Anas zaitoun5th year medical studentJourdan university of science and technology

definition of TMS : Transcranial magnetic stimulation (TMS) is a

procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. Transcranial magnetic stimulation may be tried when other depression treatments haven't worked.

With TMS, a large electromagnetic coil is placed against your scalp near your forehead. The electromagnet used in TMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression

Precautions : Tell your doctor or mental health provider if: You're pregnant or thinking of becoming pregnant. You have any metal or implanted medical devices in

your body. Due to the strong magnetic field produced during TMS, some people who have the following devices cannot have TMS: Aneurysm clips or coils Stents Implanted stimulators Electrodes for monitoring brain activity Any magnetic implants Bullet fragments Any other metal device or object implanted in your body

Result : If TMS works for you, your depression symptoms may

improve or go away completely. Symptom relief may take a few weeks of treatment.

TMS may be less likely to work if: 1- Your mental illness causes detachment from reality ( (psychosis) 2- Your depression has lasted for several years 3-Electroconvulsive therapy (ECT) hasn't worked to improve depression symptoms It's not yet known if TMS can be used to treat depression for

the long term, or whether you can have periodic maintenance treatments to prevent depression symptoms from returning.

Deep brain stimulation : Deep brain stimulation involves implanting electrodes within

certain areas of your brain. These electrodes produce electrical impulses that regulate abnormal impulses. Or, the electrical impulses can affect certain cells and chemicals within the brain. The amount of stimulation in deep brain stimulation is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.

Deep brain stimulation is used to treat a number of neurological conditions, such as:

Essential tremor Parkinson's disease Dystonia Deep brain stimulation is also being studied as a treatment for

epilepsy, cluster headaches, Tourette syndrome, chronic pain and major depression. Many candidates for deep brain stimulation are participants in clinical trials.

Surgery risks : Deep brain stimulation involves boring small holes in the skull to

implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:

Bleeding in the brain (hemorrhage) Stroke Infection Breathing problems Nausea Heart problems Incision scarring With deep brain stimulation, surgery isn't a one-time procedure. The

batteries that are implanted in the chest have a limited life span, and when they run out, your symptoms may quickly return. Replacing the batteries requires another surgery. It's also possible for a wire connecting the batteries to an electrode to break or for other malfunctions to occur.

Possible side effect after surgery : Seizure Infection Headache Insomnia Memory problems Temporary pain and swelling at the

implantation site

Possible side effects of stimulation Numbness or tingling sensations Muscle tightness of the face or arm Speech problems Balance problems Lightheadedness Unwanted mood changes, such as

mania and depression

Preparation : Before surgery, you need to have

medical tests to make sure that deep brain stimulation is safe for you and is a good option in your case. You also need brain-imaging studies, such as an MRI, before the surgery, to map the areas of your brain where the electrodes will be implanted.

Result : Deep brain stimulation won't cure your

disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don't go away completely. In some cases, medications may still be needed for certain conditions. Deep brain stimulation isn't successful for everyone

Vagus nerve stimulation Vagus nerve stimulation is a procedure that stimulates the

vagus nerve with electrical impulses. Vagus nerve stimulation can be used to treat epilepsy when other treatments haven't worked. Vagus nerve stimulation is also a treatment for depression, and it's being studied for conditions such as multiple sclerosis, migraine and Alzheimer's disease.

There's one vagus nerve on each side of your body, running from your brainstem through your neck to your chest and abdomen.

With vagus nerve stimulation, a device is surgically implanted under the skin on your chest. A wire is threaded under your skin connecting the device to the left vagus nerve. When activated, the device sends electrical signals along the vagus nerve to your brainstem, which then sends signals to certain areas in your brain

Risks : Pain where the cut (incision) is made to

implant the device Infection Incision scarring Difficulty swallowing Vocal cord paralysis, which is usually

temporary, but can be permanent

Side effects : Voice changes Hoarseness Throat pain Cough Headache Chest pain Breathing problems, especially during exercise Difficulty swallowing Abdominal pain or nausea Tingling or prickling of the skin

When vagus nerve stimulation may be a good option :

The Food and Drug Administration (FDA) has approved vagus nerve stimulation for people who:

Are 12 and older Have focal (partial) epilepsy Have seizures that aren't well controlled with medications In addition, the FDA has approved vagus nerve stimulation for

the treatment of depression in adults who: Have chronic, hard-to-treat depression (treatment-resistant

depression) Haven't improved after trying four or more medications or

electroconvulsive therapy (ECT), or both Continue standard depression treatments along with vagus

nerve stimulation

Result : Vagus nerve stimulation isn't a cure for epilepsy. Most

people with epilepsy won't stop having seizures altogether. But many people will have fewer seizures, as many as 30 to 50 percent fewer. Seizure intensity may lessen as well.

It can take as long as two years of vagus nerve stimulation before you notice any significant reduction in the number of seizures. Vagus nerve stimulation may also shorten the recovery time after a seizure. People who've had vagus nerve stimulation to treat epilepsy generally have an improved quality of life.