Transcranial magnetic stimulation: studying motor neurophysiology of psychiatric disorders
- 261 Downloads
Transcranial magnetic stimulation (TMS) is a noninvasive tool that directly stimulates cortical neurons by inducing magnetic and secondary electric fields. Traditionally TMS has been used to study the motor neurophysiology of healthy subjects and those with neurological disorders.
Given the known motor dysfunctions in many psychiatric disorders supplemental usage of TMS to study the underlying pathophysiology of certain psychiatric disorders and to assess treatment outcomes is underway. Such studies include examination of motor neuronal membrane, corticospinal and intracortical excitability. Our objective is to overview the past findings.
We review the past literature that used TMS as an assessment tool in psychiatric disorders such as schizophrenia, mood disorders, Tourette's syndrome, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, and substance abuse.
While the findings are still preliminary due to small sample-size, inconsistent patient population (diagnosis, medication), differences in methodology between research groups, studies restricted to the motor region and possible lack of sensitivity and specificity, the studies are yielding interesting results which could potentially lead to trait- and state-markers of psychiatric disorders.
Future studies using TMS alone or in combination with other neuroimaging techniques promise to further expand the application of TMS from studies of motor excitability to higher cognitive functions.
Keywords.Transcranial magnetic stimulation Psychiatry Trait-marker State-marker Cortical excitability Neurophysiology
This research was supported in part by grants from the Cellular Science Research Foundation, Yoshida Science Foundation, and the Japan North America Medical Exchange Foundation to F.M., and the National Alliance for Research and Schizophrenia and Depression and the National Institutes of Mental Health (RO1MH57980) to A. P.-L.
- Barker AT, Freeston IL, Jalinous R, Merton PA, Morton HB (1985a) Magnetic stimulation of the human brain. J Physiol (Lond) 369:3PGoogle Scholar
- Barker AT, Jalinous R, Freeston IL (1985b) Non-invasive magnetic stimulation of the human motor cortex. Lancet I:1106–1107Google Scholar
- Bohning DE, Shastri A, McConnell KA, Nahas Z, Lorberbaum JP, Roberts DR, Teneback C, Vincent DJ, Boroojerdi B, Foltys H, Krings T, Spetzger U, Thron A, Topper R (1999) Localization of the motor hand area using transcranial magnetic stimulation and functional magnetic resonance imaging. Clin Neurophysiol 110:699–704PubMedGoogle Scholar
- Burke D, Hicks R, Gandevia SC, Stephen J, Woodforth I, Crawford M (1993) Direct comparison of corticospinal volleys in human subjects to transcranial magnetic and electrical stimulation. J Physiol (Lond) 470:383–393Google Scholar
- Chokroverty S, Picone MA, Chokroverty M (1991) Percutaneous magnetic stimulation of human cervical vertebral column: site of stimulation and clinical applicationperipheral nerves. Electroencephalogra Clin Neurophysiol 81:359–365Google Scholar
- Date M, Schmid UD, Hess CW, Schmid J (1991) Influence of peripheral nerve stimulation on the responses in small hand muscles to transcranial magnetic cortex stimulation. In: Levy WJ, Cracco RQ, Barker AT, Rothwell J (eds) Magnetic motor stimulation: basic principles and clinical experience. Elsevier, Amsterdam, pp 212–223Google Scholar
- Davidson RJ (1998) Cerebral asymmetry, affective style, and psychopathology. In: Kinsbourne M (ed) Cerebral hemisphere function in depression. American Psychiatric, Washington, pp 1–2Google Scholar
- Day BL, Dressler D, Maertens De Noordhout A, Marsden CD, Nakashima K, Rothwell JC, Thompson PD (1989) Electrical and magnetic stimulation of human motor cortex: surface EMG and single motor-unit responses. J Physiol (Lond) 412:449–473Google Scholar
- Freund S, Keenan JP, Tarsy D, Pascual-Leone A (1999) Intracortical disinhibition in tardive dystonia demonstrated by paired-pulse transcranial magnetic stimulation (TMS). Mov Disord 14:902Google Scholar
- George MS, Belmaker RH (2000) Transcranial magnetic stimulation in neuropsychiatry. APA, Washington DCGoogle Scholar
- George MS, Wassermann EM, Kimbrell TA, Little JT, Williams WE, Danielson AL, Greenberg BD, Hallett M, Post RM (1997) Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry 154:1752–1756PubMedGoogle Scholar
- Goodwin GM, Austin MP, Dougall N, Ross M, Murray C, O'Carroll RE, Moffoot A, Prentice N, Ebmeier KP (1993) State changes in brain activity shown by the uptake of 99mTc-exametazime with single photon emission tomography in major depression before and after treatment. J Affect Disord 29:243–253PubMedGoogle Scholar
- Gunther W, Streck P, Steinberg R, Gunther R, Raith L, Backmund M (1989) Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy. IV. Brain dysfunction during motor activation measured by EEG mapping. Eur Arch Psychiatry Neurol Sci 239:194–209PubMedGoogle Scholar
- Hallett M, Fieldman J, Cohen LG, Sadato N, Pascual-Leone A (1994) Involvement of primary motor cortex in motor imagery and mental practice. Behav Brain Sci 17:210Google Scholar
- Hodgkin AL, Huxley AF (1952a) Currents carried out by sodium and potassium ions through the membrace of the giant axon of Loligo. J Physiol (Lond) 116:449–472Google Scholar
- Hodgkin AL, Huxley AF (1952b) The components of membrane conductance in the giant axon of Loligo. J Physiol (Lond) 116:473–496Google Scholar
- Hodgkin AL, Huxley AF (1952c) A quantitative description of membrance current and its application to conduction and excitation in nerve. J Physiol (Lond) 116:500–544Google Scholar
- Inghilleri M, Berardelli A, Cruccu G, Manfredi M (1993) Silent period evoked by transcranial stimulation of the human cortex and cervicomedullary junction. J Physiol (Lond) 466:521–534Google Scholar
- Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM, Repella JD, Danielson AL, Willis MW, Benson BE, Speer AM, Osuch E, George MS, Post RM (1999) Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 46:1603–1613PubMedGoogle Scholar
- Kujirai T, Caramia MD, Rothwell JC, Day BL, Thompson PD, Ferbert A, Wroe S, Asselman P, Marsden CD (1993) Corticocortical inhibition in human motor cortex. J Physiol (Lond) 471:501–519Google Scholar
- Lisanby SH, Sackeim HA (2000) Transcranial magnetic stimulation in major depression. In: George MS, Belmaker RH (eds) Transcranial magnetic stimulation (TMS) in neuropsychiatry. American Psychiatric, Washington, pp 185–200Google Scholar
- Maeda F, Keenan J, Freund S, Vaccaro B, Birnbaum R, Pascual-Leone A (2000d) Transcranial magnetic stimulation studies of cortical excitability in depression. Biol Psychiatry 46:169SGoogle Scholar
- Maeda F, Topka H, Keenan JP, Pascual-Leone A (2000f) Effects of cerebellar output on intracortical motor cortex excitability studied by transcranial magnetic stimulation. Ann Neurol 48:475Google Scholar
- Maruff P, Danckert J, Pantelis C, Currie J (1998) Saccadic and attentional abnormalities in patients with schizophrenia. Psychol Med 28:1091–1100Google Scholar
- McConnell KA, Nahas Z, Shastri A, Lorberbaum JP, Kozel FA, Bohning DE, George MS (2001) The transcranial magnetic stimulation motor threshold depends on the distance from coil to underlying cortex: a replication in healthy adults comparing two methods of assessing the distance to cortex. Biol Psychiatry 49:454–459PubMedGoogle Scholar
- Mills KR (1999) Magnetic stimulation of the human nervous system. Oxford University Press, OxfordGoogle Scholar
- Mills KR, Murray NMF (1986) Electrical stimulation over the human vertebral column: which elements are excited? Electroencephalogr Clin Neurophysiol 63:582–589Google Scholar
- Mills KR, Nithi KA (1997) Corticomotor threshold to magnetic stimulation: normal values and repeatability. Muscle Nerve 20:570–576Google Scholar
- Peschina W, Conca A, Konig P, Fritzsche H, Beraus W (2001) Low frequency rTMS as an add-on antidepressive strategy: heterogeneous impact on 99m Tc-HMPAO and 18 F-FDG uptake as measured simultaneously with the double isotope SPECT technique. Pilot study. Nucl Med Commun 22:867–873CrossRefPubMedGoogle Scholar
- Priori A, Berardelli A, Inghilleri M, Accornero N, Manfredi M (1994) Motor cortical inhibition and the dopaminergic system. Pharmacological changes in the silent period after transcranial brain stimulation in normal subjects, patients with Parkinson's disease and drug-induced parkinsonism. Brain 117:317–323PubMedGoogle Scholar
- Sander D, Meyer BU, Roricht S, Matzander G, Klingelhofer J (1996) Increase of posterior cerebral artery blood flow velocity during threshold repetitive magnetic stimulation of the human visual cortex: hints for neuronal activation without cortical phosphenes. Electroencephalogr Clin Neurophysiol 99:473–478PubMedGoogle Scholar
- Stallings LE, Speer AM, Spicer KM, Cheng KT, George MS (1997) Combining SPECT and repetitive transcranial magnetic stimulation (rTMS)-left prefrontal stimulation decreases relative perfusion locally in a dose dependant manner. Neuroimage 5:S521Google Scholar
- Tormos JM, Catala MD, Juan C, Pascual-Leone Pascual A, Keenan JP, Pascual-Leone A (1998) Effects of repetitive transcranial magnetic stimulation on EEG. Neurology 50:A317–318Google Scholar
- Virtanen J, Ruohonen J, Naatanen R, Ilmoniemi RJ (1999) Instrumentation for the measurement of electric brain responses to transcranial magnetic stimulation. Med Biol Eng Comput 37:322–326Google Scholar
- Walker EF (1994) Developmentally moderated expressions of the neuropathology underlying schizophrenia. Schizophr Bull 20:453–480Google Scholar
- Ziemann U, Rothwell JC, Ridding MC (1996d) Interaction between intracortical inhibition and facilitation in human motor cortex. J Physiol (Lond) 496:873–881Google Scholar