Відео

You are welcome!

Thank you!

Great question! That is exactly what my own research is about. And indeed we found that physical therapy together with TMS is more effective in recovery of movement than PT alone. And there are many more studies like that! Currently I am doing another study to understand the effects of TMS better in stroke survivors.

@@psycheddiscussions4661 nice. I think in Holland we are behind with tms

Yea, I think there is some cool research. But implentation to clinics is slow. Coverage by insurance companies is limited and it took very long.

@@psycheddiscussions4661 hm hope my dad can do this, and that it will be covered from health insurance

Thank you!

I am not aware of Temporal lobe TMS for therapy. At least not FDA approved. I know there are some research studies on temporal stimulation on working memory. Also temporoparietal stimulation for spatial memory and navigation. But all of that is not in a therapeutic setting.

Yes. I need t emporaal lbe treatment as well. Please help. I'm desperate!

Thank you for watching! TMS is not guaranteed to work, but it would be great if we can make the odds as good as possible :)

Great!

Hi Ruby. It depends a little. I would say that it is not ideal, because the effects of TMS are cummulative. BUT, the effects also will not go away after two weeks. You may need to add an additional week at the end or so. It will also depend on what you will be doing when you are away in those two weeks. A stressful two weeks can be detrimental. But a relaxed vacation may be even beneficial.

Of course, here it is: Salehinejad, M.A., Wischnewski, M., Ghanavati, E. et al. Cognitive functions and underlying parameters of human brain physiology are associated with chronotype. Nat Commun 12, 4672 (2021). doi.org/10.1038/s41467-021-24885-0

Thank you for taking the time to watch!

It really is confusing right? haha. I will break it down from full to detail. The entire thing is 3 to 4 minutes. Within those 3 minutes there are blocks of 2 seconds of stimulation and 8 seconds of rest. within each 2 second block of stimulation there are 10 so called "bursts" each burst consists of 3 TMS pulses that are super fast after each other. Here is a video on my other channel: ua-cam.com/video/gwQd0beSGXo/v-deo.html I think at some point I do show a picture of how the protocol pattern looks like

There is indeed some research, but it is limited. The best summary is this paper: doi.org/10.1016/j.heliyon.2019.e02187 Important to note is that ketamine + TMS seems to be safe. So that is truly a good thing. Also the combination seems to be positive in treatment of both unipolar and bipolar depression. The only issue I see that it is "too much" for the brain, leading to more pronounced side effects (most likely extreme fatigue). But of course you yourself are the only person who can judge that. So, my advice would be to keep on taking ketamine while getting TMS in a small dose and then assess how you feel. If it goes well, keep going, if not, you may want to take a break from the ketamine.

@@psycheddiscussions4661 okay great thanks for the reply. I was wondering what you think about doing the ketamine troches during the actual TMS session? For example, taking a dose of ketamine right before i sit in the chair for TMS.

Oral ketamine takes about 20 to 30 minutes to be taken up by the body, so if you want to try it, you should at least have that much time in between. But I don't know how ketamine and TMS will interact. I cannot tell you whether it will amplify the effect or interfere. I am sorry, but I cannot rely answer your question.

I’m learning more and more thanks

❤

Thank you! I am happy that it was useful! I currently live in Minneapolis, MN :)

The cough medicine indeed can slow neuroplasticity, but to be honest, it would only be a problem in high doses (more than 3x the recommended dose). Sleep aids should be out of your system by the time you wake up. So those are no problem I think. Moreover, if they help you sleep, they can actually have a positive effect, because it is important to be well rested. Sleep deprivation also hurts neuroplasticity. So, in most cases I would suggest to keep using sleep meds :)

No. Many people do not feel any immediate effects. The effects of TMS in the first few hours are subtle and do often not immediately translate to how you feel. These effects in the first few hours have been studied mostly in animal studies where we can stick an measuring electrode into the brain. But a change in neurons is not immediately followed by a change in behaviour or a change in how you feel. Many people do not experience improvements until several weeks into the treatment.

I am not expert on pharmaceuticals, so this question is one you should probably ask your psychiatrist. But what I do know is that dextromethorphan (which I mentioned in the talk) is used in research to block NMDA receptors (which is a specific kind of connection between brain cells). Dextromethorphan is often used in non-invasive brain stimulation research to inhibit neuroplasticity. It can be found in various medications against cough. But, it is only really a problem when using more than 5x times the suggested dose. Also, how pharamaceuticals affect the brain is incredibly complex and not straight forward. Memantine and Ketamine for example, also are also NMDA antagonist, yet they can have positive effects on cognition and depressive symptoms. How these drugs act when they are combined together with TMS is still unclear. So when it comes to medications, definitely ask someone who is an expert!

Thank you again for watching! Glad you enjoyed!

Hi Kim, Thank you again for listening and your great questions. About the movements. During motor mapping you will experiences finger or hand movements. But during treatment they move the TMS to another place. At that time, it is unlikely that you feel any movement in your fingers anymore. But, what is very normal during treatment is movement of the jaw and other facial muscles, like eye brows, cheeks and nose. Those twitches come from stimulation of superficial muscles that cannot be avoided. For some it can be really annoying, such that they need to wear teeth protection. So although that is normal, I also would say that you still should feel, more or less, comfortable. So if 120% is really too much, you should be really explicit about it and tell them that you would prefer 110%. The intensity of 120% is used as a magic number by therapists. But in reality, the science shows that there is a lot of variability and in many cases lower intensities work perfectly. So if you feel that 1) 120% is too much and 2) your depression symptoms improved after 110%, then I think that 110% is correct for you and 120% is not needed. If you can, try to friendly but insistently tell them that. :) (Note: my opinion is based on a lot of reading and 9 years of TMS experience, but in the end it is "just" an opinion)

Thanks Miles! I do experience some of the jaw movements but at the 120% I also experienced my right hand twitching during the treatment. We also did switch machines from the one I was originally mapped on, so I don’t know it that makes a difference. I really appreciate you offering up yourself for questions as I feel that the technicians aren’t fully trained on the science but the techniques. Well mine are, I’m not sure that is the case with every center. My technician is very sweet but I don’t feel she has the training on the inner workings of the brain, but does have training on the technology of the machine. So a lot of my questions are answered with guesses rather than actual facts. So it’s nice to be able to communicate with someone with so much knowledge and actual training in the field and on the machines. It’s very much appreciated! Hopefully you can help many others like me get the answers they need, and maybe the training for the centers. I’ve never even spoken to a doctor at my center. But I do have an appointment on Monday to talk to the Nurse Practitioner.

Good technicians are important, and I agree that maybe not all of them understand the nitty gritty of the matter. So it is nice to hear that you can trust your techs! Good luck on Monday! :)

I did not really touch on this, but exercise is a positive thing, particularly if it is not too straining. Some steady state cardio, or low to medium resistance exercise has shown to improve neuroplasticity. So, I love to hear that you do this before the sessions! Indeed, the 1 or 2 cups of coffee probably make no big difference. It starts to become an issue if people drink upwards of 2-3 cups more than usual. Thanks for listening and commenting!

Yea, I would agree with that! Introducing positive habits is never a bad thing. That is why I also said that sleep medication or meditation may help if it improves sleep. So adding in these new positive aspects can certainly improve the effect of TMS. I think what I wanted to point out is that you shouldn’t make any haphazard changes to your life style if you don't know if they will help. :) Thanks for the comment!

Thank you for watching/listening. I am glad it was helpful :)

Hi Kim, glad the video was helpful! About your situation, it is of course difficult to predict. But my educated guess is that the two weeks of will not be negative. The neuroplastic changes that you have build up until now don't just disappear. But it may take a few session to reactivate these networks again. So, if possible you may want to add like 3 or 4 session at the end (if that is possible at all). If not, I don't think it would be a huge problem. Just have a look at how you feel after 36 sessions. If you feel good, keep it like it is. If you feel it could be a little better, try and see if you can add a handful of sessions. In the future I will also dedicate an episode to neuroplasticity and how the dips may occur. Thanks for sticking around!

I am very glad to hear that it helped!

Thanks! There is some in the beginning, but I will talk about it a little bit more in the beginning of the next time.

Thanks!