (Brainsway) was developed. A different group of potential predictors can be obtained from the neurophysiological data. In addition to demographical and physiological markers, genetic markers may have potential in the prediction of treatment outcome. Bocchio-Chiabetto and colleagues (2008) demonstrated in their study that carriers of the LL variant of the 5-HTTLPR gene showed significantly greater decreases in depressive symptoms following rTMS (as reflected by % decrease on the HAM-D), in comparison to carriers of the S allele. In summary, although rTMS is a relative newcomer among the treatment options for depression, the investigation of ‘individual characteristics’ related to treatment response appears to be progressing rather rapidly. AC contactor magnetic electrical dc overload relay, View AC contactor magnetic, Kripal Product Details from Zhejiang KRIPAL Electric Co., Ltd. U moet JavaScript geactiveerd hebben om de volledige functionaliteit van deze website te kunnen benutten. Magneten zijn er in verschillende legeringen, er zijn dan stoffen toegevoegd aan de magneet waardoor de klank anders wordt opgepakt.Zo zijn er Alnico II (ALuminium,NIkkel en CObalt), Alnico III, Alnico V, Alnico VII en Kermische magneten.
Natuurlijk is het soort magneet, het aantal windingen en soort koperdraad van groot belang, maar het type element bepaald het grootste gedeelte van de klank. Een nieuwe vinding zijn de zogenaamde Hum-Canceling elementen, dit is in wezen een humbucker in een enkelspoels element gebouwd met de klank van een enkelspoels element.
Vaak kunnen op humbuckers de poolstaafjes (dat zijn de ronde metalen staafjes recht onder de snaren) versteld worden met een imbussleutel zodat volumeverschillen tussen snaren onderling kan worden aangepast.
Het Lipstick element zoals deze bekend is van de Telecastermodellen, is in feite een enkelspoels element met een ronde afdekkap over de magneten.
Een voordeel van deze pickup is dat er geen metalen snaren nodig zijn om trilling op te vangen, en is dus perfect voor Klassieke gitaren omdat de 3 hoogste snaren enkel van nylon zijn. Omdat 'gewone' magnetische elementen een eigen klankkarakter hebben die niet kan worden verandert zijn er actieve systemen waarop  -gevoed met een batterij- veel kan worden verandert. Natuurlijk zijn dit richtlijnen en is niets in een hokje te plaatsen, je zou namelijk zeker niet de eerste zijn die enkelspoelselementen gebruikt met veel oversturing (en daarbij veel ruis) om net die klank te krijgen die je zo mooi vindt.
The first application, demonstrated first by these researchers, was the induction of a motor evoked potential (e.g.
Continuing progress on the technical aspects of TMS devices soon made it possible to deliver multiple pulses within in a short time period, i.e. In a study on motor conductivity, changes in mood in several normal volunteers who received single pulses over the motor cortex were described (Bickford, Guidi, Fortesque & Swenson, 1987). The World Health Organization has predicted that depression will globally become the 2nd largest burden of disease by 2020, following cardiovascular conditions  (Murray & Lopez, 1997). In these early studies arbitrary stimulation parameters over various and non-specific brain regions were applied (Hoflich, Kasper, Hufnagel, Ruhrmann, Moller, 1993).
In large part this is due to limited understanding of the mechanisms underlying the clinical treatment effect. In the first section various rTMS protocols will be reviewed in terms of the different stimulation parameters that are of interest. To date HF-rTMS protocols have mostly used stimulation frequencies of 10 Hz (but this has varied from 5 to 20 Hz). In a double-blind, randomized, sham-controlled study, 60 treatment resistant patients were divided into three groups; one received HF-rTMS trains to the left prefrontal cortex at 10 Hz, the second group received five LF-rTMS trains at 1 Hz to the right prefrontal cortex and the third group received sham treatment. This protocol was examined in a double-blind study that included 50 patients with depression. This involves the application of low intensity high-frequency trains (usually 6 Hz) followed by standard low frequency stimulation. The motivation behind choosing this brain area stems from various imaging studies that indicated depression is associated with regional brain dysfunction in, among other regions, the DLPFC (Cummings, 1993).
The hand area of the primary motor cortex (M1) (which elicits a contralateral motor response of the thumb when stimulated), is taken as the detectable reference point.
This has been directly tested in one study with 52 patients who were randomized to stimulation localized by the ‘5 cm rule’ or neuronavigation (Fitzgerald et al., 2009).
In addition, the pathophysiology of depression is certainly not limited to the DLPFC (Drevets, Price & Furey, 2008). The intensity of the magnetic field that induces this current is referred to as the stimulation intensity.
That is, pulses are delivered in trains and are separated by certain time intervals: the inter train interval (ITI).
Treatment outcome has been shown to vary with protocols, but some protocols have proven their efficacy. Although clinical results appear promising, mechanisms explaining the symptomatic reduction are unknown. Together, these efforts will hopefully explain the substrate of the antidepressant effects of rTMS. Most imaging studies to date have used positron emission tomography (PET) or single-proton emission computed tomography (SPECT) to identify brain regions with altered blood flow or glucose metabolism as a result of rTMS. Several neuroimaging studies have indeed demonstrated rTMS-induced changes within the DLPFC. A single TMS pulse can lead to effects in more distal brain areas within the same network as the stimulated area (Siebner et al., 2009). This study, using fMRI recordings during a cognitive task, found that low frequency stimulation produced a bilateral reduction in neural activity whereas high frequency stimulation had the opposite effect. The rTMS induced effects on neuroanatomical functions are commensurate with some known abnormalities in depression, e.g.
Many lines of research on antidepressant mechanisms have focused on monoaminergic neurotransmission, i.e. Both neurotransmitters are known to be associated with the pathology of depression and change with clinical improvement in depression (Petty, Kramer, Gullion & Rush, 1992; Sanacora, Rothman, Mason & Krystal, 2003). It is known that LF- rTMS in particular induces prolonged decreases in motor cortex excitability  (Chen et al., 1997), while HF-rTMS induces an increase in motor cortex excitability (Pascual-Leone, Valls-Sole, Wassermann & Hallett, 1994). BDNF is a neurotrophin which plays a role in survival of neuronal cells and in synaptic plasticity and connectivity (Bath & Lee, 2006). These developments are of a diverse nature, including technological progress in equipment and software, protocol innovations and optimizations, and advances in the understanding of long-term effects. This has been put forward as a technique that could have important implications for the treatment of conditions such as epilepsy, depression and Parkinson’s Disease (Paulus, 2005). The field involved in identifying such features is referred to as personalized medicine: a research towards establishing patient’s characteristics (clinical, physiological or parametric variables) related to (better) clinical outcome. In the search for physiological markers for treatment response to rTMS, Price and colleagues (Price, Lee, Garvey & Gibson, 2008) investigated alpha EEG activity measures, i.e.

The serotonin-related polymorphisms SERTPR and 5-HT(1A) have also been investigated in relation to depression treatment outcome (Zanardi et al., 2007). Developments to date seem to mainly focus on fMRI and PET imaging studies and to a lesser extent on genetic polymorphism and EEG parameters.
If you require further details regarding the transaction data, please contact the supplier directly. Een single-coil element bevat 2 magneten en 1 spoel, een humbucker bestaat in feite uit 2 single-coils en levert dus meer signaal en een strakkere toon. Een enkelspoels element kan in de brugpositie een heldere en open klank geven wat perfect is voor subtiele slagpartijtjes.
In 1955 kwam Gibson technicus Seth Lover erachter dat wanneer je 2 enkelspoels elementen naast elkaar zet en de plus en min van beide spoelen op elkaar aansluit, er veel minder ruis is en de output veel hoger is.
Omdat de magneten hierbij niet uitsteken is er ook niet zo een sterk signaal als bij een gewoon enkelspoels element, dus perfect voor soepele slagpartijtjes of ritmewerk. Omdat de trilling van een snaar ook drukverandering geeft wordt deze meestal onder het zadel van een gitaar geplaatst. The basic principle of TMS is the application of short magnetic pulses over the scalp of a subject with the aim of inducing electrical currents in the neurons of the cortex. Following this initial observation, the technical progress and the increasing availability of TMS devices has led to the opportune investigation of rTMS in the treatment of depression. Individuals with depression experience a wide range of symptoms including a loss of interest or pleasure, feelings of sadness, guilt, low self-esteem, disturbances in sleep and appetite, poor concentration and suicidal ideations (DSM-IV, 1994). A substantial research effort, already in progress, may elucidate the mechanisms of the beneficial effects of rTMS in depressed patients. Subsequently, some potential physiological mechanisms that are associated with antidepressant outcome will be reviewed. The most important parameters that rTMS protocols in depression can be distinguished on are the stimulation frequency and the stimulation location. The clinical results showed that the groups treated with HF-rTMS and LF-rTMS had a similar reduction in depressive symptoms, and for both groups, treatment response was better than within the sham group  (Fitzgerald et al., 2003). In recent years, add-on, bilateral -sequential and priming protocols have been postulated and investigated. Half of the group received 1 Hz rTMS over the right prefrontal cortex, followed by HF-rTMS over the left prefrontal cortex in the same session, for a period of 4-6 weeks. Basic neurophysiological studies have shown that priming stimulation results in greater suppression of cortical excitability than low frequency stimulation applied alone (Iyer, Schleper & Wassermann, 2003). Other researchers have not only proposed an ‘underactivated’ L-DLPFC, but suggested an imbalance between frontal regions. Neuronavigationally targeted treatment resulted in a statistically significant greater response in depression scores than treatment targeted by the traditional method. Investigation of antidepressant effects of rTMS applied to other brain regions has therefore been explored  (Schutter, 2009a; Schutter, Peper, Koppeschaar, Kahn & van Honk, 2005). However, it has been argued that it is unlikely that the current combinations of stimulation parameters potentiate optimum clinical effects. In order to optimize rTMS for therapeutic use, it is necessary to gain a better understanding of possible neurobiological mechanisms underlying the clinical response. In the following paragraphs, studies in each of the fields mentioned above on rTMS-induced changes will be reviewed. These modalities have lower temporal resolution compared to fMRI, and therefore not much is known about the time course of brain activation in response to rTMS. The direction of these effects was in keeping with traditional models of the effect of low and high frequency TMS. Nevertheless, there are some indications that rTMS might modulate serotonergic neurotransmission. So far, only a few studies have directly addressed rTMS-induced changes in GABAergic neurotransmission. Cortical excitability is thought to be to be maintained by a balance of neurotransmitter levels of GABA and glutamate.
As discussed in the ‘neurotrophin’ section, the modulation of the expression of brain-derived neurotrophic factors (BDNF) is a likely modulating factor through which treatment response is exerted. TBS usually involves short bursts of 50 Hz rTMS applied at a rate of 5Hz (hence the name theta burst stimulation).
H-coils, on the other hand, are capable of stimulating deeper brain regions (Zangen et al., 2005). Especially relevant to the rTMS area is the research on identifying objective markers of clinical response. However, genetics as potential biomarkers for susceptibility to antidepressant medications is still a relatively novel concept, and only a limited amount of research has been conducted. Possibly this is due to the observed direct and indirect interactions with underlying brain regions, and the fact that PET and fMRI imaging are especially effective for highlighting induced changes in regional blood flow and metabolism. In de brugpositie zijn enkelspoelers scherp en bijtend; perfect om een felle solo uit de mix te laten springen.
Dit extra signaal gaat wel ten koste van de heldere en open klank zoals die op een enkelspoels element aanwezig zijn. Op deze manier kan via een schakelaar gekozen worden of het element 1 of 2 spoelen gebruikt. A typical TMS device consists of a stimulator that can generate a strong electrical current, and a coil in which the fluctuating electrical current generates magnetic pulses. With the development of rTMS, researchers were able to induce changes that outlasted the stimulation period (Pascual-Leone et al., 1999). Apart from being the first investigated psychiatric application, it is also the most investigated psychiatric application in many centers all around the world. It is obvious that major depression has a disabling effect on daily activity, indicating that effective treatment is crucial.
In regard to this, we present an overview of rTMS-induced effects found in imaging studies, pharmacological studies and genetic studies.
These will be discussed at length by reviewing literature that used diverse choices for these parameters. HF-rTMS is usually applied over the left prefrontal cortex, whilst LF-rTMS is mostly applied over the right prefrontal cortex (see ‘stimulation location’ for a more elaborate review). This study also showed a significant larger improvement in depression scores in the active as compared to the sham group. A single clinical study has compared such priming stimulation to 1 Hz TMS (both applied to the right side) and shown a greater clinical effect in the priming group compared to the sham group (Fitzgerald & Daskalakis, 2008). For example, the ‘frontal asymmetry hypothesis’ of depression states that in depression there is an imbalance in left vs. Schutter and colleagues (Schutter, 2009a) applied 2 Hz rTMS at 90% of the motor threshold (see next section) to the right parietal cortex in a group of patients with depression for a period of 10 sessions. The MT is usually determined prior to each session by applying the TMS coil over the ‘thumb’ area of the motor cortex. Schutter (2009a) suggested that similar to antidepressant medication, rTMS treatment may involve a delayed therapeutic onset.
It is likely that there is much room for improvement, and studies directly addressing the question of optimal stimulation parameters are urgently required. The neurophysiology of rTMS at the neuronal level in general is outside the scope of this review. However, the fact that changes were produced bilaterally when both groups improved clinically to a similar degree, is not consistent with laterality models of depression, such as that proposed by Henriques and Davison (1990).
Additionally, other research has shown similar changes in rCBF and metabolism relating to improvement of depression either after spontaneous recovery (Bench, Frackowiak & Dolan, 1995) or after treatment with antidepressant medication  (Kennedy et al., 2001). Depression is thought to be associated with deficiencies in monoaminergic neurotransmission, and antidepressant medication is thought to act through enhancement of monoamines.
The observation that increased dopamine levels were only found in the ipsilateral striatal area (site of stimulation) was particularly interesting, because it suggests that the increased release was exerted through cortico-striatal projections from the targeted DLPFC (Strafella et al., 2001). In an animal model, GABAergic levels were increased in hippocampal regions and striatum, and reduced in hypothalamic regions after 15 days of LF-rTMS stimulation (Yue, Xiao-Lin & Tao, 2009).
It can be hypothesized that glutamate and GABA in this animal model is mediated by excitability levels. Several studies have focused on addressing this question by investigating specific clinical features. Subjects were investigated using two TBS protocols; a cTBS protocol which is thought to suppress excitability and an iTBS protocol which is known to generally cause an increase in excitability. The utility of genetic polymorphism in relation to predicting treatment response, in particular the BDNF gene, has potential. Repetitive transcranial magnetic stimulation in depression: Protocols, mechanisms and new developments. Enkelspoels elementen hebben niet veel output en zijn - bij veel oversturing- zeer gevoelig voor feedback en ruis. Wanneer dit in combinatie met een passief element wordt gedaan, dan wordt ook de ruis van dit element versterkt, niet erg praktisch dus.
Treatment with antidepressant medication is the most common and first line treatment for many individuals. This study marked the start of the serious pursuit of rTMS as a potential treatment option for depressed patients. Some other relevant parameters (intensity, number of trains, inter train interval and number of sessions) will be briefly described.
This was a randomized study in which 301 medication-free patients were treated with 10 Hz stimulation frequency. In the largest controlled study on LF-rTMS in depression, 130 patients were initially assigned to a stimulation protocol of either 1 or 2 Hz  (Fitzgerald et al., 2006). It was concluded that both treatment modalities appeared to be equally efficacious (Fitzgerald et al., 2009). It can be argued that this literal “rule of thumb” has some flaws and may result in inconsistent results between sessions within subjects.
Their findings did not show statistically significant changes between the active and sham group. Investigation of the number of sessions optimally required is important for gaining information about the temporal course of the antidepressant effect. This statement is further supported by the finding that early rTMS depression protocols have shown less favorable results compared to relatively newer, more promising protocols (Gross, Nakamura, Pascual-Leone & Fregni, 2007). However, the interested reader is referred to an excellent review by Wasserman and colleagues on this topic (Wassermann, Epstein & Ziemann, 2008).
In a study by our own group it was shown that using an auditory oddball paradigm, patients who were treated with HF-rTMS over left DLPFC showed localized changes on N1, P2, N2 and P300 amplitudes over left frontal areas, but not over the right frontal region. To the best of the author’s knowledge, only Luborzewski’s study (Luborzewski et al., 2007) investigated rTMS induced changes in levels of glutamate in depressed patients.
In one study, BDNF serum levels were assessed before and after a series of 5 rTMS sessions and considered in relation to treatment outcome as rated by the HAM-D. Muller and colleagues investigated BDNF mRNA expression in an animal model involving applying 55 HF-rTMS sessions over a period of 11 weeks. 3 pulses at a rate of 50 Hz) and the frequency of delivery of the number of bursts within one second which is at a rate of 5 per second (5 Hz). The application of the H-coil in the treatment of depression is currently under investigation in a multi-site trial.

As discussed previously in this section, several studies show treatment-induced changes on BDNF. Change in amplitude measures of the Motor Evoked Potential was taken as an outcome measure reflecting excitability.
Currently, rTMS is used for an increasing variety of applications such as the study of pathophysiology of diseases, the investigation of the contribution of certain brain regions to particular cognitive functions and, most relevant for this section, the treatment of psychiatric diseases. Subsequently, a reasonably large number of open label as well as randomized sham-controlled studies were performed. In a recent non-industry sponsored trial, George and colleagues (2010) demonstrated that 10 Hz HF-rTMS yielded a remission rate of 14% in the active group as compared to 5% in the sham. Of the 130 patients enrolled, approximately 51% could be classified as responders after 10 days of treatment. Hence, it is likely that different protocols act through different mechanisms and that different patient groups are susceptible to different approaches. Moreover, it may not target the DLPFC at all due to differences in head size and shape across individuals and––even more relevant––in the folding patterns of the cortex.
However, comparison of both groups on a partial response outcome (at least a 30% reduction in HAM-D score) showed a significantly higher response in the active rTMS group as compared to the sham group. The minimal output intensity which yields a motor response (moving of the thumb) in at least half of the applied trials is determined to be the MT.
Secondly, the repetitive release of strong electrical pulses causes heating of the electronics of the TMS device. Increasing knowledge about the mechanisms underlying treatment efficacy – the topic of the next section - may result in new protocols with closer to optimal treatment effects. Of clinical relevance, it was demonstrated that increases in rCBF in the L-DLPFC are related to significant improvement in clinical outcomes, and that increases in the R-DLPFC and subcortical regions mentioned above are negatively correlated with the change in depressive symptoms (Kito et al., 2008a). These results were interpreted as an increased positivity in the ERP, which was localized to the stimulated area only (Spronk et al., 2008). In these two studies, no correlation between the binding factors reflecting dopamine release and clinical outcome could be demonstrated. In addition, studies on serotonergic receptors and binding sites (which indirectly provide a measure of availability of certain neurotransmitters in the brain) after a single TMS session in a rat model showed an increase in serotonergic binding sites (Kole, Fuchs, Ziemann, Paulus & Ebert, 1999), and down-regulation of receptors in cortical as well as subcortical areas (Ben-Shachar, Gazawi, Riboyad-Levin & Klein, 1999; Gur, Lerer, Dremencov & Newman, 2000). Additionally, in an in vivo study of depressed patients with a specific focus on the nucleus accumbens, changes in glutamate levels were observed after successful treatment of 10 HF-rTMS sessions (Luborzewski et al., 2007).
More research on the release of GABA and glutamate by means of using in vivo techniques is needed to better specify the involvement of these neurotransmitters. Half of the participants (N=8) were treated with a LF-rTMS design, while the other half (N=8) were treated with a HF-rTMS design. They found significant increases in BDNF mRNA expression in the hippocampus (CA3 region) and parietal and piriform cortices. TBS can be applied as either a continuous (cTBS), or intermittent (iTBS) train (Huang, Edwards, Rounis, Bhatia & Rothwell, 2005).
They assigned 33 patients to different types of TBS-TMS treatment protocols over either left or right DLPFC. These results suggest that elderly patients and patients with a greater number of prior treatment failures are likely to benefit less from rTMS. To date, in respect to the rTMS treatment of depression several genetic polymorphisms have been proposed to be related to treatment outcome. The results showed that Met allele carriers had less (or no) rTMS induced changes in excitability; in both TBS protocols no changes in excitability in either direction were evident.
Despite some remarkable clinical results (Husain et al., 2004), ECT is a controversial and unpopular treatment option due to the required induction of a seizure and associated side-effects such as memory loss (Robertson and Pryor, 2006). The total number of intention to treat patients was 190, a group which was characterized by a highly treatment resistant depression. However, direct comparisons of the effect sizes of HF and LF-rTMS did not show a statistically significant difference.
It could also be argued that subjects in the add-on protocol received more sessions, and possibly needed longer to respond to treatment. In order to solve this problem, technical advances have enabled structural MRI based neuronavigation systems.
So if the intensity of a TMS protocol is 100% MT, then it is the same as the output intensity of the device which was determined to be MT.
It should be noted, however, that there are many methodological issues making interpretations from animal rTMS research difficult, such as the size of the head in relation to the coil size.
Despite the relatively high response rate, these findings should be regarded as preliminary and non-specific since no changes between different types of protocols were observed. However, this has not been confirmed by all studies in this area (Fitzgerald et al., 2006). In addition, Speer et al., (2009) correlated treatment outcome after 2 weeks of LF or HF-rTMS with pre-treatment baseline perfusion measures. This biomarker (labeled antidepressant treatment response (ATR) index) is measured from frontal electrode positions and is based on the proportion of relative and absolute Theta power. Highly speculatively, it can be argued that these results potentially indicate that this same group of Met carriers are less receptive to rTMS induced clinical improvement. The application of physiological predictors may better guide the parameters to be selected in the future.
De grootste speler in deze aktieve markt is EMG die al jaren bezig zijn om dit te perfectioneren.
In the practice of TMS, a subject is seated in a chair and an operator positions the coil above the scalp of the subject, tunes the stimulation parameters of the stimulator, and applies the TMS pulses.
Following initial positive results with depression, and due to its painless and non-invasive administration, rTMS has been proposed as a ‘better’ alternative to ECT (Paus & Barrett, 2004) or as an alternative for patients who may not be willing to undergo ECT, or for whom ECT may not be suitable.
Apart from these large multi-center studies, numerous single site studies applying stimulation frequencies of 10 Hz have been performed. The choice of the stimulation frequency is thus closely linked to the stimulation location.
Due to safety reasons for the subject and protection of the device, all devices are manufactured to automatically turn off as soon as a certain heat-limit has been reached. Responders showed lower pre-treatment glutamate levels, and showed the highest increase in glutamate after successful treatment (see also later section on ‘optimizing treatment’).
To the authors' knowledge, this is the only study that has investigated the antidepressant effect of TBS-TMS in the treatment of depression. In contrast, shorter duration of the depressive episode and high level of sleep disturbance are predictive of better treatment outcome  (Brakemeier et al., 2007). Baseline hypo-perfusion was associated with a more beneficial effect of HF-rTMS compared to LF-rTMS (Speer et al., 2009). In Daskalakis’s study it was shown that subjects who could be classified as ‘responders’ after 6 weeks of treatment scored higher on this ATR index. These have shown response (more than 50% decrease on the depression scale) rates between 30-50% (Avery et al.
Aside from the comparison of clinical effects, it appears that LF-rTMS is better tolerated i.e.
Of the three groups, patients who were treated with the unilateral LF-rTMS protocol benefited most from treatment. A series of software co-registrations are made between real anatomical points on the head (which are fixed in location) and the corresponding anatomical points in a three-dimensional reconstruction of the patient’s MRI scan. As these early reports indicate, current knowledge of the utility of EEG in the prediction of antidepressant treatment outcome is limited. Dit geeft het geluid een extra compressie en helderheid, een ideale combinatie in het Metal genre. This allows one to establish the scalp point that corresponds to a location on the brain scan that becomes the proposed target for TMS treatment. Although this determination of stimulation intensity may seem arbitrary, it takes individual differences in motor cortex excitability (and therefore excitability of other brain regions) into account. Similarly speculative are claims regarding the effects of rTMS on the third member of the monoaminergic group, noradrenalin (norepinephrine). Further limitations are that effects were not shown in a specific animal model of depression in any of these three studies.
It has, however, been proposed as having great potential for predicting response to rTMS in the treatment of depression. A more complicated process can also allow the position and orientation of the coil relative to the corresponding brain region to be monitored in real time.
However, the overheating of the device is still possible when multiple sessions are performed within a short period, or if a highly demanding (e.g. For example, it has been suggested that rTMS can potentially interact with specific EEG frequency patterns (Funk & George, 2008).
Notably, studies that have reported an advantage of ECT have compared an unlimited number of usually flexibly administered (unilateral or bilateral) ECT treatments to a fixed number of only one type of rTMS, potentially biasing the results of these studies.
BDNF plasma levels increased at the end of the treatment period, but solely in patients who could be classified as responders (>50% decrease in depressive symptoms as measured on the HAM-D scale) or partial responders (>25% decrease in depressive symptoms).
For a discussion on genetic polymorphisms and treatment outcome in human patients see the section ‘Optimizing treatment’. The majority of the depression protocols use stimulation intensities of 100% MT or 110% MT.
Train durations in HF-rTMS protocols are usually between 2 and 10 seconds with an ITI between 20-60 seconds. Together, these findings suggest that rTMS is indeed able to induce effects on BDNF levels. The finding that BDNF levels were changed only in the responder group suggests that the BDNF level is related to the clinical outcome, rather than simply a physiological effect. The group who received the individualized frequency showed a higher reduction in negative symptoms in comparison to the patients who were treated with standard stimulation frequencies. In addition, Luborzewski and colleagues (Luborzewski et al., 2007) have shown beneficial treatment effects in patients who had received 10 sessions of 20Hz rTMS. This is further supported by the finding that responses to HF and LF-rTMS appear to be similar. Due to the limited number of studies no definitive conclusions can be drawn, but results suggest that 5, 17 or 20 Hz stimulation frequencies do at least have antidepressant effect. This result, among others, suggests more beneficial outcomes for higher stimulation intensities. However, some reports have shown differential effects of different stimulation parameters, including a report of 9 Hz rTMS tending to be less beneficial than 10 Hz (Arns, 2010). However, in this study subjects were treated with a stimulation frequency of one Hz above their individualized alpha peak frequency. The results demonstrated this type of individualized stimulation frequency was not beneficial.
In contrast, this study suggested that there could be differential effects of different TMS stimulation frequencies; more specifically, 9 Hz yielded different effects compared to 10 Hz TMS. This was also shown in a study by Conca and colleagues (2000) who found that non-responders to rTMS had a slower alpha peak frequency.

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    Investigation and seek the regarded least a 3-day provide of nonperishable food, such as granola.
  2. Escalade writes:
    And wish, preserve most equipment building practices to create three walls with.
  3. POSSAJIR57 writes:
    And February 7, 1812 first, possibly it did camp for what ever.