IEEE/ICME CME 2011 Conference
Plenary Talk 1

From Minimal Input to Stable Network Modulation - Transcranial Magnetic Stimulation in Neuropsychiatry

Frank Padberg, M.D.
Professor, Director
Laboratory of Transcranial Brain Stimulation and Neuroplasticity
Department of Psychiatry and Psychotherapy
Ludwig-Maximilian University of Munich
Nussbaumstrasse 7
80336 München, Germany
E-mail: padberg@med.uni-muenchen.de

Abstract:
Transcranial Magnetic Stimulation (TMS) is a key method for non-invasive stimulation of the human brain. Thus, there is a wide range of different applications from measuring excitability within the human motor system to experimentally or therapeutically modulating regional brain function by repetitive TMS (rTMS). Previously, rTMS has been used to investigate perceptive functions within the visual system as well as higher cognitive functions or emotional regulation within prefrontal, parietal and other cortex regions (Grossheinrich et al. Biol. Psychiatry 2009). Methodologically, coil designs have been modified to specific stimulation demands and targeted focal stimulation has been achieved by neuronavigation based on magnetic resonance imaging. However, more recent interest has been focussing on the differential action of pulse shapes, state dependent variations of rTMS action related to homeostatic plasticity and the duration of post-stimulation effects. The latter may be particularly relevant for enhancing the action of rTMS in experimental as well as therapeutic interventions. The question how long post-stimulation effects last, when to apply a second or third rTMS session in order to produce longer-lasting or even stable effects and summation of such effects over time have been poorly studied so far. However, there is a large body of evidence supporting the role of stimulus summation and interference in long-term potentiation (LTP) or depression (LTD) research. In therapeutic applications, rTMS has to compete with invasive stimulation approaches like vagus nerve stimulation (VNS) or deep brain stimulation (DBS), where a more or less continuous stimulation is provided 24 hours a day. Different rTMS approaches have been developed in order to enhance post-stimulation effects: Burst protocols (e.g. theta burst stimulation – TBS), coupled TMS (e.g. paired, tripled or quadripulse) or priming rTMS by transcranial direct current stimulation (tDCS). Beside an overview of rTMS methods, examples of neurocognitive experiments and therapeutic interventions will be presented in this review. As the largest body of evidence for therapeutic rTMS is available in major depression (Padberg and George Exp. Neurology 2009), the presentation will also focus on this application including recent data for TBS as antidepressant intervention (Holzer and Padberg Brain Stimulation 2010).

Frank Padberg is Associate Professor at the Ludwig-Maximilian University in Munich and Director of the Laboratory of Transcranial Brain Stimulation and Neuroplasticity, Dept. of Psychiatry and Psychotherapy. He is a leading expert in the application of non-invasive brain stimulation for the treatment of psychiatric disorders and holds the position of the Secretary of the Task Force on Brain Stimulation of the World Federation of Societies of Biological Psychiatry (WFSBP). He is the current President of the German Society of Brain Stimulation in Psychiatry. He has received research grants from various sponsors, e.g. the German Ministry of Education and Research, the German Research Foundation and industry grants. He has published over 100 papers in international peer-reviewed journals and a recent book on non-invasive brain stimulation in psychiatric disorders.