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August 27, 2004

Transcranial Maganetic Stimulation Looks Hopeful for Bipolar Disorder

repetitive Transcranial Magnetic Stimulation or rTMS - May be helpful for Bipolar Disorder

From Canada's Toronto Star comes this news that suggests rTMS may be helpful for Bipolar Disorder.

The News story suggests that "The 61-year-old St. Catharines man says he "lost everything" after he developed bipolar mood disorder. Despite trying several different medications and numerous rounds of electroshock therapy, nothing seemed to stabilize his wild and debilitating mood swings. At one point, he was so despondent, he tried to kill himself.

Then Schmidt learned of a new approach available in Hamilton that showed good results with hard-to-treat (or treatment-resistant) cases like his own.

The treatments are called Transcranial Magnetic Stimulation or rTMS - and this treatment uses pulsed magnetic fields to alter the brain's chemistry.

As the news story suggests, there have been many research studies over the past 10 years have shown the treatment can help depression and stabilize mood swings as effectively as electroshock therapy (known as ECT) without the discomfort, memory loss and seizures that are part and parcel of that treatment.

However, unlike ECT, there isn't the need for a general anesthetic during rTMS. And because the magnetic pulses target a small, yet specific, brain region, the procedure does not cause seizures or any major side effects, research shows. The only commonly reported after-effect is a headache, experienced after treatment by 10 to 20 per cent of patients.

"Schmidt was ready to try anything to avoid ECT. He began working with Dr. Gary Hasey of the mood disorders program at St. Joseph's hospital in Hamilton, Ontario Canada and soon he started therapy with rTMS." the Star reports.

Within a few weeks, Schmidt states that he felt like "a new man. I could not believe it ... it worked and there was nothing scary about it," he says. "You don't have anesthetic and really feel nothing. But it has changed my life. I have hope."

The treatment was first developed in 1985 and is still undergoing refinement and research as new tests and studies explore how to use it safely and effectively. It works based on principles similar to regular MRI scans, but rTMS uses different frequencies of magnetic pulses aimed at a small area - about the size of a silver dollar - in the brain's prefrontal cortex. Researchers have long believed this part of the brain regulates mood.

However, though researchers knew rTMS could be highly effective for some patients, getting lasting results was a challenge.

Studies were conducted with pulses of different frequencies. Some targeted the left or right side of the brain and others both sides.

Health Canada has approved various makes of the device since the mid-1990s. This spring, a firm called Mindcare Centres, opened a private clinic in Toronto treating people for $3,000 to $6,000, depending on whether the patient needs maintenance sessions.

Iain Glass, president of Mindcare Centres, says the new clinic in Toronto, and one that opened in Vancouver two years ago, have treated about 100 people to date - with the majority showing significant improvement. Clinic treatments last about half an hour.

Dan Strasbourg, spokesperson for the Ontario health ministry, says repetitive Transcranial Magnetic Stimulation has been reviewed by the Ontario Health Technology Advisory Committee and its recommendations to the ministry will be posted on the committee's website on Wednesday. The committee will recommend whether rTMS should be used, where and when, and if government resources will be spent on it.

Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's College Health Sciences Centre, hopes to bring the therapy to his hospital should the government review permit. He believes it is based on sound, evidence-based medicine.

Levitt says if you imagine depression as caused by an over-excited brain chemistry, rTMS targets the part of the brain that helps co-ordinate brain chemistry so it can work normally.

If the health ministry approves the device for use in Ontario hospitals, "it will provide an excellent alternative to ECT in some people," he says.

Despite the initial price tag, Levitt says he thinks rTMS may turn out to be more cost-effective than ECT. believes. In addition, "it is less invasive and safer."

But some doctors think the device is not ready for clinical use. Hasey, who treated Schmidt, has been researching rTMS in Hamilton since 1997. Though the therapy has promise, it will take at least five years of continued refinements before it is ready for clinical use, he feels.

His work shows the procedure works very well in 30 per cent of cases, with another 20 to 30 per cent of patients showing improvement.

Since individuals' physiology varies so much, researchers still can't reliably target the correct brain site, he says. "If they are off by a few centimetres, maybe the patient doesn't respond. But it's not due to the treatment, it is due to where they are applying it," he says.

The best candidates for the treatment are younger patients and those without psychotic depression, studies show. Over the years that rTMS has been researched, people with a history of seizures or who have close relatives with seizure disorders have been excluded as have those with pacemakers, certain heart conditions or ferromagnetic items implanted in their skull.

Hasey is conducting research that he says may indicate people who respond to rTMS have different brain wave patterns than people who do not. His clinic in Hamilton is conducting studies of rTMS for depression and bipolar disorder and is looking for volunteers.


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