Electroconvulsive therapy in the treatment of neuropsychiatric conditions and transcranial magnetic stimulation as a pathophysiological probe in neuropsychiatry.
It is a challenging task to review transcranial magnetic stimulation (TMS) studies in neuropsychiatric disorders alongside assessments of longstanding clinical applications of ECT as an empirical treatment. The task is challenging because TMS was developed as a probe of neural mechanisms, whereas, in marked contrast, ECT has been a clinical technique from its inception. Since the onset of modern psychopharmacology, the understanding of the potential applications of ECT to neuropsychiatric disorders is generally restricted to case reports of patients with intractable disease that have had at least a partial response to ECT. Studies of the possible efficacy of TMS in neuropsychiatric conditions have a significant advantage over ECT as the treatments are associated with less morbidity. The only serious known complication in TMS is a risk of seizures that may increase in patients with neuropsychiatric conditions such as course brain disease. Only cortical structures are themselves accessible to TMS using current technology. Present TMS techniques, however, seem capable of affecting activity in deeper brain structures that are functionally linked to cortical brain regions. TMS permits novel explorations of relationships between regional brain activity and symptoms of a number of neuropsychiatric disorders, as well as in research relating activity in functionally related brain regions to modulation of cognition and affective states in healthy individuals. This is particularly true at present because TMS and powerful neuroimaging and neuropsychological tools are all making rapid advances simultaneously.
McDonald
W M
WM
Geriatric Mood Disorders Program, Emory University Department of Psychiatry and Behavioral Sciences, Wesley Woods Geriatric Hospital, 1821 Clifton Rd., NE, Atlanta, GA 30329, USA. wmcdona@emory.edu
Greenberg
B D
BD
D001927:Brain Diseases / Q000503:physiopathology / Q000628:therapy*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D004565:Electroconvulsive Therapy; D004574:Electromagnetic Fields; D006801:Humans; D019965:Neurocognitive Disorders / Q000503:physiopathology / Q000628:therapy*; D012680:Sensitivity and Specificity; D009435:Synaptic Transmission / Q000502:physiology