Brief reportTreatment of bipolar mania with right prefrontal rapid transcranial magnetic stimulation
Introduction
In the last decade, transcranial magnetic stimulation (TMS) has developed from a primarily diagnostic tool into a therapeutic strategy in neuropsychiatry (George et al., 1999). The therapeutic use of TMS has been suggested in a wide range of psychiatric disorders including posttraumatic stress disorder (McCann et al., 1998), catatonia (Grisaru et al., 1998a), obsessive compulsive disorder (Greenberg et al., 1997) and mood disorders (Kolbinger et al., 1995, Yaroslavsky et al., 1999). While left prefrontal rapid TMS has been described as a successful antidepressant strategy in most (George et al., 1995, George et al., 1997, Pascual-Leone et al., 1996a, Pascual-Leone et al., 1996b, Avery et al., 1999), but not all studies (Loo et al., 1999, Padberg et al., 1999), Grisaru et al. (1998b) have reported antimanic effects for rapid TMS of the right prefrontal cortex.
To test the possible effects of this therapeutic strategy, nine bipolar (I) in-patients diagnosed with mania were treated for 4 weeks with right prefrontal rapid TMS in an open and prospective study at the Mood Disorders Unit of the Psychiatric Department of Münster University Hospital.
Section snippets
Methods
As opposed to Grisaru et al.’s (1998b) 14-day treatment, our patients were given five sessions during weeks 1 and 2; and three sessions during weeks 3 and 4. Rapid TMS was carried out with a Dantec MagPro 16E62 magnetic stimulator (20 trains per session, frequency of 20 Hz for 2 s per train, intertrain interval of 1 min). The motor magnetic threshold (Hallett and Cohen, 1989) was assessed in each patient before the first TMS treatment; 80% of this motor threshold was then administered at all
Results
Both TMS monotherapy and add-on-treatment with TMS were safe treatment strategies with little subjective side effects. During the 4 weeks of treatment with right prefrontal rapid TMS, a sustained reduction of manic symptoms as measured by BRMAS was observed in all nine patients (Table 1).
Discussion
Our data obtained in a prospective, open trial show that right prefrontal rapid TMS is safe and efficacious in the treatment of bipolar mania. While double-blind controlled studies are essential in the evaluation of novel treatment strategies, methodologically well performed open studies are generally considered to be valid (Sulzbacher, 1973; Pajonk et al., 2000). In our study, BRMAS scores were stable between days −7 and 0 and showed a reduction after addition of TMS. Nevertheless, it should
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2018, Psychiatric Clinics of North AmericaCitation Excerpt :Compared with sham, however, right-sided stimulation did not provide any benefit in mania symptoms. Subsequently in 2004, there were 2 small case series using 10-Hz and 20-Hz rTMS over the right DLPFC that reported significant improvements in mania symptoms.52,53 Providing conflicting evidence regarding the usefulness of rTMS to treat mania, there have been 2 subsequent randomized controlled trials of high-frequency rTMS over the right DLPFC.