Talk:Transcranial magnetic stimulation

add a section to article called EFFECTIVENES OF TMS

There should be a section of the article with the following information but I am not competent to pick throuh the scientific litterature.

Outside Opinion

I am a patient who has been receiving rTMS treatments from for severe depression since 1998. It's been my salvation - the only treatment that has worked for me. If you have any questions from a patient's point of view, my email is joan.miller AT post.harvard.edu. [jmmg18, 9/24/11]

transcranial direct current stimulation

New Scientist Article

TMS as an interrogation/control

enhancing geek brains is one thing, directly controlling human value judgements to gain a military/police advantage is quite another: Scientific American article on the first success in magnetic mind control

Massimini reference

I removed this at the end of TMS in Research section (add back if you can add the suitable connection to TMS):

Massimini et al. (Science, 2005)(Massimini M, Ferrarelli F, Huber R, Esser SK, Singh H, Tononi G. Breakdown of cortical effective connectivity during sleep. Science. 2005 Sep 30;309(5744):2228-32.) used EEG to show that during sleep, brain areas do not pass signals to other brain areas as effectively as during wakefulness.

TMS research is multi-disciplinary

Of course, physicists and engineers are involved in TMS research. In my lab, medics collaborate with engineers, neuroscientists, psychologists, medical physicists and mathematicians. Modelling papers on TMS fields are published in engineering and medical journals (just look up Pubmed), and the companies building these devices are engineers too trying to improve their product line.

Magnetic water treatment

I added this link to a controversial science article, as the mechanism within the blood chemistry may be similar: could it be that the magneto-mechanical action works on the blood to precipitate obstructive placa which is then carried by the blood to be fairly rapidly processed and presumably excreted in urine or excrement, who knows? I doubt that the magnetic field has much effect on the neurones, since we humans have lived in an electro-magnetic soup for almost a century without noticing much change other than obesity - but of course this is only my speculation - does it help, perhaps?

Corrections based on FDA Wikipedia guidelines

Dear User:Doc James,User:Corker1

I'd like to make a couple of edits that meet recent US government FDA wikipedia guidelines . These edits have been verified and approved by a legal as well as a medical team to ensure they meet the recent government guidelines. The medical and legal review teams agreed and concluded that the current state of the page does not represent neutral views. Please let us know if you have any objections for the following changes. Neutral references are provided or available for all proposed edits. Appreciate your input.

Thank you. --WikiCorrect-Health (talk) 20:07, 28 October 2014 (UTC)

1) Introduction section

Original Text:

Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan." A variant of TMS, repetitive transcranial magnetic stimulation (rTMS), has been tested as a treatment tool for various neurological and psychiatric disorders including migraine, stroke, Parkinson's disease, dystonia, tinnitus and depression.

Proposed Text:

Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan. Single pulse TMS has been cleared by the FDA to relieve pain caused by migraine headaches[1]. A variant of TMS, repetitive transcranial magnetic stimulation (rTMS), has been cleared by the FDA for the treatment of Major Depressive Disorder[2]. Repetitive transcranial magnetic stimulation is still being studied as a treatment tool for various other neurological and psychiatric disorders including stroke, Parkinson's disease, dystonia, and tinnitus.

2) Risks - Updated introduction paragraph

To be added as the first paragraph of the risks section: TMS is generally regarded as safe. The greatest acute risk is the rare occurrence of induced seizures.[1] In 1998, a conference was held to establish safety parameters for TMS.[2] Since the establishment of these guidelines, there have been 16 reports of TMS-related seizures (as of 2009), with seven reported before the publication of safety guidelines in 1998[2], and nine reported afterwards[1]. The seizures are primarily associated with rTMS, although they have been reported following single-pulse TMS. Reports have stated that, in at least some cases, predisposing factors (medication, brain lesions or genetic susceptibility) may have contributed to the seizure. A review of nine seizures associated with rTMS that had been reported after 1998 stated that four seizures were within the safety parameters, four were outside of those parameters, and one had occurred in a healthy volunteer with no predisposing factors. A 2009 international consensus statement on TMS that contained this review concluded that based on the number of studies, subjects, and patients involved with TMS research, the risk of seizure with rTMS is considered very low.[1]

3) Risks - Modified second paragraph

Original Text:

A comprehensive safety study of rTMS in the treatment of major depression looked at three separate groups totalling over 300 patients. It found that rTMS was associated with a low incidence of side effects, most of which were mild to moderate. Additionally, only 4.5% of patients discontinued their participation during acute treatment because of adverse events.

Modified Text:

A comprehensive safety study of rTMS in the treatment of major depression looked at three separate groups totalling over 300 patients. It found that rTMS was associated with a low incidence of side effects, most of which were mild to moderate. The most common side effect observed was discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin.[1] Additionally, 4.5% of patients discontinued their participation during acute treatment because of adverse events.

4) Therapeutic Use - Introduction

Original Text:

Studies of the use of TMS and rTMS to treat many neurological and psychiatric conditions have generally shown only modest effects with little confirmation of results. However, reviews have stated that rTMS appeared to be effective in the treatment of certain types of major depression under certain specific conditions.

Modified Text:

Studies of the use of TMS and rTMS to treat neurological and psychiatric conditions have been conducted. Recent meta-analyses of the use of rTMS have shown “level A or B evidence supports an efficacy of rTMS protocols in depression, pain, motor stroke and schizophrenia."[1] "Numerous studies have shown that repetitive transcranial magnetic stimulation (rTMS) produced significant clinical effects in patients with various neurological and psychiatric disorders."[1]

5) Therapeutic Use - Addition of Second Paragraph

TMS Therapy has gained general acceptance as a safe and proven treatment for major depression. The American Psychiatric Association’s (APA) 2010 Practice Guidelines for the Treatment of Patients with Major Depressive Disorder state that, “for patients whose symptoms have not responded adequately to medication…transcranial magnetic stimulation could also be considered…”[1]. Additionally, in 2009 the Canadian Network for Mood and Anxiety Disorders[2] and the World Federation of Societies for Biological Psychiatry[3] both independently concluded there is now sufficient Level 1 evidence to support the use of TMS as an acute treatment for major depression. More recently, the Royal Australia and New Zealand College of Psychiatrists endorsed the evidence base substantiating the clinical importance of TMS as a treatment option for patients with major depressive disorder (2013).

6) Therapeutic Use - Modification of second (as per current structure) paragraph

Original Text:

A meta-analysis of 34 studies comparing rTMS to sham treatment for the acute treatment of depression found that rTMS was effective with an effect size of 0.55. This is comparable to commonly reported effect of medications for treatment of depression in the range of 0.17-0.46. However, this meta-analysis found that rTMS was worse than electroconvulsive therapy (ECT), although there were significantly fewer adverse effects with rTMS. An analysis of one of the studies included in the meta-analysis found that one extra remission from depression occurred for every 3 people given electroconvulsive therapy rather than rTMS.

Modified Text:

A meta-analysis of 34 studies comparing rTMS to sham treatment for the acute treatment of depression found that rTMS was effective with an effect size of 0.55 (p<.001). This is comparable to commonly reported effect sizes of pharmacotherapeutic strategies for treatment of depression in the range of 0.17-0.46. However, this meta-analysis found that ECT yields more favorable results then TMS. Although rTMS cannot replace ECT in depressive patients, there may be subgroups in which rTMS can replace antidepressant medication. The article concluded that, “rTMS deserves a place in the standard toolbox of psychiatric treatment methods, as it is effective for depression and AVH and has a mild side effect profile.”

7) FDA Actions - Depression - Paragraph 1

Original Text:

In January 2007, an advisory panel of the United States Food and Drug Administration (FDA) did not recommend clearance for marketing of an rTMS device, stating that the device appeared to be reasonably safe but had failed to demonstrate efficacy in a study of people with major depression who had not benefitted from prior adequate treatment with oral antidepressants during their current major depressive episode.[31] The panel agreed that "unblinding was greater in the active group, and considering the magnitude of the effect size, it may have influenced the study results."[31] However, the FDA determined in December 2008 that the rTMS device was sufficiently similar to existing devices that did not require a premarket approval application and allowed the device to be marketed in accordance with Section 510(k) of the Federal Food, Drug, and Cosmetic Act[32] In March 2014, the FDA cleared this device "for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode".

Modified Text:

The FDA cleared the first rTMS device in the US for the treatment of major depression in 2008 via the de novo reclassification process described in Section 513 (f)(2) of the Federal Food, Drug, and Cosmetic Act.(1) Through de novo reclassification, lower risk medical devices for which no marketed predicate device exists, are cleared for marketing based on safety and efficacy data submitted for that device. For the rTMS device, these data were the results of an industry-sponsored multi-center randomized controlled trial (DEN070003/K061053).(2) The results of a second, industry-independent randomized controlled trial (3) resulted in an expanded FDA clearance for this device for major depression to include patients with a broad range of treatment resistance (K133408).(4)

--WikiCorrect-Health (talk) 20:07, 28 October 2014 (UTC)

Interesting. So who is funding these proposed changes? Additionally it is not clear which references you plan to use. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:01, 29 October 2014 (UTC)

Dear User:Doc James,

The specific edits are not funded by any specific organization. But collectively we gathered the information from IMS Health medical team after we received requests from the industry as part of our WikiCorrect-Health project workshops. This as a result of US Government(FDA) providing guidelines to the manufactures to fix misinformation and biases on Wiki pages. The references have been incorporated in the comments as they already have been provided in the page by previous authors. For example for the edits above references [1], [2], [3] [31] [32] will be used.