Non-Invasive Neuromodulation of the Central Nervous System Opportunities and Challenges: Workshop Summary (2015) / Chapter Skim
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4 Therapeutic Uses of Non-Invasive Neuromodulation
4 Therapeutic Uses of Non-Invasive Neuromodulation
Pages 31-40
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From page 31... ...
Neuromodulatory devices provide tools that can translate insights from cognitive neuroscience into targeted therapies for disorders of the 31
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In other words, he said, these neuromodulatory approaches enable targeting not of the disease itself, but specific symptom complexes that map onto specific neural substrates. Most of the work on developing therapeutic applications of neurostimulation has focused on transcranial current stimulation (tDCS and tACS)
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For this he advocated combining brain stimulation techniques with neuroimaging and neurophysiology, that is, by using magnetic resonance imaging (MRI) -guided approaches for optimal spatial precision and EEG-guided approaches for optimal frequency for a given cortical location or condition.
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In one study comparing active TMS to sham TMS, TMS was significantly superior to sham after 4 and 6 weeks of five sessions per week (O'Reardon et al., 2007)
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. AHRQ strives to identify the highest quality evidence available and synthesize that information quantitatively to answer key questions that are of public health or medical importance.
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Gaynes said the ability to quantitatively synthesize data from TMS studies was hindered by varying definitions of treatment-resistant depression; an unclear number of prior treatment episodes; varying parameters such as coil location, motor threshold, stimulus pulse, and number of pulses; whether TMS was used as an add-on or substitute treatment; and baseline levels of depression. In addition, journal articles from which data were derived often report only group effects, making it difficult to answer simple questions such as how depression severity affects outcomes.
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His group starts by understanding how intact cognitive systems work and how injured systems differ from normal systems, using this knowledge to guide the development of brain stimulation protocols. For example, a meta-analysis from his group looked at functional imaging data from aphasic subjects during language tasks compared to normal subjects, and determined that while normal subjects activate left-dominant networks, aphasic subjects also activate additional areas in both the left and right hemispheres (Turkeltaub et al., 2011)
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More than 88 percent of the subjects receiving rTMS stimulation had a meaningful clinical response compared to only 38 percent who received sham stimulation (Harvey et al., 2014) , prompting a much larger Phase III trial that is currently ongoing, said Hamilton.
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Mark Demitrack, vice president and chief medical officer of Neuronetics, for example, said he believes combinatorial work across device platforms as well as combinations of neurostimulation with behavioral interventions are ripe for study now. Ana Maiques, however, said she believes the barriers separating pharmaceutical and device companies are diminishing; and Atul Pande, chief medical officer at Tal Medical, added that most studies are currently conducted against a background of existing pharmacotherapy.
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