Entry #1 - Lightly Annotated Bibliography of TMS Therapy by Dr. Will Sauve
Now for my first entry. It is very appropriate to begin with Dr. Will Sauve who is a triple threat in psychiatry. He is an excellent clinician who is very knowledgeable across many fields of psychiatry. He is an outstanding lecturer and consistently ranks as the highest rated lecturer at Stephen Stahl’s NEI Congress. In 2014, he gave the Master Talk on TMS at the NEI Congress. His teaching abilities extend to the written word as seen in this article. Lastly, he is the medical director of TMS NeuroHealth Centers which is one of the fastest growing and influential TMS Centers in the country.
The Science of Transcranial Magnetic Stimulation
William M. Sauvé, MD; Lawrence J. Crowther, MEng. Psychiatric Annals. June 2014 - Volume 44 · Issue 6: 279-283
In 2014, Dr. Sauve had the above article appear in the Psychiatric Annals dedicated to discussing TMS. This is an excellent review which includes a brief history of TMS, the mechanism of action, clinical implications and a discussion of future uses for TMS. When one begins reading the literature on TMS, terms and concepts arise which the reader has, most likely, not previously encountered. Definitions for these concepts abound, but it is like learning the name of a Martian food you have never seen and for which you have no reference.
In Dr. Sauve’s article, he defines these terms in detail and in context, applying them directly to the field of Transcranial Magnetic Stimulation. He begins by describing Faraday’s Law and why it is important with regard to conduction of an electromagnetic pulse in the skull and brain tissue. This leads to a discussion concerning why an electromagnetic pulse can, and does, depolarize nerve cells and introduces the concept of long-term potentiation which gives the treatment its stability and duration over time.
He describes pulse sequencing which is within the FDA approved parameters for treating depression. He also entertains a discussion of high and low frequency stimulation and the difference this makes depending upon which hemisphere of the brain is being stimulated. There is then a brief segment on Theta-Burst Stimulation which is helpful to those who are trying to understand Dr. Stubbeman, a former otolaryngologist, who has a complex protocol for treating Tinnitus.
Next, Dr. Sauve discusses the design of TMS machines and the two basic processes of monophasic and biphasic stimulation. A number of different magnetic coils have been used, and Dr. Sauve talks about the early development, as well as some of the changes which have occurred such as the use of iron core magnets. Finally, Dr. Sauve talks about the different coils which may stimulate different depths within the cortical surface. This discussion is interesting as one of the recent FDA approved devices describes itself as “deep brain stimulation” but, in fact, only has a slightly greater depth than the originally approved FDA device. A discussion of the research states that the depth differential does not affect treatment. That concept may also produce confusion for those who are reading the literature on TMS for the first time, as deep brain stimulation is generally reserved for those who are intraoperative.
The article should be readily available should you have access to a medical library, or it can be purchased for $5.00 from the following website: http://www.healio.com/psychiatry/journals/psycann/2014-6-44-6/%7Ba1d46ef9-847b-4b89-9c32-1da82f0120e6%7D/the-science-of-transcranial-magnetic-stimulation. Even if you have to purchase the article, it will be money well spent.