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Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:133-166. [PMID: 36740349 DOI: 10.1016/j.psc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obsessive-compulsive disorder (OCD) patients need novel therapeutic interventions since most experience residual symptoms despite treatment. Converging evidence suggest that OCD involves dysfunction of limbic cortico-striato-thalamo-cortical loops, including the medial prefrontal cortex (mPFC) and dorsal anterior cingulate cortex (dACC), that tends to normalize with successful treatment. Recently, three repetitive transcranial magnetic stimulation (rTMS) coils were FDA-cleared for treatment-refractory OCD. This review presents on-label and off-label clinical evidence and relevant physical characteristics of the three coils. The Deep TMS™ H7 Coil studies' point to efficacy of mPFC-dACC stimulation, while no clear target stems from the small heterogenous D-B80 and figure-8 coils studies.
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Das R, Sharma P, Sundas A, Goyal N, Kumar G, Shukla D, Roy C, Das B. Safety and efficacy of H7 deep transcranial magnetic stimulation in adolescent obsessive-compulsive disorder: A case report. Asian J Psychiatr 2023; 83:103510. [PMID: 36827931 DOI: 10.1016/j.ajp.2023.103510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Ruchira Das
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
| | - Pooja Sharma
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India.
| | - Ambika Sundas
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
| | - Nishant Goyal
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
| | - Gulesh Kumar
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
| | - Devangi Shukla
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
| | | | - Basudeb Das
- Central Institute of Psychiatry Ranchi, Jharkhand 834006, India
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Tzirini M, Roth Y, Harmelech T, Zibman S, Pell GS, Kimiskidis VK, Tendler A, Zangen A, Samaras T. Detailed measurements and simulations of electric field distribution of two TMS coils cleared for obsessive compulsive disorder in the brain and in specific regions associated with OCD. PLoS One 2022; 17:e0263145. [PMID: 36040972 PMCID: PMC9426893 DOI: 10.1371/journal.pone.0263145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The FDA cleared deep transcranial magnetic stimulation (Deep TMS) with the H7 coil for obsessive-compulsive disorder (OCD) treatment, following a double-blinded placebo-controlled multicenter trial. Two years later the FDA cleared TMS with the D-B80 coil on the basis of substantial equivalence. In order to investigate the induced electric field characteristics of the two coils, these were placed at the treatment position for OCD over the prefrontal cortex of a head phantom, and the field distribution was measured. Additionally, numerical simulations were performed in eight Population Head Model repository models with two sets of conductivity values and three Virtual Population anatomical head models and their homogeneous versions. The H7 was found to induce significantly higher maximal electric fields (p<0.0001, t = 11.08) and to stimulate two to five times larger volumes in the brain (p<0.0001, t = 6.71). The rate of decay of electric field with distance is significantly slower for the H7 coil (p < 0.0001, Wilcoxon matched-pairs test). The field at the scalp is 306% of the field at a 3 cm depth with the D-B80, and 155% with the H7 coil. The H7 induces significantly higher intensities in broader volumes within the brain and in specific brain regions known to be implicated in OCD (dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC) and pre-supplementary motor area (pre-SMA)) compared to the D-B80. Significant field ≥ 80 V/m is induced by the H7 (D-B80) in 15% (1%) of the dACC, 78% (29%) of the pre-SMA, 50% (20%) of the dlPFC, 30% (12%) of the OFC and 15% (1%) of the IFG. Considering the substantial differences between the two coils, the clinical efficacy in OCD should be tested and verified separately for each coil.
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Affiliation(s)
- Marietta Tzirini
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- THESS, Thessaloniki Software Solution S.A., Thessaloniki, Greece
- * E-mail:
| | - Yiftach Roth
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | | | | | - Gaby S. Pell
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
| | - Vasilios K. Kimiskidis
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aron Tendler
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- BrainsWay Ltd., Jerusalem, Israel
- Advanced Mental Health Care Inc., United States of America
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Theodoros Samaras
- School of Physics, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physics, University of Malta, Msida, Malta
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Harmelech T, Tendler A, Arikan MK, Çetin HL, Esmeray MT, Ilhan R, Vidrine R, Muir O, MacMillan C, Sinclair R, Shakir S, Kent D, Evangelidis N, Roth Y. Long-term outcomes of a course of deep TMS for treatment-resistant OCD. Brain Stimul 2022; 15:226-228. [PMID: 34982981 DOI: 10.1016/j.brs.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tal Harmelech
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel.
| | - Aron Tendler
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel; Advanced Mental Health Care Inc., 1903 Southern Blvd. Royal Palm Beach, FL, 33411, USA; Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mehmet Kemal Arikan
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Hamide Laçin Çetin
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Muhammed Taha Esmeray
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Reyhan Ilhan
- Akademik Psychiatry & Psychotherapy Center, Halaskargazi Cad. No: 103, Gün Apt, apartment: 4B, 34371, Osmanbey, Istanbul, Turkey
| | - Ryan Vidrine
- Mindful Health Solutions, 360 Post Street, Suite #500, San Francisco, CA, 94108, USA
| | - Owen Muir
- Brooklyn Minds, 347 Grand St, Brooklyn, NY, 11211, USA
| | | | | | - Saad Shakir
- Silicon Valley TMS, 2039 Forest Ave STE 201, San Jose, CA, 95128, USA
| | - David Kent
- NuMe TMS, 2375 S Cobalt Point Way #102, Meridian, ID, 83642, USA
| | | | - Yiftach Roth
- BrainsWay Ltd., 19 Hartum St. Har Hotzvim, Jerusalem, 9777518, Israel; Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Beer Sheva, Israel
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Harmelech T, Roth Y, Tendler A. Deep TMS H7 Coil: Features, Applications & Future. Expert Rev Med Devices 2021; 18:1133-1144. [PMID: 34878347 DOI: 10.1080/17434440.2021.2013803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) uses magnetic pulses to induce electrical current in the underlying neuronal tissue. A variety of TMS coils exist on the market, differing primarily in configuration, orientation, and flexibility of the wire windings of the coil. Deep TMSTM utilizes H-Coils, flexible coils with different configurations for stimulating different brain regions implicated in different neuropsychiatric disorders. The H7 Coil, designed to target primarily the medial prefrontal cortex and the anterior cingulate cortex, is FDA-cleared for obsessive-compulsive disorder (OCD). It was chosen as the focus of this review since it recently showed promise in various neuropsychiatric populations in addition to growing understanding of its mechanism of action (MOA). AREAS COVERED Here we assembled all peer-reviewed publications on the H7 Coil to showcase its efficacy in: (a) various OCD patient populations (e.g., different degrees of symptom severity, treatment resistance, comorbidities) (b) other neuropsychiatric populations (e.g., addiction, major depressive disorder and autism spectrum disorder). EXPERT OPINION While substantial evidence pertaining to the H7 Coil's efficacy as well as its MOA has accumulated, much work remains. In the final section of this review, we highlight areas of ongoing and future research that will further elucidate the coil's MOA as well as its full efficacy potential.
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Affiliation(s)
| | - Yiftach Roth
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aron Tendler
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Advanced Mental Health Care Inc, FL, USA
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