Zapping Those Voices in The Head
WebMD News Archive
In an interview with WebMD, rTMS developer Alvaro Pascual-Leone, MD, PhD,
says that the device originally was created as a way to map the language areas
of the brain without surgery. While testing the device, he found that it had
long-lasting effects on the brain. Depending on how, when, and where in the
brain it was used, the rTMS had either a stimulating or calming effect. Taking
advantage of these effects, he and other researchers began exploring whether
rTMS could be used as an alternative to electroconvulsive therapy (ECT),
sometimes called "shock therapy," in patients with severe depression.
They have since expanded their studies to try the technique in patients with
other psychiatric conditions, and Pascual-Leone finds the Hoffman results
"Suppression of hallucination for months is fabulous and very
interesting," Pascual-Leone says. "It is a very hard problem --
patients generally do not get very good responses even after long-term
medication. To help with that aspect of the disease would be very helpful
Pascual-Leone, director of the Harvard laboratory of magnetic brain
stimulation, notes that his group also is experimenting with rTMS as a
treatment for schizophrenia. He says that one problem he has encountered is
that when the effects of treatment wear off, some patients have worse symptoms
than they did before undergoing the experimental therapy.
This rebound effect has not occurred in patients treated with rTMS for
depression in studies under way at Emory University, according to William
McDonald, MD, director of the Fuqua center for late-life depression. "The
biggest concern is that it can cause seizures, so people are excluded from our
studies if they have a history of seizures," he tells WebMD. "There is
no apparent downside. There are no memory deficits, which gives rTMS an
advantage over ECT."
Hoffman says he has undergone rTMS so that he could personally evaluate the
effects. "It doesn't exactly feel like a shock but it feels weird, like a
tingling sensation, kind of like a woodpecker tapping on the skull," he
says. "It also causes a contraction of the scalp or face, and may produce
other contractions. It feels odd, but by and large the patients tolerate it
very well. But we have a selected group of patients who volunteer for this.
They are pretty desperate, and their families are desperate."
One fear Hoffman was worried about was whether paranoid patients with a
delusional fear that people were trying to control their brains would object to
the use of electromagnetic waves to -- well, to control their brains. "It's
something we are concerned about, but the patients have actually been
reasonable," he says. "It is more acceptable to deal with someone
actually trying to control their brain than their fears about it."