Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018)
Paris 12 Val de Marne University1, University Medical Center Groningen2, Eindhoven University of Technology3, University Hospital of Lausanne4, French Institute of Health and Medical Research5, Università Campus Bio-Medico6, University of Belgrade7, University of Cologne8, Ludwig Maximilian University of Munich9, École Polytechnique Fédérale de Lausanne10, Turku University Hospital11, University of Regensburg12, Università telematica San Raffaele13, Paris Descartes University14, Paracelsus Private Medical University of Salzburg15, University of Bern16, Universidade Nova de Lisboa17, Medical Park18, University of Göttingen19, University of Messina20, Central European Institute of Technology21, University of Siena22, University of Turku23, University of Tübingen24
TL;DR: These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018, and are based on the differences reached in therapeutic efficacy of real vs. sham rT MS protocols.
About: This article is published in Clinical Neurophysiology.The article was published on 2020-01-01 and is currently open access. It has received 822 citations till now. The article focuses on the topics: Dorsolateral prefrontal cortex & Transcranial magnetic stimulation.
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University of Siena1, University of Göttingen2, UCL Institute of Neurology3, City College of New York4, National Institutes of Health5, Brown University6, University of Toronto7, Università Campus Bio-Medico8, Beth Israel Deaconess Medical Center9, Medical University of South Carolina10, Cincinnati Children's Hospital Medical Center11, Aristotle University of Thessaloniki12, Aalto University13, Paris 12 Val de Marne University14, Vita-Salute San Raffaele University15, University of Trento16, Ludwig Maximilian University of Munich17, Harvard University18, Duke University19, University of Messina20, Copenhagen University Hospital21, Fukushima Medical University22, Ben-Gurion University of the Negev23, University of Tübingen24
TL;DR: New operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
387 citations
TL;DR: In this article, the authors focus on spinal cord stimulation (SCS) therapies discussed within the framework of other invasive, minimally invasive, and non-invasive neuromodulation therapies.
118 citations
16 Jun 2020
TL;DR: It is demonstrated that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks.
Abstract: Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
112 citations
TL;DR: Transcranial direct current stimulation (tDCS) has shown mixed results for depression treatment and should be considered for further studies.
Abstract: Background Transcranial direct current stimulation (tDCS) has shown mixed results for depression treatment. Objective To perform a systematic review and meta-analysis of trials using tDCS to improve depressive symptoms. Methods A systematic review was performed from the first date available to January 06, 2020 in PubMed, EMBASE, Cochrane Library, and additional sources. We included randomized, sham-controlled clinical trials (RCTs) enrolling participants with an acute depressive episode and compared the efficacy of active versus sham tDCS, including association with other interventions. The primary outcome was the Hedges' g for continuous depression scores; secondary outcomes included odds ratios (ORs) and number needed to treat (NNT) for response, remission, and acceptability. Random effects models were employed. Sources of heterogeneity were explored via metaregression, sensitivity analyses, subgroup analyses, and bias assessment. Results We included 23 RCTs (25 datasets, 1,092 participants), most (57%) presenting a low risk of bias. Active tDCS was superior to sham regarding endpoint depression scores (k = 25, g = 0.46, 95% confidence interval [CI]: 0.22-0.70), and also achieved superior response (k = 18, 33.3% vs. 16.56%, OR = 2.28 [1.52-3.42], NNT = 6) and remission (k = 18, 19.12% vs. 9.78%, OR = 2.12 [1.42-3.16], NNT = 10.7) rates. Moreover, active tDCS was as acceptable as sham. No risk of publication bias was identified. Cumulative meta-analysis showed that effect sizes are basically unchanged since total sample reached 439 participants. Conclusions TDCS is modestly effective in treating depressive episodes. Further well-designed, large-scale RCTs are warranted.
85 citations
City College of New York1, Wake Forest University2, University of Florida3, University of Minnesota4, University of Vienna5, University of Szeged6, University of Coimbra7, Otto-von-Guericke University Magdeburg8, Tehran University of Medical Sciences9, Eindhoven University of Technology10, Centre for Addiction and Mental Health11, Université libre de Bruxelles12, Harvard University13, Copenhagen University Hospital14, University of New South Wales15, University College London16, Monash University17, Shahed University18, University of São Paulo19, University of Graz20, Max Planck Society21, Nagoya Institute of Technology22, University of Calgary23, Albert Einstein College of Medicine24, Research Medical Center25, Universidade Federal do Espírito Santo26, ETH Zurich27, Manipal University28, University of Zurich29, Beth Israel Deaconess Medical Center30, University of Oxford31, Technical University of Denmark32, Shanghai Mental Health Center33, University of Science and Technology of China34, McGovern Institute for Brain Research35
TL;DR: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders is developed.
83 citations
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Johns Hopkins University School of Medicine1, Johns Hopkins University2, Mayo Clinic3, McGill University4, Harvard University5, University of California, Irvine6, University of Pittsburgh7, Columbia University Medical Center8, Eli Lilly and Company9, Washington University in St. Louis10, UCL Institute of Neurology11, VU University Medical Center12, Alzheimer's Association13, Northwestern University14, National Institutes of Health15
TL;DR: The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available.
Abstract: The National Institute on Aging and the Alzheimer's Association charged a workgroup with the task of revising the 1984 criteria for Alzheimer's disease (AD) dementia. The workgroup sought to ensure that the revised criteria would be flexible enough to be used by both general healthcare providers without access to neuropsychological testing, advanced imaging, and cerebrospinal fluid measures, and specialized investigators involved in research or in clinical trial studies who would have these tools available. We present criteria for all-cause dementia and for AD dementia. We retained the general framework of probable AD dementia from the 1984 criteria. On the basis of the past 27 years of experience, we made several changes in the clinical criteria for the diagnosis. We also retained the term possible AD dementia, but redefined it in a manner more focused than before. Biomarker evidence was also integrated into the diagnostic formulations for probable and possible AD dementia for use in research settings. The core clinical criteria for AD dementia will continue to be the cornerstone of the diagnosis in clinical practice, but biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. Much work lies ahead for validating the biomarker diagnosis of AD dementia.
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TL;DR: The GRADE process begins with asking an explicit question, including specification of all important outcomes, and provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect.
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TL;DR: The approach of GRADE to rating quality of evidence specifies four categories-high, moderate, low, and very low-that are applied to a body of evidence, not to individual studies.
5,228 citations
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TL;DR: In this paper, the authors discuss the implications of these problems for the conduct and interpretation of research and suggest that claimed research findings may often be simply accurate measures of the prevailing bias.
Abstract: There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser pre-selection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.
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