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Repetitive TMS as a Probe in Anxiety Disorders: Theoretical Considerations and Case Reports

  • Benjamin D. Greenberg, Una D. McCann, Jonathan Benjamin and Dennis L. Murphy


The emergence of repetitive transcranial magnetic stimulation (rTMS) as a relatively noninvasive probe of cortical function provides an opportunity to explore the relationships between regional brain activity and symptomatology across neuropsychiatric illnesses. In this article, we briefly review evidence from functional neuroimaging studies (principally those using positron emission tomography [PET] or single-photon emission computed tomography [SPECT]) and other studies suggesting regional brain involvement in anxiety disorders, specifically obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). We also review an initial controlled study conducted by our group using rTMS as a probe of prefrontal mechanisms in OCD. This discussion is not intended to be comprehensive, but rather to provide examples of disorders that, based on current knowledge, might be good candidates for the use of rTMS as a probe. In addition, we present case reports from pilot studies of rTMS in three patients with different primary anxiety disorder diagnoses, which illustrate some of the issues involved in such studies, as well as the effects observed. The possibility that rTMS may have therapeutic potential in anxiety disorders is also discussed.



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1.Pascual-Leone, A, Grafman, J, Cohen, LG, Roth, BJ, Hallett, M. Transcranial magnetic stimulation: a new tool for the study of higher cognitive function in humans. In: Grafman N, Boller [need first initial], eds. Handbook of Neuropsychology. Amsterdam: Elsevier. In press.
2.Pascual-Leone, A, Catalá, MD, Pascual-Leone, PA. Lateralized effect of rapid-rate transcranial magnetic stimulation of the prefrontal cortex on mood. Neurology. 1996;46:499502.
3.George, MS, Wassermann, EM, Williams, W, et al.Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry Clin Neurosci. 1996;8:172180.
4.Fleischmann, A, Prolov, K, Abarbanel, J, Belmaker, RH. Effect of transcranial magnetic stimulation on behavioral models of depression. Brain Res. 1995;699:130132.
5.Rauch, SL. Neuroimaging in obsessive compulsive disorder and related disorders, pp 492-495. In: Jenicke, MA chairperson. Recent development in the neurobiology of obsessive-compulsive disorder. J Clin Psychiat. 1996;57: 492503.
6.Hoehn-Saric, R, Benkelfat, G. Structural and functional brain imaging in OCD. In: Hollander, E, Zohar, J, Marazzati, D, eds. Current Concepts in OCD. New York, NY: John Wiley & Sons; 1994:183211.
7.Brody, AL, Saxena, S. Brain imaging in obsessive-compulsive disorder: evidence for the involvement of frontal-sub-cortical circuitry in the mediation of symptomatology. CNS Spectrums. 1996;1:2741.
8.Rauch, SL, Jenike, MA, Alpert, NM, et al.Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry. 1994;51:6270.
9.Baxter, LR, Schwartz, JM, Bergman, KS. Caudate glucose metabolic rate changes with drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:681689.
10.Schwartz, JM, Stoessel, PW, Baxter, LR, et al.Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Arch Gen Psychiatry. 1996;53:109113.
11.Mindus, P, Rauch, SL, Nyman, H, Baer, L, Edman, G, Jenicke, M. Capsulotomy and cingulotomy as treatments for malignant obsessive compulsive disorder: an update. In: Hollander, E, Zohar, J, Marazzati, D, eds. Current Concepts in OCD. New York, NY: John Wiley & Sons; 1994:244276.
12.Mindus, P. Ericson, K, Greitz, T, Meyerson, BA, Nyman, H, Sjogren, I. Regional cerebral glucose metabolism in anxiety disorders studied with positron emission tomography before and after psychosurgical intervention: a preliminary report. Acta Radiol Suppl. 1986;369:444448.
13.Greenberg, BD, George, MS, Martin, JD, et al.Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. In press.
14.Semple, WE, Goyer, P, McCormick, R, et al.Preliminary report: brain blood flow using PET in patients with posttraumatic stress disorder and substance-abuse histories. Biol Psychiatry. 1993;34:115118.
15.Rauch, SL, van der Kolk, BA, Fisler, RE, et al.A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Arch Gen Psychiatry. 1996;53(S):380387.
16.Schwartz, GE, Davidson, RJ, Maer, F. Right hemisphere lateralization for emotion in the human brain: interactions with cognition. Science. 1975;190:286288.
17.Tucker, DM, Roth, BS, Arneson, BA. Right hemisphere activation during stress. Neuropsychologia. 1977;15:697700.
18.Lavidas, E, Nicoletti, R, Umilta, C, Rizzolatti, G. Right hemisphere interference during negative affect: a reaction time study. Neuropsychologia. 1984;22:479485.
19.Ahern, GL, Schwartz, GE. Differential lateralization for positive and negative emotion in the human brain: EEG spectral analysis. Neuropsychologia. 1985;23:745756.
20.Tomarken, AJ, Davidson, RJ, Henriques, JB. Resting frontal brain asymmetry predicts affective responses to films. J Pers Soc Psychol. 1990;59:791801.
21.Schiffer, F, Teicher, MH, Papanicolaou, AC. Evoked potential evidence for right brain activity during the recall of traumatic memories. J Neuropsychiatry Clin Neurosci. 1995;7(2):169175.

Repetitive TMS as a Probe in Anxiety Disorders: Theoretical Considerations and Case Reports

  • Benjamin D. Greenberg, Una D. McCann, Jonathan Benjamin and Dennis L. Murphy


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