Transcranial Brain Stimulation for Treatment of Psychiatric Disorders Advances in Biological Psychiatry Vol. 23 Series Editors D. Ebert, Freiburg K.P. Ebmeier, Oxford W.F. Gattaz, São Paulo W.P. Kaschka, Ulm Transcranial Brain Stimulation for Treatment of Psychiatric Disorders Volume Editors M.A. Marcolin, SãoPaulo F. Padberg, Munich 34 figures, 4 in color, and 19 tables, 2007 Basel·Freiburg·Paris·London·New York· Bangalore·Bangkok·Singapore·Tokyo·Sydney Marco Antonio Marcolin, MD, MPH, PhD Priv. Doz. Dr. med. Frank Padberg Institute of Psychiatry Department of Psychiatry and University of São Paulo Psychotherapy 05403-010 São Paulo (Brazil) Ludwig-Maximilian University Munich DE-80336 Munich (Germany) Library of Congress Cataloging-in-Publication Data Transcranial brain stimulation for treatment of psychiatric disorders / volume editors, M.A. Marcolin, F. Padberg. p. ; cm. – (Advances in biological psychiatry, ISSN 0378-7354 ; v. 23) Includes bibliographical references and indexes. ISBN-13: 978-3-8055-8186-8 (hard cover : alk. paper) 1. Transcranial brain stimulation. 2. Mental illness–Treatment. I. Marcolin, M. A. (Marco Antonio) II. Padberg, F. (Frank) III. Series. [DNLM: 1. Transcranial Magnetic Stimulation–methods. 2. Brain–physiology. 3. Deep Brain Stimulation–methods. 4. Electroconvulsive Therapy–methods. 5. Mental Disorders–therapy. W1 AD44 v.23 2007 / WL 141 T772 2007] RC386.6.M32T58 2007 616.89(cid:1)1–dc22 2007002876 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents®and Index Medicus. Disclaimer. The statements, options and data contained in this publication are solely those of the individ- ual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. © Copyright 2007 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN 0378–7354 ISBN 978–3–8055–8186–8 Contents VII Preface Electroconvulsive Therapy 1 Electroconvulsive Therapy: Update and New Research Eser, D.; Schüle, C.; Rupprecht, R.; Baghai, T.C. (Munich) Repetitive Transcranial Magnetic Stimulation: Mechanisms of Action 18 Repetitive Transcranial Magnetic Stimulation Effects in vitro and in Animal Models Keck, M.E. (Zurich) 35 Neuroimaging of Repetitive Transcranial Magnetic Stimulation Effects on the Brain George, M.S.; Bohning, D.E.; Li, X.; Nahas, Z.; Denslow, S.; Ramsey, D.; Roberts, D.R.; Johnson, K.; Ricci, R.; Borckardt, J.J. (Charleston, S.C.) Repetitive Transcranial Magnetic Stimulation: Clinical Applications 53 Efficacy and Safety of Prefrontal Repetitive Transcranial Magnetic Stimulation in Affective Disorders Padberg, F.; Grossheinrich, N.; Pogarell, O.; Möller, H.-J. (Munich); Fregni, F. (Boston, Mass.) V 84 Repetitive Transcranial Magnetic Stimulation in Augmentation of Antidepressant Drugs Rumi, D.O. (São Paulo); Conca, A. (Rankweil); Herwig, U. (Zurich); Gattaz, W.F.; Marcolin, M.A. (São Paulo) 97 Transcranial Magnetic Stimulation versus Electroconvulsive Therapy for the Treatment of More Severe Major Depression Janicak, P.G.; Dowd, S.M. (Chicago, Ill.); Marcolin, M.A.; Rosa, M.A. (São Paulo) 110 Transcranial Magnetic Stimulation in Schizophrenia Odebrecht Rosa, M. (São Paulo); Belmonte-de-Abreu, P. (Porto Alegre); Eichhammer, P.; Hajak, G. (Regensburg); Marcolin, M.A. (São Paulo) 124 Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder and Other Anxiety Disorders Pridmore, S. (Hobart); Marcolin, M.A.; Ribeiro, C.S.; Mansur, C.G. (São Paulo) 134 Repetitive Transcranial Magnetic Stimulation in Non-Psychiatric Disorders: Pain, Parkinson's Disease, Stroke, Tinnitus Lefaucheur, J.-P. (Créteil); Khedr, E.M. (Assiut) Other Approaches: Magnetic Seizure Therapy, Transcranial Direct Current Stimulation 155 Magnetic Seizure Therapy for the Treatment of Depression Lisanby, S.H.; Peterchev, A.V. (New York, N.Y.) 172 Induction and Modulation of Neuroplasticity by Transcranial Direct Current Stimulation Nitsche, M.A.; Antal, A.; Liebetanz, D.; Lang, N.; Tergau, F.; Paulus, W. (Göttingen) Recent Developments and Perspectives 187 Theta Burst Stimulation Huang, Y.-Z. (Taipei); Rothwell, J.C. (London) 204 Transcranial Magnetic Stimulation of Deep Brain Regions: Principles and Methods Roth, Y. (Tel Hashomer); Padberg, F. (Munich); Zangen, A. (Rehovot) 225 Author Index 226 Subject Index Contents VI Preface Modern neuropsychopharmacology has led to important insights into the pathophysiology of mental disorders and the development of effective drugs since the 1950s. More recently, findings derived from functional neuroimaging studies have emphasized the neuroanatomical perspective in mental disorders. This is directly linked to the idea of focally stimulating distinct brain regions in order to exert therapeutic effects. Many different brain stimulation approaches have been considered during the last decades and some of them have been developed into effective therapeu- tic interventions. Electroconvulsive therapy (ECT), for example, is a well- established treatment for depression and catatonia, and deep brain stimulation (DBS) is widely applied in patients suffering from severe Parkinson’s disease. Many of these methods converge in terms of underlying mechanisms of action based on fundamental principles of brain function. Sometimes they even show common neurobiological effects, demonstrated by functional neuroimaging, neurophysiology methods and molecular neuroscience techniques. One exam- ple are the effects of antidepressant interventions on regional cerebral activity demonstrated by functional neuroimaging: antidepressant drugs and ECT as well as DBS of the subgenual cingulate cortex, which has most recently been investigated [Mayberg et al., 2005], act in a similar manner on dysfunctional regional brain activity in depression, i.e. modulating limbic and paralimbic brain activity in rest towards a state normally observed in healthy volunteers and associated with mental health. However, it is often difficult or impossible to identify the key mechanisms of action and to distinguish them from epiphenomena VII purely associated with the recovery from disease, but not related to a specific action of an intervention. The different brain stimulation methods can principally be distinguished by specific characteristics. (1) They act on neuronal circuits through various neuroanatomic ‘windows’. In some interventions these ‘windows’ can be defined in terms of neuroanatomic structures as in vagal nerve stimulation (VNS), DBS or repetitive transcranial magnetic stimulation (rTMS), and in some interventions the action on the brain is not focal at all as in ECT, magnetic seizure therapy (MST) and transcranial direct current stimulation (tDCS). (2) The methods range in terms of their invasiveness from practically noninvasive approaches (rTMS, tDCS), to ECT and MST, which provoke an epileptic seizure, require general anesthesia and may somehow be regarded as ‘more invasive’than rTMS and tDCS, to clearly invasive techniques (VNS and DBS) where stimulation electrodes and a neurostimulator are implanted. (3) Finally, they differ in terms of the duration of the intervention, i.e. ECT, rTMS, MST and tDCS represent acute treatments normally applied over several weeks and rarely extended towards maintenance treatment, whereas VNS and DBS work through a permanent stimulator and are per se long-term treatment strategies, particularly suitable for chronic or frequently relapsing disorders. Our book focuses on transcranially applied, non- or low-invasive interven- tions not requiring surgery, i.e. ECT, rTMS, MST and tDCS. Recent progress in this field has prompted us to edit this book in order to provide an overview on this spectrum of fascinating techniques – not only for scientists, but also for clinicians who are interested in these methods and who may even consider applying one or the other approach for the treatment of their patients. However, it is important to emphasize that the different methods are at different stages of development in specific disorders. To reflect this range, the book contains a state-of-the-art chapter on ECT, which still represents a kind of gold standard in this field. It reviews more recent methods, particularly rTMS, which is just about to become clinically applicable as treatment for several mental disorders and introduces the most recent achievements: MST, tDCS and two novel vari- ants of rTMS, i.e. theta burst stimulation and deep rTMS. The latter chapters do not present ready-to-use approaches, but are thought to stimulate a wider interest in methodology and trigger a substantial discussion about options for method development which is clearly needed in this field. We are extremely grateful to our colleagues who have spent their valuable time writing for this book, despite the large number of publication duties a scientist faces in our times. All authors have contributed to the benefit of our readers. Moreover, we thank the staff of S. Karger AG, Basel for their Preface VIII excellent, accurate and speedy work during the editorial process. Finally, we particularly acknowledge the initiative and the input of the series editors (K.P. Ebmeier, W.P. Kaschka, D. Ebert and W.F. Gattaz) who made this book possible. Marco Antonio Marcolin Frank Padberg São Paulo and Munich Reference Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH: Deep brain stimulation for treatment-resistant depression. Neuron 2005;45:651–660. Preface IX