Viyana 8. Dünya Psikiyatri Kongresi Sempozyum Sunumu - Prof. Dr. Nevzat TARHAN

Electrical brain activity following magnetic stimulation as recorded with high-resolution QEEG

Presented in the 8th World Congress of Psychiatry in Vienna in July 2th, 2005.

(A symposium called ‘Brain Stimulation Techniques in Psychiatry and Electrophysiology’. Chair: Bilgen Taneli, Co-chair: Mark George, Other speakers: David Avery, Nevzat Tarhan). Published in The World Journal of Biological Psychiatry, Volume 5-3 (Supplement 1), 2005-July. www.wfsbp-vienna2005.com Prof. Dr. Nevzat Tarhan'ın Viyana 8. Dünya Psikiyatri Kongresi Sunumu (PPS Formatında indirmek için tıklayınız.) Electrical brain activity following magnetic stimulation as recorded with high-resolution QEEG Prof. Dr. Nevzat Tarhan nt_vienna1rTMS
  • First TMS capable of delivering a pulse every three seconds (as diagnostic aids for neurologists.)
  • New machines which can give up to 50 stimuli per second (rTMS)
  • A non-invasive technique, free of serious side effects, easily modifying activity of specific brain areas
How does rTMS work for brain electrical activity?
  • rTMS gives short pulses of magnetic energy to Limbic system structures
  • Small electric charges can cause the neurons to fire or to become active
Ilmoniemi et.al.(1997) were able to measure with QEEG just seconds after electromagnetic pulse
  • Nashaat et.al (2001),
  • Nikulin et.al (2003),
  • Kommsi et.al (2004) have used ongoing rTMS and QEEG Monitoring
Brain electrical activity changes with rTMS
  • lAcute rTMS induces changes in regional activity throughout the brain
  • Stimulation intensity is important
  • Low frequency has a tendency to decrease
  • High frequency has a tendency to increase
Resynchronization effects
  • lNormal brain function requires synchronized activity of interconnected brain areas
  • rTMS may help ‘reset’ the normal synchrony between brain regions (Garcia-Toro et.al. 2001, Avery 2004)
nt_vienna2GABA and QEEG
    • lGABA increases functional connectivity on QEEG (Benzodiazepine effect)
    • GABA decreases with stress
    • GABA decreases in plasma and in brain (MRS) of depressed patients
    • ECT increases GABA level in depressed patients.
    • rTMS: increase ?
State marker improves after treatment
  • Trait marker doesn’t improve after treatment
‘State markers’ of QEEG being:
  • lRatio of Alpha waves
  • Ratio of Delta waves
  • Hemispheric asymmetry
  • Alpha/Delta ratio of the frontal area
Acute drug effect in QEEG
  • lTricyclic Antidepressant drugs: Alpha, Theta, Delta
  • Antipsychotic drugs :Theta and Delta waves
  • Antianxiety drugs :beta
  • Cognitive activator drugs : Alpha
  • SSRI drugs: Alpha (Itil 1989)
The Response to drug treatment in depression
  • •Delta waves: good response,
  • Alpha and Beta waves: good response,
  • Unchanged QEEG: bad response. (Kendler)
The Distribution of Brain waves in QEEG after 10 sessions of rTMS (preliminary findings)
nt_vienna3According to HAM ScoresHAM Scores and QEEG after 10 sessions of rTMS “An interpretation”
  • lAll patients showed 30-50% treatment response
  • In Alpha increases group, HAM improvement was greater
  • In no changes group, HAM improvement was minimal
  • More verification, and MEG studies, are necessary
Pregnancy and rTMS (Case Study I)
  • lOne case (I.D., 32 years)
  • She had serious non-psychotic Chronic Major Depression.
  • She used antiepileptic and antidepressant drugs.
  • She became pregnant during treatment.
  • She wanted to continue the pregnancy.
Pregnancy and rTMS (Case Study II)
  • lFirstly, we stopped her using the antidepressant drugs
  • We applied 40 sessions of rTMS to her.
  • Every session was 25 Hz. and 1000 pulses.
  • Now, she has a healthy baby.
  • After birth, rTMS was continued.
Frequency of seizures
  • lWe applied rTMS at approximately 15,000 sessions in two years
  • In every session, rTMS was applied at 25 Hz
  • In most cases, 1000 pulses were applied in every session
  • Grandmal seizures were observed only in 3 cases.(3 /15,000)
  • 25 Hz, 1 Pulses, 50% Power
  • 25 Hz, 1 Pulses, 100% Power
  • 25 Hz, 3 Pulses, 100% Power
  • 5 Hz, 10 Pulses, 50% Power, Duration 1.8 sec
  • 5 Hz, 10 Pulses, 75% Power, Duration 1.8 sec
  • 5 Hz, 10 Pulses, 100% Power, Duration 1.8 sec
  • 25 Hz, 50 Pulses, 50% Power, Duration 1.9 sec
  • 25 Hz, 50 Pulses, 75% Power, Duration 1.9 sec
  • 25 Hz, 50 Pulses, 100% Power, Duration 1.9 sec
Scientific Inspiration
  • One day, in 1990 at a London Hospital in an elevator, a passenger was giggling. A magnetic stimulation had been applied to his head. It was a neuro-diagnostic motor test, for thumb jerk
  • Dr. Mark George observed and was astonished by this situation. He suspected that magnetic fields could move much more than the thumb.
  • The story of magnetic therapy in psychiatry started like this.


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