Combined TMS and EEG
With the combination of TMS and the simultaneous measurement of EEG activity, a further development of fMRI connectivity analyses is currently being tested. Dr. Grefkes-Hermann believes that this procedure, which is more cost-effective, has higher temporal resolution, can be used directly at the bedside, and has more potential for personalized therapy planning in clinical practice.
The TMS-EEG procedure also makes it possible to predict the risk of post-stroke delirium, which affects around 30% of stroke patients and greatly worsens the outcome, underlined Ulf Ziemann, MD, medical director of the department of neurology at Tübingen (Germany) University Hospital. In a study of 33 patients with acute stroke, the onset of post-stroke delirium could be predicted with a high degree of accuracy by using the TMS-EEG procedure no later than 48 hours after the event.
Other promising, noninvasive methods for neuron activation mentioned by Dr. Ziemann include transcranial focused ultrasound stimulation (tFUS) with low intensity, which is being studied for chronic pain, dementia, epilepsy, traumatic brain injury, and depression, as well as transcranial pulse stimulation (TPS), which is also based on ultrasound. In a pilot study of 35 patients with Alzheimer’s disease, use of TPS within 3 months had positive effects on cognition. However, the study was not controlled and therefore further assessments are needed.
Custom deep brain stimulation
For deep brain stimulation (DBS), an established therapy for Parkinson’s disease and other movement disorders, the aim is individualized, symptom-related network stimulation, reported Andrea Kühn, MD, head of the movement disorders and neuromodulation section in the department of neurology at Charité University Hospital Berlin.
At the panregional collaborative research center ReTune, which has been supported for 4 years now by €10 million from the German Research Foundation (DFG), imaging and computer-assisted programming algorithms are being developed for DBS. They will greatly simplify the time-consuming standard procedure for the best possible setting of the stimulation parameters, which requires a hospital stay of several days.
A randomized crossover study of 35 patients with Parkinson’s disease proved the equivalence of the fast, algorithm-assisted DBS for the control of motor symptoms compared with standard procedures.
The new methods have the potential to considerably improve the outcome of patients with neurological and psychiatric diseases, according to scientists. However, the positive data must still be validated in further studies.
This article was translated from Medscape’s German edition. A version of this article appeared on Medscape.com.