Transcranial Magnetic Stimulation in Clinical Psychiatry

Book excerpt: As understanding evolves about how different brain regions are involved in carrying out everyday tasks -- and in causing brain diseases when they go awry -- this book describes a new technology that allows physicians to focally stimulate the brain in awake adults through a non-invasive procedure. Transcranial Magnetic Stimulation in Clinical Psychiatry is an accessible and authoritative review of TMS, a procedure that is showing promise as a treatment in several disorders. Its authors explain how the procedure works, then the latest findings in a wide range of situations -- notably in depression, but also in other conditions ranging from migraine to stroke recovery. This concise overview of TMS offers practical guidance for psychiatrists and other clinicians using it as a therapy, or referring their patients to have this done, as well as updating the field for neuroscientists and neurologists. It begins with background on the physics and safety of TMS, a guide for administering the procedure, and a review of basic neurophysiological studies with TMS, showing how it can be used to measure connectivity and excitability of the cerebral cortex. The heart of book is then devoted to its clinical applications, organized by disorder: Epilepsy, movement disorders, and pain -- describes the use of TMS in inducing and inhibiting seizures and investigating their pathophysiology; in treating Parkinson's disease; and in relieving pain through motor cortex stimulation Major depression -- provides a critical review of research in the most-studied clinical application of TMS in psychiatry, where it is used as a therapeutic intervention and a neurophysiological probe Mania -- explores the effectiveness of TMS in light of its ECT-like properties through a trial of right TMS vs. sham TMS Anxiety disorders -- reports on investigations on the uses of TMS in treating obsessive-compulsive disorder and posttraumatic stress disorder Schizophrenia -- reviews studies utilizing single- or paired-pulse TMS to assess cortical inhibition and those that explore effects of extended trains of repetitive TMS in altering symptoms A further chapter on TMS in brain imaging shows how integrating imaging and TMS allows one to better place the TMS coil, better understand TMS effects on the brain, and improve understanding of how the brain mediates behavior. With a concluding overview of prospects for the future of repetitive TMS, this volume offers a definitive look at this cutting-edge research and provides critical guidance on how and when clinicians might use TMS in their practice.