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1.
Background
the influence of pulse width, pulse waveform and current direction on transcranial magnetic stimulation (TMS) outcomes is of critical importance. However, their effects have only been investigated indirectly with motor-evoked potentials (MEP). By combining TMS and EEG it is possible to examine how these factors affect evoked activity from the cortex and compare that with the effects on MEP.Objective
we used a new controllable TMS device (cTMS) to vary systematically pulse width, pulse waveform and current direction and explore their effects on global and local TMS-evoked EEG response.Methods
In 19 healthy volunteers we measured (1) resting motor threshold (RMT) as an estimate of corticospinal excitability; (2) global mean field power (GMFP) as an estimate of global cortical excitability; and (3) local mean field power (LMFP) as an estimate of local cortical excitability.Results
RMT was lower with monophasic posterior-to-anterior (PA) pulses that have a longer pulse width (p?<?0.001). After adjusting for the individual motor threshold of each pulse type we found that (a) GMFP was higher with monophasic pulses (p?<?0.001); (b) LMFP was higher with longer pulse width (p?=?0.015); (c) early TEP polarity was modulated depending on the current direction (p?=?0.01).Conclusions
Despite normalizing stimulus intensity to RMT, we found that local and global responses to TMS vary depending on pulse parameters. Since EEG responses can vary independently of the MEP, titrating parameters of TMS in relation to MEP threshold is not a useful way of ensuring that a constant set of neurons is activated within a cortical area. 相似文献2.
Martin Sommer Matteo Ciocca Raffaella Chieffo Paul Hammond Andreas Neef Walter Paulus John C. Rothwell Ricci Hannah 《Brain stimulation》2018,11(3):558-565
Background
Biphasic pulses produced by most commercially available TMS machines have a cosine waveform, which makes it difficult to study the interaction between the two phases of stimulation.Objective
We used a controllable pulse TMS (cTMS) device delivering quasi-rectangular pulse outputs to investigate whether monophasic are more effective than biphasic pulses.Methods
Temporally symmetric (“biphasic”) or highly asymmetric (“monophasic”) charge-balanced biphasic stimuli were used to target the hand area of motor cortex in the anterior-posterior (AP) or posterior-anterior (PA) initial current direction.Results
We observed the lowest motor thresholds and shortest motor evoked potential (MEP) latencies with initial PA pulses, and highest thresholds and longest latencies with AP pulses. Increasing pulse symmetry tended to increase threshold with a PA direction whereas it lowered thresholds and shortened latencies with an AP direction. Furthermore, it steepened the MEP input-output curve with both directions.Conclusions
“Biphasic” TMS pulses can be viewed as two monophasic pulses of opposite directions, each stimulating a different set of interneurons with different thresholds (PA?<?AP). At threshold, the reverse phase of an initially PA pulse increases threshold compared with “monophasic” stimulation. At higher intensities, the reverse phase begins to activate AP-sensitive neurones and increase the effectiveness of stimulation above that of a “monophasic” PA pulse. “Biphasic” stimulation with initially AP pulses is dominated at threshold by activation produced by the lower threshold reverse (PA) phase.Significance
The effects of biphasic stimulation are best understood as the summed output of two independent sets of directionally selective neural populations. 相似文献3.
Michele Dileone Laura Mordillo-Mateos Antonio Oliviero Guglielmo Foffani 《Brain stimulation》2018,11(4):676-688
Background
Transcranial static magnetic field stimulation (tSMS) was recently added to the family of inhibitory non-invasive brain stimulation techniques. However, the application of tSMS for 10–20?min over the motor cortex (M1) induces only short-lasting effects that revert within few minutes.Objective
We examined whether increasing the duration of tSMS to 30?min leads to long-lasting changes in cortical excitability, which is critical for translating tSMS toward clinical applications.Methods
The study comprised 5 experiments in 45 healthy subjects. We assessed the impact of 30-min-tSMS over M1 on corticospinal excitability, as measured by the amplitude of motor evoked potentials (MEPs) and resting motor thresholds (RMTs) to single-pulse transcranial magnetic stimulation (TMS) (experiments 1–2). We then assessed the impact of 30-min-tSMS on intracortical excitability, as measured by short-interval intracortical facilitation (SICF) and short-interval intracortical inhibition (SICI) using paired-pulse TMS protocols (experiments 2–4). We finally assessed the impact of 10-min-tSMS on SICF and SICI (experiment 5).Results
30-min-tSMS decreased MEP amplitude compared to sham for at least 30?min after the end of the stimulation. This long-lasting effect was associated with increased SICF and reduced SICI. 10-min-tSMS –previously reported to induce a short-lasting decrease in MEP amplitude– produced the opposite changes in intracortical excitability, decreasing SICF while increasing SICI.Conclusions
These results suggest a dissociation of intracortical changes in the consolidation from short-lasting to long-lasting decrease of corticospinal excitability induced by tSMS. The long-lasting effects of 30-min-tSMS open the way to the translation of this simple, portable and low-cost technique toward clinical trials. 相似文献4.
Background
Movement simulation helps increasing the chances to reach goals. A cognitive task used to study the neuro-behavioral aspects of movement simulation is mental rotation: people mentally re-orient rotated pictures of hands. However, the involvement of the primary motor cortex (M1) in mental rotation is largely controversial.Hypothesis
Such inconsistency could arise from potential methodological flaws in experimental procedures and data analysis. In particular, until now, the timing of M1 activity has been computed in absolute terms: from the onset of mental rotation (onset-locked), neglecting intra- and inter-subject variability.Methods
A novel phase-locked approach is introduced to synchronize the same phases of cognitive processing among different subjects and sessions. This approach was validated in the particular case of corticospinal excitability of the motor cortex during mental rotation.Results
We identified the relative time-windows during which the excitability of M1 is effector-specifically modulated by different features of mental rotation. These time windows correspond to the 55%–85% of the subjective timing.Conclusions
In sum, (i) we introduce a new method to study the neurophysiology of motor cognition, and (ii) validating this method, we shed new light on the involvement of M1 in movement simulation. 相似文献5.
Xiaoming Du Laura M. Rowland Ann Summerfelt Andrea Wijtenburg Joshua Chiappelli Krista Wisner Peter Kochunov Fow-Sen Choa L. Elliot Hong 《Brain stimulation》2018,11(5):1071-1079
Background
Animal studies suggest that synchronized electrical activities in the brain are regulated by the primary inhibitory and excitatory neurotransmitters gamma-aminobutyric acid (GABA) and glutamate, respectively. Identifying direct evidence that this same basic chemical-electrical neuroscience principle operates in the human brains is critical for translation of neuroscience to pathological research.Objective/Hypothesis
We hypothesize that the background neurochemical concentrations may affect the cortical excitability probed by transcranial magnetic stimulation (TMS).Methods
We used TMS with simultaneous evoked potential recording to probe the cortical excitability and determined how background frontal cortical GABA and glutamate levels measured using magnetic resonance spectroscopy (MRS) modulate frontal electrical activities.Results
We found that TMS-evoked N100 reflects a balance between GABA-inhibitory and glutamate-excitatory levels. About 46% of individual variances in frontal N100 can be explained by their glutamate/GABA ratio (r?=??0.68, p?=?0.001). Both glutamate (r?=??0.51, p?=?0.019) and GABA (r?=?0.55, p?=?0.01) significantly contributed to this relationship but in opposite directions.Conclusion
The current finding encourages additional mechanistic studies to develop TMS evoked N100 as a potential electrophysiological biomarker for translating the known inhibitory GABAergic vs. excitatory glutamatergic chemical-electrical principle from animal brain studies to human brain studies. 相似文献6.
Natalie Schaworonkow Jochen Triesch Ulf Ziemann Christoph Zrenner 《Brain stimulation》2019,12(1):110-118
Background
Corticospinal excitability depends on the current brain state. The recent development of real-time EEG-triggered transcranial magnetic stimulation (EEG-TMS) allows studying this relationship in a causal fashion. Specifically, it has been shown that corticospinal excitability is higher during the scalp surface negative EEG peak compared to the positive peak of μ-oscillations in sensorimotor cortex, as indexed by larger motor evoked potentials (MEPs) for fixed stimulation intensity.Objective
We further characterize the effect of μ-rhythm phase on the MEP input-output (IO) curve by measuring the degree of excitability modulation across a range of stimulation intensities. We furthermore seek to optimize stimulation parameters to enable discrimination of functionally relevant EEG-defined brain states.Methods
A real-time EEG-TMS system was used to trigger MEPs during instantaneous brain-states corresponding to μ-rhythm surface positive and negative peaks with five different stimulation intensities covering an individually calibrated MEP IO curve in 15 healthy participants.Results
MEP amplitude is modulated by μ-phase across a wide range of stimulation intensities, with larger MEPs at the surface negative peak. The largest relative MEP-modulation was observed for weak intensities, the largest absolute MEP-modulation for intermediate intensities. These results indicate a leftward shift of the MEP IO curve during the μ-rhythm negative peak.Conclusion
The choice of stimulation intensity influences the observed degree of corticospinal excitability modulation by μ-phase. Lower stimulation intensities enable more efficient differentiation of EEG μ-phase-defined brain states. 相似文献7.
8.
Takuya Sasaki Satoshi Kodama Naohiko Togashi Yuichiro Shirota Yusuke Sugiyama Shin-ichi Tokushige Satomi Inomata-Terada Yasuo Terao Yoshikazu Ugawa Masashi Hamada 《Brain stimulation》2018,11(2):400-410
Background
Responses to continuous theta burst stimulation (cTBS) applied to the human primary motor cortex are highly variable between individuals. However, little is known about how to improve the after-effects of cTBS by adjusting the protocol characteristics.Objective
We examined whether current directions adopted in the measurement of cortical motor excitability indexed as motor evoked potentials (MEPs) affect the responses to cTBS. We also tested whether the stimulus intensity of cTBS influences the after-effects.Methods
Thirty-one healthy volunteers participated. The after-effects of cTBS with the conventional intensity of 80% of individual active motor threshold (AMT) (cTBS80%) were tested by measuring MEP amplitudes induced by not only posterior-anterior (PA) but also anterior-posterior (AP) and biphasic (PA-AP) currents. We also investigated cTBS with 65% AMT (cTBS65%) and 100% AMT (cTBS100%) in subjects who showed depression of MEP amplitudes after cTBS80%, as well as cTBS65% in subjects in whom facilitation of MEPs was induced by cTBS80%.Results
Current directions in MEP measurement had no influence on the cTBS responses. In subjects whose MEPs were depressed by cTBS80%, cTBS100% partly induced MEP facilitation, while cTBS65% abolished the after-effects. In subjects who showed MEP facilitation by cTBS80%, cTBS65% partly induced MEP depression.Conclusions
Stimulus intensity of cTBS influenced the responses to cTBS, and lowering stimulus intensity induced the expected after-effects of cTBS in some subjects. 相似文献9.
Martin Schecklmann Carmen Weidler Peter Eichhammer Göran Hajak Berthold Langguth 《Brain stimulation》2018,11(5):1080-1082
Background
Schizophrenia is associated with changes in inhibitory and facilitatory brain networks which can be assessed by motor cortex excitability.Objective
Here, we investigate differences between large cross-sectional samples of un-medicated and medicated patients with schizophrenia and healthy controls in single- and double-pulse transcranial magnetic stimulation parameters.Methods
We measured right abductor digiti minimi muscle activity in 71 un-medicated, 43 medicated patients and 131 healthy controls. To exclude sample bias analyses were repeated with groups comparable for age and gender (un-medicated: n?=?43; medicated: n?=?38; controls: n?=?49).Results
Un-medicated patients showed increased short-interval intracortical inhibition (SICI) in contrast to medicated patients and healthy controls. No group differences were found for resting and active motor threshold, cortical silent period and intracortical facilitation.Conclusion
Increases in SICI are in contrast to literature and highlight the necessity for large-scaled multi-centric studies with high methodological standards. 相似文献10.
Elisa Kallioniemi Petri Savolainen Gustaf Järnefelt Päivi Koskenkorva Jari Karhu Petro Julkunen 《Brain stimulation》2018,11(2):322-326
Background
Transcranial magnetic stimulation (TMS) induced I-wave behavior can be demonstrated at neuronal population level using paired-pulses and by observing short-interval cortical facilitation (SICF). Advancements in stimulator technology have made it possible to apply biphasic paired-pulses to induce SICF.Objective
Our aim was to characterize the SICF I-wave interaction by biphasic paired-pulses with the ultimate objective to enhance TMS effects via SICF in various TMS-applications.Methods
We used biphasic paired-pulses in 15 volunteers to characterize corticospinal SICF using various 1.2–8.0ms inter-stimulus intervals, and measuring SICF input-output response.Results
SICF interaction with the first I-wave (I1) was observed in the output responses (motor evoked potentials; MEPs) in all subjects. Most subjects (≥80%) also exhibited later SICF I-wave interaction. SICF at I1 was present at all applied intensities below 140% of resting motor threshold. At I2, we observed SICF only with intensities just above motor threshold.Conclusions
Biphasic paired-pulses can reliably induce SICF shown by the facilitatory I-wave interaction, and could therefore be applied with repetitive bursts to enhance responsiveness to TMS. 相似文献11.
Dalia Khammash Molly Simmonite Thad A. Polk Stephan F. Taylor Sean K. Meehan 《Brain stimulation》2019,12(3):702-704
Background
Transcranial magnetic stimulation (TMS) is a non-invasive method to stimulate localized brain regions. Despite widespread use in motor cortex, TMS is seldom performed in sensory areas due to variable, qualitative metrics.Objective
Assess the reliability and validity of tracing phosphenes, and to investigate the stimulation parameters necessary to elicit decreased visual cortex excitability with paired-pulse TMS at short inter-stimulus intervals.Methods
Across two sessions, single and paired-pulse recruitment curves were derived by having participants outline elicited phosphenes and calculating resulting average phosphene sizes.Results
Phosphene size scaled with stimulus intensity, similar to motor cortex. Paired-pulse recruitment curves demonstrated inhibition at lower conditioning stimulus intensities than observed in motor cortex. Reliability was high across sessions.Conclusions
TMS-induced phosphenes are a valid and reliable tool for measuring cortical excitability and inhibition in early visual areas. Our results also provide appropriate stimulation parameters for measuring short-latency intracortical inhibition in visual cortex. 相似文献12.
Background
There has been increased interest in the potential use of transcranial direct current stimulation (tDCS) as treatment for multiple conditions including depression, pain, and cognitive impairment. However, few studies account for the possible influence of comorbid medications when conducting tDCS research.Objective/Hypothesis
This literature review was conducted to examine what is currently known about the impact of medications on tDCS, provide recommendations for future research practices, and highlight areas where more research is needed.Methods
Key terms were searched in PubMed and Web of Science to identify studies that examine the impact of medication on tDCS effects in adults. Relevant papers' reference lists were also reviewed for thoroughness. Studies examined the effects of medication on 1 mA tDCS delivered to M1 (motor) and orbit/supraorbital (SO) area. All studies measured the effects of tDCS via MEP TMS paradigm.Results
Results of the literature review suggest multiple classes of medications, including sodium and calcium channel blockers, and medications that influence various neurotransmitter systems (GABA, dopamine, serotonin, etc.) may all impact tDCS effects on tissue excitability.Conclusions
Research to date suggests multiple classes of medications may impact tDCS effects. These results highlight the importance of documenting medication use in research subjects and carefully considering what types of medications should be allowed into tDCS trials. Many questions still remain regarding the exact mechanisms of action for tDCS and how various parameters (medication dosages, tDCS stimulation intensity, etc.) may further impact the effects of medications on tDCS. 相似文献13.
Background
Despite recent developments in navigation and modeling techniques, the type and location of the structures that are activated by transcranial magnetic stimulation (TMS) remain unknown.Objective
We studied the relationships between electrophysiological measurements and electric fields induced in the brain to locate the TMS activation site.Methods
The active and resting motor thresholds of the first dorsal interosseous muscle were recorded in 19 subjects (7 female, 12 male, age 22 ± 4 years) using anteromedially oriented monophasic TMS at multiple locations over the left primary motor cortex (M1). Structural MR images were used to construct electric field models of each subject's head and brain. The cortical activation site was estimated by finding where the calculated electric fields best explained the coil-location dependency of the measured MTs.Results
The experiments and modeling showed individual variations both in the measured motor thresholds (MTs) and in the computed electric fields. When the TMS coil was moved on the scalp, the calculated electric fields in the hand knob region were shown to vary consistently with the measured MTs. Group-level analysis indicated that the electric fields were significantly correlated with the measured MTs. The strongest correlations (R2 = 0.69), which indicated the most likely activation site, were found in the ventral and lateral part of the hand knob. The site was independent of voluntary contractions of the target muscle.Conclusion
The study showed that TMS combined with personalized electric field modeling can be used for high-resolution mapping of the motor cortex. 相似文献14.
Robert Guggenberger Dominic Kraus Georgios Naros Maria Teresa Leão Ulf Ziemann Alireza Gharabaghi 《Brain stimulation》2018,11(6):1331-1335
Background
Pairing cortical and peripheral input during motor imagery (MI)-related sensorimotor desynchronization (ERD) modulates corticospinal excitability at the cortical representation (hotspot) of the imagined movement.Objective
To determine the effects of this associative stimulation protocol on the cortical motor map beyond the hotspot.Methods
In healthy subjects, peripheral stimulation through passive hand opening by a robotic orthosis and single-pulse transcranial magnetic stimulation to the respective cortical motor representation were applied in a brain-machine interface environment. State-dependency was investigated by concurrent, delayed or non-specific stimulation with respect to ERD in the beta-band (16–22?Hz) during MI of finger extension.Results
Concurrent stimulation led to increased excitability of an extended motor map. Delayed and non-specific stimulation led to heterogeneous changes, i.e., opposite patterns of increased excitability in either the center or the periphery of the motor map.Conclusion
These results could be instrumental in closed-loop, state-dependent stimulation in the context of neurorehabilitation. 相似文献15.
Jose Gomez-Tames Atsushi Hamasaka Ilkka Laakso Akimasa Hirata Yoshikazu Ugawa 《Brain stimulation》2018,11(4):839-848
Background
Transcranial magnetic stimulation (TMS) activates target brain structures in a non-invasive manner. The optimal orientation of the TMS coil for the motor cortex is well known and can be estimated using motor evoked potentials. However, there are no easily measurable responses for activation of other cortical areas and the optimal orientation for these areas is currently unknown.Objective
This study investigated the electric field strength, optimal coil orientation, and relative locations to optimally stimulate the target cortex based on computed electric field distributions.Methods
A total of 518,616 stimulation scenarios were studied using realistic head models (2401 coil locations?×?12 coil angles?×?18 head models). Inter-subject registration methods were used to generate an atlas of optimized TMS coil orientations on locations on the standard brain.Results
We found that the maximum electric field strength is greater in primary somatosensory cortex and primary motor cortex than in other cortical areas. Additionally, a universal optimal coil orientation applicable to most subjects is more feasible at the primary somatosensory cortex and primary motor cortex. We confirmed that optimal coil angle follows the anatomical shape of the hand motor area to realize personalized optimization of TMS. Finally, on average, the optimal coil positions for TMS on the scalp deviated 5.5?mm from the scalp points with minimum cortex-scalp distance. This deviation was minimal at the premotor cortex and primary motor cortex.Conclusion
Personalized optimal coil orientation is preferable for obtaining the most effective stimulation. 相似文献16.
Samuel S. Shin Vijai Krishnan William Stokes Courtney Robertson Pablo Celnik Yanrong Chen Xiaolei Song Hanzhang Lu Peiying Liu Galit Pelled 《Brain stimulation》2018,11(6):1306-1313
Background
Therapeutic strategies for traumatic brain injury (TBI) in the last three decades have failed to show significant benefit in large scale studies. Given the multitude of pathological mechanisms involved in TBI, strategies focusing on multimodality regimen have gained interest as promising future interventions.Hypothesis
We hypothesized that combining noninvasive transcranial magnetic stimulation (TMS) with rehabilitative training in an environmental enrichment (EE) can facilitate post-TBI recovery in rats via cortical excitability and reorganization.Methods
We subjected rats to controlled cortical impact, and then assigned them to one of four groups: 1. No treatments (TBI), 2. EE after injury (TBI + EE), 3. TMS for one week (TBI + TMS), and 4. TMS for one week combined with EE (TBI + TMS/EE). For TMS, a 10 Hz repetitive TMS protocol was used.Results
At 7 days, TBI + TMS and TBI + TMS/EE groups had significantly increased primary somatosensory cortex local field potential (LFP) compared to TBI and TBI + EE groups (P < 0.05). Also, TBI + TMS/EE group had significantly improved performance on beam walk test compared to TBI group (P < 0.005). At 6 weeks, there was significantly higher response in TBI + TMS/EE group compared to TBI + TMS for somatosensory cortex LFP (P < 0.05), bicep motor evoked potentials (MEP) (P < 0.05), challenge ladder test performance (P < 0.01), and fMRI responses to tactile forepaw stimulation.Conclusions
We demonstrate here for the first time the mechanism by which combined therapy using TMS and EE after TBI leads to functional improvement, possibly via cortical excitability and reorganization. 相似文献17.
Yeowool Huh Dahee Jung Taeyoon Seo Sukkyu Sun Su Hyun Kim Hyewhon Rhim Sooyoung Chung Chong-Hyun Kim Youngwoo Kwon Marom Bikson Yong-an Chung Jeansok J. Kim Jeiwon Cho 《Brain stimulation》2018,11(5):1151-1160
Background
The bursting pattern of thalamocortical (TC) pathway dampens nociception. Whether brain stimulation mimicking endogenous patterns can engage similar sensory gating processes in the cortex and reduce nociceptive behaviors remains uninvestigated.Objective
We investigated the role of cortical parvalbumin expressing (PV) interneurons within the TC circuit in gating nociception and their selective response to TC burst patterns. We then tested if transcranial magnetic stimulation (TMS) patterned on endogenous nociceptive TC bursting modulate nociceptive behaviors.Methods
The switching of TC neurons between tonic (single spike) and burst (high frequency spikes) firing modes may be a critical component in modulating nociceptive signals. Deep brain electrical stimulation of TC neurons and immunohistochemistry were used to examine the differential influence of each firing mode on cortical PV interneuron activity. Optogenetic stimulation of cortical PV interneurons assessed a direct role in nociceptive modulation. A new TMS protocol mimicking thalamic burst firing patterns, contrasted with conventional continuous and intermittent theta burst protocols, tested if TMS patterned on endogenous TC activity reduces nociceptive behaviors in mice.Results
Immunohistochemical evidence confirmed that burst, but not tonic, deep brain stimulation of TC neurons increased the activity of PV interneurons in the cortex. Both optogenetic activation of PV interneurons and TMS protocol mimicking thalamic burst reduced nociceptive behaviors.Conclusions
Our findings suggest that burst firing of TC neurons recruits PV interneurons in the cortex to reduce nociceptive behaviors and that neuromodulation mimicking thalamic burst firing may be useful for modulating nociception. 相似文献18.
Pedro Caldana Gordon Debora Desideri Paolo Belardinelli Christoph Zrenner Ulf Ziemann 《Brain stimulation》2018,11(6):1322-1330
Background
The analysis of cortical responses to transcranial magnetic stimulation (TMS) recorded by electroencephalography (EEG) has been successfully applied to study human cortical physiology. However, in addition to the (desired) activation of cortical neurons and fibers, TMS also causes (undesired) indirect brain responses through auditory and somatosensory stimulation, which may contribute significantly to the overall EEG signal and mask the effects of intervention on direct cortical responses.Objectives
To test differences in EEG responses to real TMS at intensities above and below resting motor threshold (RMT) and a realistic sham stimulation.Methods
12 healthy subjects participated in one session in which single-pulse TMS was applied to the left motor cortex in 3 different blocks, 150 pulses per block: 110%RMT, 90%RMT and realistic sham stimulation. Cortical responses were collected by a 64 electrode EEG system. TMS evoked potentials (TEPs) and TMS induced oscillations were analyzed.Methods
12 healthy subjects participated in one session in which single-pulse TMS was applied to the left motor cortex in 3 different blocks, 150 pulses per block: 110%RMT, 90%RMT and realistic sham stimulation. Cortical responses were collected by a 64-channel EEG system. TMS evoked potentials (TEPs) and TMS induced oscillations were analyzed.Results
TEPs from all conditions differed significantly, with TEPs from 110%RMT showing overall highest amplitudes and realistic sham lowest amplitudes. Sham stimulation had only minor effects on induced cortical oscillations compared to pre-stimulus baseline, TMS at 90%RMT resulted in a significant increase (50–200?m?s) followed by a decrease (200–500?m?s) in power of alpha and beta oscillations; TMS at 110% RMT led to an additional increase in beta power at late latencies (650–800?m?s).Conclusions
Real TMS of motor cortex results in cortical responses significantly different from realistic sham. These differences very likely reflect to a significant extent direct activation of neurons, rather than sensory evoked activity. 相似文献19.
Background
TMS is safe and effective in the treatment of MDD, but as with other treatments, relapse may occur on cessation of treatment.Objective
To prevent relapse in MDD, following successful acute TMS treatment.Method
5 TMS treatments over 3 days, repeated at about monthly intervals.Results
14 patients received this care for more than 12 months. At the commencement of each series the mood scores were close to relapse, but at completion they were in the remitted range.Conclusion
Such treatment is useful. It is better conceptualized as relapse prevention rather than remittance maintenance. 相似文献20.