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Academic Journal
ANXIETY
| Title: |
Neurobiology of repeated transcranial magnetic stimulation in the treatment of anxiety: a critical review
| | Date: | May 2009 | | Author(s): |
Stefano Pallanti and Silvia Bernardi
| | Source: | International Clinical Psychopharmacology 2009 | | Abstract: |
Abstract: Transcranial magnetic stimulation (TMS) has been applied to a growing number of psychiatric disorders as a neurophysiological probe, a primary brain-mapping tool, and a candidate treatment. Although most investigations have focused on the treatment of major depression, increasing attention has been paid to anxiety disorders. The aim of this study is to summarize published findings about the application of TMS as a putative treatment for anxiety disorders. TMS neurophysiological and mapping findings, both clinical and preclinical, have been included when relevant. We searched Medline, PsycInfo, and the Cochrane Library from 1980 to January 2009 for the terms 'generalized anxiety disorder', 'social anxiety disorder', 'social phobia', 'panic', 'anxiety', or 'posttraumatic stress disorder' in combination with 'TMS', 'cortex excitability', 'rTMS', 'motor threshold', 'motor evoked potential', 'cortical silent period', 'intracortical inhibition', 'neuroimaging', or 'intracortical facilitation'. Most of the therapeutic experiences with repetitive TMS available in the literature are in the form of case reports, not controlled or blinded studies. Stimulation of the right dorsolateral prefrontal cortex, especially at high frequencies, has been reported to reduce anxiety symptoms in posttraumatic stress disorder and panic disorder; nevertheless, results are mixed. A specific role for the right dorsolateral prefrontal cortex in the posttraumatic stress disorder symptom core can be hypothesized. TMS remains an investigational intervention that has not yet gained approval for the clinical treatment of any anxiety disorder. Clinical sham-controlled trials are scarce. Many of these trials have supported the idea that TMS has a significant effect, but in some studies, the effect is small and short lived. The neurobiological correlates suggest possible efficacy for the treatment of social anxiety that still has to be investigated.
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| | Title: |
Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of Panic Disorder (PD) with comorbid major depression
| | Author(s): |
Mantovani A, Lisanby SH, Pieraccini F, Ulivelli M, Castrogiovanni P, Rossi S.
| | Source: | Journal of Affective Disorders 102 (2007) 277–280 | | Keywords: |
Repetitive Transcranial Magnetic Stimulation (rTMS); Resting Motor Threshold; Panic Disorder (PD); Major Depressive Disorder
| | Abstract: |
Abstract: BACKGROUND: Studies suggest that the dorsolateral prefrontal cortex (DLPFC) participates in neural circuitry that is dysregulated in Panic Disorder (PD) and Major Depressive Disorder (MDD). We tested whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) could normalize the overactivity of right frontal regions and thereby improve symptoms. METHODS: Six patients with PD and comorbid MDD were treated with daily active 1-Hz rTMS to the right DLPFC for 2 weeks in this open-label trial. RESULTS: Clinical improvements were apparent as early as the first week of treatment. After the second week, 5/6 of patients showed improvements in panic and anxiety, and 4/6 showed a decrease in depression, with sustained improvement at 6 months of follow-up. Right hemisphere resting motor threshold increased significantly after rTMS. LIMITATIONS: Limitations of this study are the open design and the small sample size. CONCLUSIONS: Slow rTMS to the right DLPFC resulted in significant clinical improvement and reduction of ipsilateral motor cortex excitability. Replications in larger sample will help to clarify the relevance of this preliminary data and to define the potential role of right DLPFC rTMS in panic with major depression.
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| | Title: |
Anxiolytic effects of transcranial magnetic stimulation—an
alternative treatment option in anxiety disorders?
| | Date: | 2009 | | Author(s): |
Peter Zwanzger, A. J. Fallgatter, M. Zavorotnyy, F. Padberg
| | Source: | J Neural Transm | | Keywords: |
Anxiety disorders - Panic - PTSD -
Treatment - Transcranial magnetic stimulation -
rTMS
| | Abstract: |
In contrast to major depression, only few
studies are available so far on the effects of repetitive
transcranial magnetic stimulation (rTMS) in anxiety disorders.
In order to summarise available data concerning the
putative anxiolytic action of repetitive rTMS, a systematic
literature review was carried out. Although interpretation
of the results is difficult because of a large variety of used
treatment protocols and the lack of a placebo-controlled
design in the majority of studies, there is evidence for
anxiolytic action of rTMS both from preclinical trials and
studies in humans. Based on the idea of interhemispheric
imbalance and/or deficits in cortico-limbic control as a
model for human anxiety, inhibitory rTMS of the prefrontal
cortex has been shown to exert beneficial effects in a
number of studies in healthy subjects, patients with PTSD
and panic disorder. However, to further elucidate the
putative anxiolytic action of rTMS in patients with anxiety
disorders future studies have to be conducted addressing in
particular the limitations of the studies mentioned above.
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