Mandana Modirrousta

THE EFFICACY OF DEEP REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OVER THE MEDIAL PREFRONTAL CORTEX IN OBSESSIVE COMPULSIVE DISORDER: RESULTS FROM AN OPEN‐LABEL STUDY

Significant numbers of patients with obsessive compulsive disorder (OCD) respond minimally to currently available treatments. Furthermore, the application of both high‐ and low‐frequency repetitive transcranial magnetic stimulation (rTMS) to dorsolateral prefrontal cortex has shown to be ineffective in the reduction of OCD symptoms. In this study, we instead targeted the medial prefrontal cortex (mPFC) and applied low‐frequency rTMS to patients with OCD and assessed their clinical response.

Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury.

Background Traumatic brain injury (TBI) is a common cause of physical, psychological, and cognitive impairment, but many current treatments for TBI are ineffective or produce adverse side effects. Non-invasive methods of brain stimulation could help ameliorate some common trauma-induced symptoms. Objective This review summarizes instances in which repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have been used to treat symptoms following a TBI. A subsequent discussion attempts to determine the value of these methods in light of their potential risks. Methods The research databases of PubMed/MEDLINE and PsycINFO were electronically searched using terms relevant to the use of rTMS and tDCS as a tool to decrease symptoms in the context of rehabilitation post-TBI. Results Eight case-studies and four multi-subject reports using rTMS and six multi-subject studies using tDCS were found. Two instances of seizure are discussed. Conclusion There is evidence that rTMS can be an effective treatment option for some post-TBI symptoms, such as depression, tinnitus, and neglect. Although the safety of this method remains uncertain, the use of rTMS in cases of mild TBI without obvious structural damage may be justified. Evidence on the effectiveness of tDCS is mixed, highlighting the need for additional investigations.

The neural basis of humour comprehension and humour appreciation: The roles of the temporoparietal junction and superior frontal gyrus

Psychological well-being and social acumen benefit from the recognition of humourous intent and its enjoyment. The enjoyment of humour requires recognition, but humour recognition is not necessarily accompanied by humour enjoyment. Humour recognition is crucial during social interactions, while the associated enjoyment is less critical. Few neuroimaging studies have explicitly differentiated between the neural foundations of humour comprehension and humour appreciation. Among such studies, design limitations have obscured the specification of neural correlates to humour comprehension or appreciation. We implemented a trichotomous response option to address these design limitations. Twenty-four participants rated 120 comics (90 unaltered with humourous intent and 30 caption-altered without humourous intent) as either funny jokes (FJ), not funny jokes but intended to be funny (NFJ), or not intended to be funny or non-jokes (NJ). We defined humour comprehension by NFJ minus NJ and humour appreciation by FJ minus NFJ. We measured localized blood oxygen level dependent (BOLD) neural responses with a 3T MRI scanner. We tested for BOLD responses in humour comprehension brain regions of interest (ROIs), humour appreciation ROIs, and across the whole-brain. We found significant NFJ-NJ BOLD responses in our humour comprehension ROIs and significant FJ-NFJ BOLD responses in select humour appreciation ROIs. One key finding is that comprehension accuracy levels correlated with humour-comprehension responses in the left temporo-parietal junction (TPJ). This finding represents a novel and precise neural linkage to humour comprehension. A second key finding is that the superior frontal gyrus (SFG) was uniquely associated with humour-appreciation. The SFG response suggests that complex cognitive processing underlies humour appreciation and that current models of humour appreciation be revised. Finally, our research design provides an operational distinction between humour comprehension and appreciation and a sensitive measure of individual differences in humour comprehension accuracy.

Efficacy of twice-daily vs once-daily sessions of repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: a retrospective study

Purpose There is no clinical consensus on the optimal protocol for the treatment of major depressive disorder (MDD) using repetitive transcranial magnetic stimulation (rTMS). Accelerated protocols using more than a single session of treatment per day have been suggested as a means to reduce the overall length of time required for rTMS therapy. The objective of this study is to compare the treatment outcomes of patients with MDD who received two sessions of rTMS per day vs those who received one session per day, keeping the overall number of delivered pulses constant. Patients and methods In a retrospective study, we compared treatment outcomes of 36 patients with MDD who received 30 sessions of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Patients received 3,000 pulses per session (5 s trains, 25 s intertrain interval) at 110% of resting motor threshold using a figure-eight coil. Patients received either two rTMS sessions per day (n=17) or one session per day (n=19). Depression symptoms were assessed by a psychiatrist using the Hamilton Rating Scale for Depression at baseline and after every 10 sessions of rTMS. Results The majority of patients in both groups responded to treatment, and there was a trend toward greater response rate in the twice-daily (TD) group (82.4%) compared to the once-daily (OD) group (52.6%). TD stimulation was tolerable for patients and produced no adverse side effects. Patients in the TD group experienced an improvement in symptoms faster than the OD group due to the accelerated therapy period. Conclusion Administration of two rTMS treatment sessions per day is tolerable for patients and does not seem to be inferior in efficacy to a OD protocol. TD administration has the benefit of producing symptom improvement over a shorter time span and requires fewer visits to the clinic.

Right Temporoparietal Junction Transcranial Magnetic Stimulation in the Treatment of Psychogenic Non-epileptic Seizures: A Case Series

BACKGROUND Psychogenic non-epileptic seizures (PNES) may involve hypoactivity in the right temporoparietal junction (TPJ), suggesting a promising target for therapeutic neuromodulation. In this proof-of-concept case series, we aimed to investigate the tolerability and potential efficacy of high frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the right TPJ to decrease non-epileptic seizure rates. METHODS Seven subjects with video-EEG documented PNES without comorbid epileptic seizures were recruited. The rTMS protocol involved thirty stimulation sessions administered twice per day over three weeks. Each session consisted of three thousand pulses of high frequency (10 Hz) rTMS applied over the right TPJ. Tolerability was monitored throughout treatment. Weekly PNES counts were recorded at baseline, during treatment, and at post treatment intervals as the primary outcome measure. Additional psychometric scales assessing dissociation and functional neurological symptoms were collected at baseline and within 1-week post treatment as secondary outcome measures. RESULTS Treatment with rTMS was well tolerated by all participants. Participants reported a decrease in weekly seizure rates post vs. pre-treatment, which was sustained at 3-month follow-up. Improvement was also reported on the Dissociative Experiences Scale and the Conversion Disorder Subscale of the Screening for Somatoform Symptoms-7 Scale. CONCLUSION High-frequency rTMS over the right TPJ represents a promising treatment for PNES that warrants additional research.