developing-neuroimaging-phenotypes-default-mode-network-ptsd

Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity

Complementary structural and functional neuroimaging techniques used to examine the Default Mode Network (DMN) could potentially improve assessments of ...

Alpert Medical School, Brown University

Repetitive transcranial magnetic stimulation (rTMS) is a comparatively novel option for the treatment of major depressive disorder (MDD) and other psychiatric illnesses. Previous research has shown rTMS to be safe and without significant side effects compared to pharmacologic options. However, rare cases of rTMS-induced mania have been reported. This case report describes such an affective switch in a 52 year old female veteran with treatment-resistant MDD and a history of electroconvulsive therapy (ECT)-induced mania. Six treatments of rTMS were administered at 5 Hz for a total of 3000 pulses per day, when the patient began to display multiple hypomanic symptoms. These symptoms decreased after the termination of treatment and abated within a couple of days. In conclusion, caution should be used when administering rTMS to patients with a history of ECT-induced mania.

Repetitive transcranial magnetic stimulation induced hypomanic symptoms in a woman with a history of electroconvulsive therapy induced mania:  a case report.

Vagus nerve stimulation (VNS) and repetitive transcranial stimulation (rTMS) devices are FDA cleared for therapeutic use in treatment resistant depression. Since VNS systems have ferromagnetic components and large-scale safety testing has not been done, the implanted VNS device is considered a contraindication for rTMS therapy. This contraindication should not be considered absolute, as VNS components typically lie outside the electromagnetic field generated by an rTMS treatment coil. We solicited information from clinicians at several academic medical centers through an informal survey about their use of rTMS for depressed patients with implanted VNS systems, and reviewed relevant safety issues with one rTMS device manufacturer. rTMS clinical practices may use special consent procedures and take additional precautions to enhance safety in these situations. Specific recommendations are provided for minimizing risks (heating or movement of VNS components and unintended change in VNS stimulation parameters) when delivering rTMS to patients with implanted VNS systems.

Article	Year
Repetitive transcranial magnetic stimulation induced hypomanic symptoms in a woman with a history of electroconvulsive therapy induced mania: a case report. F1000Research\| PubMed ID: 24715970	2013
Safe Use of Repetitive Transcranial Magnetic Stimulation in Patients With Implanted Vagus Nerve Stimulators. Brain stimulation\| PubMed ID: 24794163	2014

S. Louisa Carpenter

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