Into the island: a new technique of non-invasive cortical stimulation of the insula.

STUDY AIM: We describe a new neuronavigation-guided technique to target the posterior-superior insula (PSI) using a cooled-double-cone coil for deep cortical stimulation. INTRODUCTION: Despite the analgesic effects brought about by repetitive transcranial magnetic stimulation (TMS) to the primary motor and prefrontal cortices, a significant proportion of patients remain symptomatic. This encouraged the search for new targets that may provide stronger pain relief. There is growing evidence that the posterior insula is implicated in the integration of painful stimuli in different pain syndromes and in homeostatic thermal integration. METHODS: The primary motor cortex representation of the lower leg was used to calculate the motor threshold and thus, estimate the intensity of PSI stimulation. RESULTS: Seven healthy volunteers were stimulated at 10 Hz to the right PSI and showed subjective changes in cold perception. The technique was safe and well tolerated. CONCLUSIONS: The right posterior-superior insula is worth being considered in future studies as a possible target for rTMS stimulation in chronic pain patients.

Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study.

BACKGROUND AND PURPOSE: Tinnitus is a frequent disorder which is very difficult to treat and there is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Targeted modulation of tinnitus-related cortical activity has been proposed as a promising new treatment approach. We aimed to investigate both immediate and long-term effects of low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) in patients with tinnitus and normal hearing. METHODS: Using a parallel design, 20 patients were randomized to receive either active or placebo stimulation over the left temporoparietal cortex for five consecutive days. Treatment results were assessed by using the Tinnitus Handicap Inventory. Ethyl cysteinate dimmer-single photon emission computed tomography (SPECT) imaging was performed before and 14 days after rTMS. RESULTS: After active rTMS there was significant improvement of the tinnitus score as compared to sham rTMS for up to 6 months after stimulation. SPECT measurements demonstrated a reduction of metabolic activity in the inferior left temporal lobe after active rTMS. CONCLUSION: These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus, by demonstrating a significant reduction of tinnitus complaints over a period of at least 6 months and significant reduction of neural activity in the inferior temporal cortex, despite the stimulation applied on the superior temporal cortex.

Transient tinnitus suppression induced by repetitive transcranial magnetic stimulation and transcranial direct current stimulation.

Modulation of activity in the left temporoparietal area (LTA) by 10 Hz repetitive transcranial magnetic stimulation (rTMS) results in a transient reduction of tinnitus. We aimed to replicate these results and test whether transcranial direct current stimulation (tDCS) of LTA could yield similar effect. Patients with tinnitus underwent six different types of stimulation in a random order: 10-Hz rTMS of LTA, 10-Hz rTMS of mesial parietal cortex, sham rTMS, anodal tDCS of LTA, cathodal tDCS of LTA and sham tDCS. A non-parametric analysis of variance showed a significant main effect of type of stimulation (P = 0.002) and post hoc tests showed that 10-Hz rTMS and anodal tDCS of LTA resulted in a significant reduction of tinnitus. These effects were short lasting. These results replicate the findings of the previous study and, in addition, show preliminary evidence that anodal tDCS of LTA induces a similar transient tinnitus reduction as high-frequency rTMS.

Effects of antidepressant treatment with rTMS and fluoxetine on brain perfusion in PD.

BACKGROUND: Although depression is highly prevalent in Parkinson disease (PD), little is known about the neural correlates associated with depression and antidepressant treatment in PD. OBJECTIVE: To examine the effects of fluoxetine and repetitive transcranial magnetic stimulation (rTMS) on regional cerebral blood flow (rCBF) using SPECT in patients with PD and depression. METHODS: Twenty-six patients were enrolled into two groups: One received active rTMS and placebo medication and the other sham rTMS and fluoxetine 20 mg/day. Brain SPECT was performed at baseline and after 2 and 8 weeks. Changes in rCBF were compared across timepoints and correlated with clinical scores. In addition, baseline rCBF of these patients was compared with that of 29 healthy, age-matched subjects. RESULTS: At baseline, patients with PD and depression showed significantly lower rCBF in the left prefrontal cortex, posterior cingulate gyrus, left insula, and right parietal cortex when compared with healthy controls. Both treatments induced significant clinical improvement and increases in rCBF in the posterior cingulate gyrus and decreases in rCBF in the right medial frontal gyrus. These changes were significantly correlated to the clinical outcome. Furthermore, the comparison between these two treatments revealed that whereas rTMS treatment was associated with an increased perfusion in the right and left prefrontal cortex, fluoxetine treatment was associated with a relative rCBF increase in the occipital lobe. CONCLUSION: Depression in patients with Parkinson disease is correlated with a dysfunction of the frontal-limbic network that can be modulated by two different antidepressant therapies.

Effects of repetitive transcranial magnetic stimulation on voice and speech in Parkinson's disease.

OBJECTIVE: To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on vocal function in Parkinson's disease (PD). MATERIAL AND METHODS: Two different sets of rTMS parameters were investigated on 30 patients with PD: active or sham 15 Hz rTMS of the left dorsolateral prefrontal cortex (LDLPFC) (110% of motor threshold (MT), 3000 pulses per session) and active 5 Hz rTMS of the primary motor cortex (M1)-mouth area (90% MT, 2250 pulses per session). A blind rater evaluated speech characteristics (acoustic and perceptual analysis of voice) and voice-related quality of life (V-RQOL). RESULTS: rTMS of LDLPFC resulted in mood amelioration and subjective improvement of the V-RQOL only (71.9% improvement, P < 0.001), but not in objective measures such as fundamental frequency (P = 0.86) and voice intensity (P = 0.99). On the other hand, rTMS of M1-mouth induced a significant improvement of the fundamental frequency (12.9% for men and 7.6% for women, P < 0.0001) and voice intensity (20.6%, P < 0.0001). CONCLUSIONS: Our findings provide initial evidence that rTMS of the primary motor cortex might yield a beneficial effect on vocal function in PD.

A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients.

The authors investigated the use of slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the unaffected hemisphere to decrease interhemispheric inhibition of the lesioned hemisphere and improve motor function in patients within 12 months of a stroke. Patients showed a significant decrease in simple and choice reaction time and improved performance of the Purdue Pegboard test with their affected hand after rTMS of the motor cortex in the intact hemisphere as compared with sham rTMS.

Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease.

OBJECTIVE: To study the efficacy of 15 Hz repetitive transcranial magnetic stimulation (rTMS) in treating depression in patients with Parkinson's disease. METHODS: 42 patients were enrolled into two groups: group 1, active rTMS (15 Hz rTMS for 10 days) and placebo drug treatment; group 2, sham rTMS and fluoxetine 20 mg/day. A specially designed sham coil was used for sham stimulation. The unified Parkinson's disease rating scale (UPDRS), activities of daily living (ADL), Hamilton rating scale for depression (HRSD), Beck depression inventory (BDI), and mini-mental state examination (MMSE) were assessed by a rater blinded to treatment arm. RESULTS: HRSD and BDI were improved to the same extent in both groups after two weeks of treatment (38% and 32% for group 1, 41% and 33% for group 2, respectively). At week 8 there was a tendency for worse motor UPDRS scores in group 2 (NS). ADL showed improvement at week 8 only in group 1. MMSE improved in both groups after treatment, but faster in group 1 than in group 2. There were fewer adverse effects in group 1 than in group 2. CONCLUSIONS: rTMS has the same antidepressant efficacy as fluoxetine and may have the additional advantage of some motor improvement and earlier cognitive improvement, with fewer adverse effects.

[Subcortical hyperintensities on magnetic resonance imaging: a comparison of normal and depressed elderly subjects]. / Hipersinais subcorticais no exame de ressonância magnética: comparação entre idosos deprimidos e idosos normais.

Previous studies reported that depressed subjects had more signal hyperintensities on magnetic resonance imaging scans than control subjects, but the subjects had cerebrovascular disease risk factors. This study used subjects with a history of major depression and matched comparison subjects, screened to exclude cerebrovascular risk factors, to determine whether depressed subjects had more white matter hyperintensities and other lesions. We evaluated the prevalence and severity of MRI signal hyperintensities in 30 elderly depressed patients and 20 controls matched for age. Deep matter hyperintensities, periventricular hyperintensities and subcortical gray hyperintensities were rated on a standard 0-3 scale by two radiologists blind to clinical diagnosis. No significant differences were found between groups for the presence of subcortical gray matter, deep white matter and periventricular hyperintensities. These findings suggest that cerebrovascular disease risk factors most likely mediated the relationship between depression and hyperintensities in previous studies.

O impacto do uso de risperidona na qualidade de vida de pacientes esquizofrenicos / The impact of the treatment with risperidone in the schizophrenic patients quality of life

OBJETIVO: Este trabalho teve o objetivo de avaliar o impacto do uso da risperidona na qualidade de vida de pacientes esquizofrenicos. MATERIAIS E METODOS: 80 pacientes portadores de esquizofrenia(56 por cento subtipo paranoide) foram tratados com risperidona em um estudo prospectivo, longitudinal e aberto por seis meses para avaliar a eficacia terapeutica da medicaçäo, seus efeitos colaterais e seu impacto na qualidade de vida dos pacientes. Para avaliar a reposta terapeutica da risperidona foram utilizadas as escalas de avaliaçäo psiquiatrica breve (BPRS) e impressäo clínica global (CGI). A qualidade de vida foi avaliada pela escala de qualidade de vida (QLS) de HEINRICHS et al.,1984, além da escala de avaliaçäo da funçäo global (GAF). Os efeitos colaterais foram avaliados por relato espontaneo dos pacientes e os extra-piramidais pela escala UKU. RESULTADOS: Os pacientes apresentaram melhora significante em todas as escalas clínicas, em avaliaçöes após um, três e seis meses de tratamento com risperidona (p<0,001). Houve melhora significante no escore global da QLS e tambem no das suas subunidades (p<0,001). A mediçäo foi bem tolerada, sem aumento significante de efeitos colaterais extrapiramidais. DISCUSSAO E CONCLUSAO: Este estudo demonstra a importancia do antipsicotico atípico risperidona no tratamento da esquizofrenia, com importante impacto na qualidade de vida dos pacientes. Poeem, maiores estudos controlados duplo-cego precisam ser feitos comparando o impacto na qualidade de vida de risperidona com outros antipsicoticos, típicos ou atípicos

Clozapina, uma alternativa no tratamento dos transtornos afetivos bipolares resistentes e esquizoafetivos / Clozapine, on option in the therapy in bipolar refractory affective disorders and schizoaffectives

A clozapina é um psicofármico antigo que ainda hoje tem revolucionado o tratamento dos transtornos peiquiátricos. Essa droga foi desenvolvida na década de 60 e aprovada pelo FDA(Food and Drug Administration) em 1984 para o tratamento da esquizofrenia refratária. Dados recentes demonstram que ela também pode ser útil no controle dos quadros afetivos bipolares resistentes nos subtipos de ciclagem rápida, quadros mistos e nos transtornos esquizoafetivos

Estimulaçäo magnética transcraniana - uma propedêutica neurológica e uma terapêutica psiquiatriátrica / Transcranial magnetic stimulation - A neurologic propedeutic and a psychiatric therapy

A estimulaçäo magnética transcraniana é um método neurofisiológico que surgiu como uma alternativa técnica para a estimulaçäo elétrica cerebral na propedêutica neurológica de investigaçäo das lesöes dos tratos motores. A grande vantagem desta técnica é a estimulaçäo direta do córtex e talvez de regiöes subcorticais com ausência de contato de eletrodod, e por ser um procedimento näo invasivo é indolor. Recentemente também tem sido usada como método terapêutico em psiquiatria, principalmente nos quadros de transtornos afetivos, com uso potencial para outros quadros

Platelet monoamine oxidase in schizophrenia: a meta-analysis.

We did a meta-analysis on all publications (English and other languages) concerned with platelet monoamine oxidase (MAO) in schizophrenia. Essentially, when patients were medicated with a neuroleptic, most studies found that schizophrenics had lower platelet MAO levels than controls. Administration of neuroleptic lowers MAO levels. MAO levels in drug-free schizophrenics were similar to controls. Only a minority of studies found drug-free schizophrenics had decreased platelet MAO levels.

The prognosis of schizophrenia across cultures.

Taken as a whole, the reported cross-cultural studies of schizophrenia suggest that both the frequency of occurrence of the disease and the outcome for individual patients vary across cultures. Some of the observed variation in incidence rates is most likely secondary to differences in the use of diagnostic criteria, and this source of error is difficult to quantify. On the other hand, good evidence suggests that much of the variability in prognosis may be related to the sociocultural context of the patient's family. Personal dynamics within the family may therefore be an important mediator of the observed cross-cultural differences in the outcome of schizophrenia. The purpose of this paper is to review three areas of research in schizophrenia; namely, the importance in variation of the "first rank symptoms" and expressed emotion in families from different societies, and the findings of the World Health Organization International Pilot Study of Schizophrenia to demonstrate that patients with this disorder in developing countries have a more positive prognosis than do comparable patients in western industrialized societies.

Estudo dos defeitos da impregnacao neuroleptica em pacientes esquizofrenicos atraves do metodo de Rorschach. / Effects of neuroleptic impregnation in schizophrenic patients by Rorschach method

Os autores pretendem estudar os efeitos do fenomeno de impregnacao neuroleptica - sindrome extrapiramidal - no processo terapeutico de pacientes exquizofrenicos. E bem conhecido que a impregnacao neuroleptica e o resultado da acao do neuroleptico nos nucleos basais do cerebro. Seus efeitos clinicos levam a uma acao antipsicotica seguida da remissao das alucinacoes e delirios nestes pacientes. Deste modo, pacientes com o diagnostico psiquiatrico de esquizofrenia paranoide (segundo Kraepelin e Bleuler) foram selecionados e submetidos ao exame de Rorschach em dois momentos: antes e durante a impregnacao.Estes pacientes foram selecionados entre aqueles internados no Hospital Psiquiatrico de Vila Mariana. Pacientes entre 25 e 35 anos foram examinadas psiquiatrica e psicologicamente