Electrical brain Electrical brain activity following activity following

magnetic magnetic stimulation as stimulation as recorded with recorded with

high-resolution high-resolution QQEEGEEG

www.biomag-hus.fi/tmswww.biomag-hus.fi/tms

rTMSrTMS

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

rTMS gives short pulses of magnetic energy to Limbic system structures

How How does does rTMS rTMS wwork for brain electrical ork for brain electrical activity?activity?

Small electric charges can cause the neurons to fire or to become active

How How does does rTMS rTMS wwork for brain electrical activity?ork for brain electrical activity?

Ilmoniemi et.al.(1997) Ilmoniemi et.al.(1997) were able towere able to measuremeasure with with QQEEG just seconds after EEG just seconds after

electromagnetic pulseelectromagnetic pulse

Nashaat et.al (2001),Nikulin et.al (2003), Kommsi et.al (2004)

have used ongoing rTMS and QEEG Monitoring

Brain electrical activity changes Brain electrical activity changes with rTMSwith 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 tendency to

increase

Resynchronization effectsResynchronization 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)

GABA and QEEGGABA and QEEG

GABA increases functional connectivity on QEEG (Benzodiazepine effect)

GABA decreases with stressGABA decreases in plasma and in brain

(MRS) of depressed patientsECT increases GABA level in depressed

patients.rTMS: increase ?

State marker improves after treatment

Trait marker doesn’t improve after treatment

‘‘State markerState markers’s’ of of QEEG beingQEEG being::

Ratio of Alpha waves Ratio of Delta wavesHemispheric asymmetryAlpha/Delta ratio of the frontal area

Acute drug effect in QEEGAcute drug effect in QEEG

Tricyclic Antidepressant drugs: Alpha, Theta, Delta

Antipsychotic drugs :Theta and Delta wavesAntianxiety drugs :betaCognitive activator drugs : Alpha SSRI drugs: Alpha (Itil 1989)

The Response The Response to drug tto drug treatment in reatment in depressiondepression

• Delta waves: good response,

• Alpha and Beta waves: good response,

• Unchanged QEEG: bad response.

(Kendler)

The Distribution of Brain waves in The Distribution of Brain waves in QEEG QEEG after 10 sessionafter 10 sessions ofs of rTMS rTMS

(preliminary findings)(preliminary findings)

After Treatment After Treatment Frequency RateFrequency Rate NN %%

Delta / AlDelta / Alphpha Rata Ratee

A . Delta increaseA . Delta increase 6767 46.246.2

B. AlB. Alphpha increasea increase 5757 39.339.3

C. No changeC. No change 2020 13.713.7

D. DifferentD. Different 11 0.60.6

TotalTotal 145145 100100

According to HAM ScoreAccording to HAM Scoress

Improvement rate ofImprovement rate of

The Delta increase The Delta increase group group

N:67N:67

+ + + +

Improvement rate ofImprovement rate of

The Alpha increase The Alpha increase groupgroup

N:57N:57

+ + ++ + +

No changes groupNo changes group

N:20N:20++

HAM ScoresHAM Scores and QEEG and QEEG after 10 sessions of rTMS after 10 sessions of rTMS

“An i“An interpretationnterpretation””All patients All patients showed showed 30- 30-550% treatment 0% treatment

responseresponse In In AlAlphpha increases groupa increases group,, HAM HAM

improvementimprovement was was greatergreater In nIn no changes o changes group, group, HAM improvement HAM improvement

was minimalwas minimalMore verification, and MEG studies,More verification, and MEG studies,

are necessary are necessary

PregnancyPregnancy and rTMS and rTMS Case Study (I) Case Study (I)

One case (I.D., 32 yOne case (I.D., 32 yearsears))She She hadhad serious serious non-psychotic non-psychotic Chronic Chronic

Major DepressionMajor Depression..She used antiepileptic She used antiepileptic

and antidepressant drugs.and antidepressant drugs.She became pregnant during treatment.She became pregnant during treatment.She wantShe wanted ed to continue to continue the the pregnancy.pregnancy.

Pregnancy Pregnancy and rTMS and rTMS Case Study (II)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.After birth, rTMS was continued.

FFrequencyrequency of seizures 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)

25 Hz, 1 Pulses, 50% Power25 Hz, 1 Pulses, 50% Power

25 Hz, 1 Pulses, 100% Power25 Hz, 1 Pulses, 100% Power

25 Hz, 3 Pulses, 100% Power25 Hz, 3 Pulses, 100% Power

5 Hz, 10 Pulses, 50% Power, Duration 1.8 sec5 Hz, 10 Pulses, 50% Power, Duration 1.8 sec

5 Hz, 10 Pulses, 75% Power, Duration 1.8 sec5 Hz, 10 Pulses, 75% Power, Duration 1.8 sec

5 Hz, 10 Pulses, 100% Power, Duration 1.8 sec5 Hz, 10 Pulses, 100% Power, Duration 1.8 sec

25 Hz, 50 Pulses, 50% Power, Duration 1.9 sec25 Hz, 50 Pulses, 50% Power, Duration 1.9 sec

25 Hz, 50 Pulses, 75% Power, Duration 1.9 sec25 Hz, 50 Pulses, 75% Power, Duration 1.9 sec

25 Hz, 50 Pulses, 100% Power, Duration 1.9 sec25 Hz, 50 Pulses, 100% Power, Duration 1.9 sec

20

A T

B T

A2A2

A T

21

A T

B T

A3A3

A T

B T

22

A4A4

B T

A T

34

A7A7

42

A T

B T

A9A9

B T

A T

32

B6B6

B T

A T

40

B8B8

49

A T

B9B9

BT

A T

63

B11B11

94

A T

B T

B17B17

A T

B T12

C3C3

B T

A T

61

C4C4

B T

A T

71

C5C5

111B T

A T

C8C8

130B T

A T

C11C11

B T

A T

11

E2E2

36

A T

B T

E6E6

95

A T

B T

E9E9

98

A T

B T

E10E10

116B T

A T

E11E11

Scientific InspirationScientific Inspiration

OneOne day, in 1990 at day, in 1990 at aa London Hospital in London Hospital in an an elevator, a passenger was giggling.elevator, a passenger was giggling. AA magnetic stimulation magnetic stimulation had been applied had been applied toto his head. It his head. It waswas a a neuroneuro--didiaagnostic motor gnostic motor test, for thumb jerktest, for thumb jerk

Dr. Mark George observed anDr. Mark George observed and was d was astonished astonished by by this situation. He suspected this situation. He suspected that magnetic fields could move much morthat magnetic fields could move much moree than the thumb.than the thumb.

The story of magnetic therapy in psychiatry The story of magnetic therapy in psychiatry startedstarted like this like this..