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McLoughlin DM, Mogg A, Eranti S, Pluck G, Purvis R, Edwards D, Landau S, Brown R, Rabe-Heskith S, Howard R, Philpot M, Rothwell J, Romeo R, Knapp M. The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis. Health Technol Assess 2007; 11:1-54. [PMID: 17580003 DOI: 10.3310/hta11240] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate if repetitive transcranial magnetic stimulation (rTMS) was as effective as electroconvulsive therapy (ECT) in treating major depressive episodes and to perform a cost-effectiveness analysis. DESIGN A single-blind pragmatic multicentre randomised controlled trial (RCT) with 6 months of follow-up to test equivalence of rTMS with ECT. SETTING The South London and Maudsley NHS Trust and Pembury Hospital in the Invicta Mental Health Trust in Kent. PARTICIPANTS Right-handed adult patients referred for ECT for treatment of a major depressive episode (DSM-IV) were assessed. During the 2.5-year trial period, 260 patients were referred for ECT, of whom 46 entered the trial. The main reason for not entering the trial was not consenting to ECT while being formally treated under the UK Mental Health Act 1983. INTERVENTIONS Patients were randomised to receive a 15-day course of rTMS of the left dorsolateral prefrontal cortex (n = 24) or a course of ECT (n = 22). MAIN OUTCOME MEASURES Patients were assessed before randomisation, at end of treatment and at the 6-month follow-up. Primary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD) and proportion of remitters (defined as HRSD score <or=8) at the end-of-treatment time point. Secondary outcomes included self-ratings for mood on the Beck Depression Inventory-II (BDI-II) and visual analogue mood scales (VAMS), the Brief Psychiatric Rating Scale (BPRS), plus subjective and objective side-effects. Low scores on the BDI-II, VAMS and BPRS are positive in terms of health. The results were analysed on an intention-to-treat basis. Cost data were collected using the Client Service Receipt Inventory and the Short Form with 36 Items was used to obtain quality of life measures. Health economic outcomes were cost of treatments, costs incurred during the 6-month follow-up period and gains in quality-adjusted life-years (QALYs). RESULTS One patient was lost to follow-up at end of treatment and another eight at 6 months. The end-of-treatment HRSD scores were lower for ECT, with 13 (59%) achieving remission compared with four (17%) in the rTMS group. However, HRSD scores did not differ between groups at 6 months. BDI-II, VAMS and BPRS scores were lower for ECT at end of treatment and remained lower after 6 months. Improvement in subjective reports of side-effects following ECT correlated with antidepressant response. There was no difference between the two groups before or after treatment on global measures of cognition. Although individual treatment session costs were lower for rTMS than ECT, the cost for a course of rTMS was not significantly different from that for a course of ECT as more rTMS sessions were given per course. Service costs were not different between the groups in the subsequent 6 months but informal care costs were significantly higher for the rTMS group and contributed substantially to the total cost for this group during the 6-month follow-up period. There also was no difference in gain in QALYs for ECT and rTMS patients. Analysis of cost-effectiveness acceptability curves demonstrated that rTMS has very low probability of being more cost-effective than ECT. CONCLUSIONS ECT is a more effective and potentially cost-effective antidepressant treatment than 3 weeks of rTMS as administered in this study. Optimal treatment parameters for rTMS need to be established for treating depression. More research is required to refine further the administration of ECT in order to reduce associated cognitive side-effects while maintaining its effectiveness. There is a need for large-scale, adequately powered RCTs comparing different forms of ECT. The next generation of randomised trials of rTMS should also seek to compare treatment variables such as stimulus intensity, number of stimuli administered and duration of treatment, with a view to quantifying an effect size for antidepressant action.
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Filipovic S, Heywood P, Rothwell J, Bhatia K. 3.243 Low-frequency repetitive transcranial magnetic stimulation (rTMS) reduces levodopa induced diphasic dyskinesias in Parkinson's disease (PD): A case report. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70881-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Orth M, Münchau A, Rothwell J. Excitability of cortico-spinal system at rest is associated with tic severity in Gilles de la Tourette syndrome. AKTUELLE NEUROLOGIE 2007. [DOI: 10.1055/s-2007-987549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van der Salm S, van Rootselaar A, Foncke E, Koelman J, Bour L, Bhatia K, Rothwell J, Tijssen M. 3.244 Polyphasic MEPs in myoclonus dystonia: A TMS study. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Toomey DP, Cahill RA, Birido N, Jeffers M, Loftus B, McInerney D, Rothwell J, Geraghty JG. Rapid assessment breast clinics – Evolution through audit. Eur J Cancer 2006; 42:2961-7. [PMID: 16956758 DOI: 10.1016/j.ejca.2006.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 06/15/2006] [Accepted: 06/29/2006] [Indexed: 10/24/2022]
Abstract
This observational, cohort study aimed to examine the potential utility of Rapid Assessment Breast Clinics (RABC) beyond cancer detection at presentation. One thousand four hundred and twenty nine women were studied over an 18 month period. 154 (10.7%) had breast cancer - 87.7% of whom were seen expediently with 92.9% being diagnosed at one attendance. One hundred and forty three (10%) of those with a benign diagnosis were found by routine questioning to have significant familial risk separate to their reason for referral. Despite careful triage, considerable contamination of appointment allotment occurred with many who were correctly triaged as non-urgent being seen 'urgently'. One hundred and seventy six attendees (12.3%) had neither the symptom that triggered referral, nor breast lump, nipple discharge nor family history of breast cancer, while 283 (19.8%) had no objective clinical or radiological abnormality. Although RABC reliably categorise malignant versus non-malignant diagnoses despite cluttering by low risk women, a significant proportion of non-cancer patients still require address of future risk rather than reassurance of their present status alone.
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Sacco P, Turner D, Rothwell J, Thickbroom G. FC45.4 Effects of interstimulus interval (ISI) and stimulus intensity on responses to triple pulse transcranial magnetic stimulation (tTMS). Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rothwell J. S4.1 Studies of cortical connectivity in movement disorders. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Etoh S, Nakanishi R, Ishikawa S, Kawahira K, Rothwell J. P37.33 TMS induced F wave – Relationship between F facilitation and MEP size. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fujiwara T, Rothwell J, Masakado Y, Tsuji T, Uemura O, Kasashima Y, Honaga K, Hase K, Liu M. P06.4 Cortical modulation of the short-term plasticity of spinal reciprocal inhibition. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rothwell J. NL3 Adrian Lecture: How do we control movement. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Toomey D, Cahill R, Birido N, Rothwell J, Geraghty J. Rapid access breast clinics for the future. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Schippling S, Koch G, Bäumer T, Rothwell J, Münchau A. Physiological connectivity of the left ventral premotor cortex to the ipsilateral primary motor cortex explored by TMS. AKTUELLE NEUROLOGIE 2006. [DOI: 10.1055/s-2006-953003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Demiralay C, Bäumer T, Hidding U, Helmich R, Wunderlich S, Rothwell J, Liepert J, Siebner H, Münchau A. Slow rTMS to the somatosensory cortex attenuates afferent inhibition in patients with writer's cramp. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Siebner H, Rizzo V, Bagnato S, Morgante F, Girlanda P, Rothwell J, Quartarone A. Homeostatic plasticity of the motor cortex is impaired in focal dystonia. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bäumer T, Bock F, Lange R, Rothwell J, Siebner H, Münchau A. Differentielle interhemisphärielle Interaktion über prämotorische und motorische Verbindungen - I1 und I3 vermittelte Phänomene? AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nowak D, Tisch S, Hariz M, Limousin P, Topka H, Rothwell J. Sensory timing cues improve bradykinesia of grasping movements in Parkinson's disease: a comparison to the effects of STN stimulation. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-919510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Siebner H, Rizzo V, Bagnato S, Rothwell J, Quartarone A. Transcranial magnetic stimulation of the motor sytem in focal dystonia. AKTUELLE NEUROLOGIE 2005. [DOI: 10.1055/s-2005-916311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Harrington RC, Kroll L, Rothwell J, McCarthy K, Bradley D, Bailey S. Psychosocial needs of boys in secure care for serious or persistent offending. J Child Psychol Psychiatry 2005; 46:859-66. [PMID: 16033634 DOI: 10.1111/j.1469-7610.2004.00388.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The mental health of child offenders who are detained in secure settings is a matter of great public and professional concern but there has been little systematic longitudinal research on the outcomes of these problems once the young person has returned to the community. The aims of the present study were to describe the psychosocial outcomes of boys in secure care and to establish if these outcomes were correlated with criminal outcomes. METHOD Prospective cohort study of 97 boys whose average age was 14 years when they were admitted to secure units in the North West of England. The boys were followed up on average 2 years later, when outcome data were obtained on 81/97 (83%) cases. The main outcome measure was a standardised assessment of mental health, social and educational needs obtained by interview with the young person and corroborated in most cases by information from informants. All data were then reviewed by experienced clinicians who made best-estimate ratings of need 'blind' to the findings from the first phase of the study. RESULTS The average number of needs requiring an intervention at follow-up (mean=3.4, sd=3.0) was much lower than before admission to secure care (mean=8.2, sd=2.5) (mean difference 4.9 needs, 95% CI 4.0 to 5.7). Educational and occupational needs were particularly well dealt with. However, many mental health problems persisted or worsened. For example, 31% had a need for treatment of substance abuse, a significant increase compared with when they were in secure care (percentage difference 21%, 95% CL 9.0% to 32.7%). No mental disorder predicted subsequent offending. CONCLUSIONS Boys who have been in secure care continue to have a high rate of mental health problems. The mental health needs of this group are not, however, static but change over time and with changing circumstances. Services need to be designed to meet these changing needs.
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Nowak DA, Rosenkranz K, Topka H, Rothwell J. Disturbances of grip force behaviour in focal hand dystonia: evidence for a generalised impairment of sensory-motor integration? J Neurol Neurosurg Psychiatry 2005; 76:953-9. [PMID: 15965201 PMCID: PMC1739702 DOI: 10.1136/jnnp.2004.043943] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Focal task specific dystonia occurs preferentially during performance of a specific task. There may be an inefficiently high grip force when doing manipulative tasks other than the trigger task, possibly reflecting a generalised impairment of sensory-motor integration. OBJECTIVE To examine how well subjects with writer's cramp (n = 4) or musician's cramp (n = 5) adapted their grip force when lifting a new object or catching a weight. METHODS Nine patients with focal hand dystonia and 10 controls were studied. Experiments addressed different motor behaviours: (A) lifting and holding an object; (B) adjusting grip force in anticipation of or in reaction to a change in load force by catching a small weight dropped expectedly or unexpectedly into a hand held receptacle. RESULTS In (A), patients produced a grip force overshoot during the initial lifts; force overflow was most pronounced in those with writer's cramp. Patients and controls adjusted their grip force to object weight within one or two lifts, though patients settled to a steady force level above normal. In (B), patients with focal hand dystonia and normal controls showed similar predictive grip force adjustments to expected changes in object load, suggesting that this aspect of sensory-motor integration was normal. Patients had a shorter latency of grip force response than controls after an unexpected load increase, reflecting either a greater level of preparatory motor activity or a disinhibited spinal reflex response. CONCLUSIONS The overall increased grip force in patients with focal hand dystonia is likely to be a prelearned phenomenon rather than a primary disorder of sensory-motor integration.
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Birido N, Atkinson M, Rothwell J, Geraghty J. The use of computer interface in the rapid diagnostic breast clinic. Ir J Med Sci 2005. [DOI: 10.1007/bf03170168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sauner D, Siebner HR, Bestmann S, Rothwell J. Primary Motor Cortex Involvement in a Handedness Recognition Task – Evidence from Transcranial Magnetic Stimulation. KLIN NEUROPHYSIOL 2004. [DOI: 10.1055/s-2004-832149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Orth M, Kirby R, Richardson M, Snijders A, Rothwell J, Trimble M, Robertson M, Münchau A. Repetitive transcranial magnetic stimulation has no effect on tics in patients with Gilles de la Tourette syndrome. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nowak DA, Topka H, Rothwell J, Hermsdörfer J, Robertson MM, Orth M. Die Modulation der Griffkraft beim Tourette-Syndrom. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lang N, Siebner H, Ward N, Nitsche M, Paulus W, Rothwell J, Lemon R, Frackowiak R. Darstellung ausgedehnter Veränderungen des regionalen zerebralen Blutflusses nach transkranieller Gleichstromstimulation mittels PET. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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