Repetitive transcranial magnetic stimulation

More than one million people in Germany experience at least one depressive phase in their lives. Up to now, patients with depression have mostly been treated with drugs and psychotherapy. However, some patients respond inadequately to these therapies. This could be partly due to the fact that many patients exhibit altered metabolism in certain areas of the cerebral cortex during depressive phases.

Efficient magnetic stimulators have now been developed with which it is possible to activate the nerve cells of individual parts of the brain in a targeted way (and almost painlessly) through the skin and bone. However, only a limited number of depressive patients have been able to be successfully treated in this way up to now by having those areas of their brains stimulated that most frequently exhibited altered metabolism during the depressive phase.

At our clinic, we use such a magnetic stimulator with which we are able to apply a series of magnetic impulses to the cerebral cortex of the patient. The actual treatment consists of two or three 5-day sessions (10 to 15 days in all), consisting of several stimulation phases, the duration of which depends on the frequency of the magnetic impulse (1 to 10 Hz), giving a total 20 minutes stimulation time. This stimulation can stop, at any time, if you so wish.

 

At the start of the session, the magnetic coil is held above the part of the brain that controls the opposite hand. The magnetic field is slowly increased until the thumb of that hand slightly twitches, which is the upper limit. The optimum magnetic dose is then calculated and applied to the spot where the altered metabolism of depressive right-handed people is probably located.

One of the most significant though rather rare side effects of magnetic stimulation is twitching of the head and forehead muscles on the stimulation side during discharge, owing to neighbouring nerves and muscles in the head also undergoing stimulation. This twitching is uncomfortable, although, in my own experience, bearable. There can be some localised numbness lasting several hours, normally quickly remedied with a bag of ice. The clacking sounds occurring during magnetic discharge are so quiet that the sensitivity of the ears is not affected if earplugs are used.

High magnetic doses can trigger epileptic fits in some patients that have previously experienced a fit. In rare cases, such epileptic fits may occasion injury, especially a bitten tongue. Breathing can be interrupted by blood and saliva. Urine and faeces may be passed. Therefore we only treat those whose EEG is insignificant, and who have never to date experienced a fit (including fever convulsions during childhood).

Pregnant women and individuals using pacemakers, vascular clamps following cranial surgery or inner ear implants may also not be treated with such magnetic fields. These safety standards have been developed over many years of experience in diagnostic magnetic stimulation, especially in neurology.

Laboratory of Psychophysiology

Head:
Kneginja Richter, MD
Assistant Medical Director, Specialist in Psychiatry and Psychotherapy, Somnologist Member of the German Society of Neurophysiology, EEG certificate

Telephone:  +49 911 398 3970

E-Mail: Kneginja.Richter@klinikum-nuernberg.de

Autorin/Autor: K. Richter

 
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