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Open Access
Article
Publication date: 22 March 2019

Maria Cristina Davila, Brianna Ely and Ann M. Manzardo

Repetitive transcranial magnetic stimulation (rTMS) has been proven to be efficacious in the treatment of Major Depressive Disorder (MDD). We previously examined the effectiveness…

Abstract

Repetitive transcranial magnetic stimulation (rTMS) has been proven to be efficacious in the treatment of Major Depressive Disorder (MDD). We previously examined the effectiveness of rTMS for MDD in an applied clinical setting, AwakeningsKC Clinical Neuroscience Institute (CNI) and found high remission rates for patients diagnosed with MDD following rTMS treatment. An unexpected relationship with body composition and rTMS unit was discovered. This sub-study extends the previous investigation through a focused analysis of the effects of body composition on response to rTMS in the treatment of MDD. We utilized data collected from a retrospective review of medical records for patients diagnosed with MDD undergoing rTMS therapy at AwakeningsKC CNI. Patient Health Questionnaire 9 (PHQ-9) scores, time to remission status and body mass index (BMI) at baseline were considered while referencing two different rTMS instruments (MagVenture; NeuroStar). We found 23 (9%) of 247 participants met criteria for obese status (BMI?30) with an average baseline PHQ-9 score of 22±4, classified as “severe depression”. Obesity status was differentially impacted by the rTMS instrument used for treatment. Patients with obesity showed a shorter time to remission (mean 2.7±0.27 vs. mean 3.4±0.3 weeks) and proportionately greater remission rate (100% vs. 71%) when treated using the MagVenture relative to the NeuroStar instrument. Clinical response to rTMS therapy for MDD appears to be guided by individual factors including body composition and rTMS parameters such as the unit used for treatment. Further study of these influences could aid in the optimization of clinical response to rTMS.

Details

Mental Illness, vol. 11 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Article
Publication date: 9 October 2023

Mohammad Ali Shenasa, Maryam Soltani, Victor Tang, Cory R. Weissman, Lawrence Gregory Appelbaum, Zafiris J. Daskalakis and Dhakshin Ramanathan

Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment with efficacy for several psychiatric disorders and has yielded promising yet mixed data…

Abstract

Purpose

Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment with efficacy for several psychiatric disorders and has yielded promising yet mixed data showing reductions in craving for substance use. Patients with substance use disorders and comorbid depression may encounter obstacles to receiving rTMS in outpatient settings for treatment of depression. In turn, implementation of rTMS in residential substance use programs would greatly benefit those with comorbid treatment resistant depression. This paper aims to provide recommendations for implementing rTMS within residential substance use treatment centers.

Design/methodology/approach

Using PubMed, the authors conducted a narrative review of manuscripts using various combinations of the following search terms: rTMS, depression, substance use and substance use disorder. The authors read manuscripts for their methodology, outcomes and adverse events to synthesize their results, which correspond to their recommendations for patient selection, safely implementing rTMS in residential substance use facilities and optimal rTMS protocols to start with.

Findings

Advantages of this approach include increased compliance, monitoring and access to care. Recommendations to safely incorporate rTMS in residential substance use disorder treatment centers revolve around selection of patients eligible for rTMS, allowing for sufficient time to elapse prior to commencing rTMS, monitoring for signs of recent substance use or withdrawal and using rTMS protocols compatible with the therapeutic programming of a treatment center.

Originality/value

This paper details the challenges and benefits of implementing rTMS for patients with dual diagnosis and provides recommendations to safely do so. To the best of the authors’ knowledge, this is a novel and unpublished endeavor.

Details

Advances in Dual Diagnosis, vol. 16 no. 4
Type: Research Article
ISSN: 1757-0972

Keywords

Open Access
Article
Publication date: 22 March 2019

Ann M. Manzardo, Brianna Ely and Maria Cristina Davila

We previously examined the efficacy of rTMS for major depressive disorder in an applied clinical practice. Clinical response was related to severity of depression as well as the…

Abstract

We previously examined the efficacy of rTMS for major depressive disorder in an applied clinical practice. Clinical response was related to severity of depression as well as the rTMS instrument utilized suggesting a relationship to instrument or magnetic field parameters and individual factors. The effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder was further evaluated using Log-Rank statistics for time to remission outcomes. A follow-up retrospective medical records study was carried out on patients with major depressive disorder undergoing rTMS therapy at AwakeningsKC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. Cox Proportional Hazard with Log-Rank statistics were applied and the time course to clinical remission was evaluated over a 6-week period with respect to age, gender, and depression severity. Clinical response was observed referencing two different rTMS instruments (MagVenture; NeuroStar). Time to remission studies of 247 case reports (N=98 males; N=149 females) showed consistently greater clinically defined remission rates after 6 weeks of rTMS treatment for patients using the MagVenture vs NeuroStar instrument. Patients previously admitted for inpatient psychiatric hospitalization exhibited higher response rates when treated with the MagVenture rTMS unit. Stepwise Cox Proportional Hazards Regression final model of time to remission included rTMS unit, inpatient psychiatric hospitalization and obese body habitus. Response to rTMS in applied clinical practice is related to severity of psychiatric illness and may require consideration of magnetic field parameters of the rTMS unit with respect to individual factors such as sex or body composition.

Details

Mental Illness, vol. 11 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Open Access
Article
Publication date: 22 March 2019

Maria Cristina Davila, Brianna Ely and Ann M. Manzardo

Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulatory technique used to modulate orbital frontal corticostriatal (OFC) activity and clinical symptomatology for…

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulatory technique used to modulate orbital frontal corticostriatal (OFC) activity and clinical symptomatology for psychiatric disorders involving OFC dysfunction. We examined the effectiveness of rTMS in the treatment of major depressive disorder in an applied clinical setting (Awakening KC CNI) to assess efficacy and optimize rTMS parameters within clinical practice. A retrospective review of medical records was carried out on patients with major depressive disorder undergoing rTMS therapy at Awakenings KC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. A detailed de-identified data set of clinical outcomes was compiled. Patient Health Questionnaire 9 (PHQ-9) total score, clinical remission rate and week achieved were evaluated over 6 weeks of treatment to assess clinical response referencing two different rTMS instruments (MagVenture; NeuroStar). Our survey included 247 participants from males (N=98) and females (N=149) with average baseline PHQ-9 scores of 21.7±4, classified as severe depression. Clinically rated remission rates of 72% were achieved in 3.1±1.0 weeks and associated with prior history of psychiatric hospitalization, suicide attempts and substance use disorder. Average baseline PHQ-9 scores decreased significantly over time with proportionately greater remission rates achieved for patients treated using the MagVenture over NeuroStar instrument. rTMS in applied clinical practice is efficacious over a wide range of settings and patients. Clinical response was related to severity of depression symptoms (e.g., prior hospitalization; suicide attempts) validating efficacy in critically ill groups. Clinical response may be impacted by rTMS instrument, magnetic field parameters or individual factors.

Details

Mental Illness, vol. 11 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Open Access
Article
Publication date: 17 September 2021

Medard Kofi Adu, Ejemai Eboreime, Adegboyega Oyekunbi Sapara, Andrew James Greenshaw, Pierre Chue and Vincent Israel Opoku Agyapong

This paper aims to explore the relevant literature available regarding the use of repetitive transcranial magnetic stimulation (rTMS) as a mode of treatment for…

2231

Abstract

Purpose

This paper aims to explore the relevant literature available regarding the use of repetitive transcranial magnetic stimulation (rTMS) as a mode of treatment for obsessive-compulsive disorder (OCD); to evaluate the evidence to support the use of rTMS as a treatment option for OCD.

Design/methodology/approach

The authors electronically conducted data search in five research databases (MEDLINE, CINAHL, Psych INFO, SCOPUS and EMBASE) using all identified keywords and index terms across all the databases to identify empirical studies and randomized controlled trials. The authors included articles published with randomized control designs, which aimed at the treatment of OCD with rTMS. Only full-text published articles written in English were reviewed. Review articles on treatment for conditions other than OCD were excluded. The Covidence software was used to manage and streamline the review.

Findings

Despite the inconsistencies in the published literature, the application of rTMS over the supplementary motor area and the orbitofrontal cortex has proven to be promising in efficacy and tolerability compared with other target regions such as the prefrontal cortex for the treatment of OCD. Despite the diversity in terms of the outcomes and clinical variability of the studies under review, rTMS appears to be a promising treatment intervention for OCD.

Research limitations/implications

The authors of this scoping review acknowledge several limitations. First, the search strategy considered only studies published in English and the results are up to date as the last day of the electronic data search of December 10, 2020. Though every effort was made to identify all relevant studies for the purposes of this review per the eligibility criteria, the authors still may have missed some relevant studies, especially those published in other languages.

Originality/value

This review brought to bare the varying literature on the application of rTMS and what is considered gaps in the knowledge in this area in an attempt to evaluate and provide information on the potential therapeutic effects of rTMS for OCD.

Article
Publication date: 31 May 2022

Miao Miao Guo, Tian Wang and Hao Di Zhai

The purpose of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on working memory (WM) and neuroelectric…

Abstract

Purpose

The purpose of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on working memory (WM) and neuroelectric activity in rats.

Design/methodology/approach

Three rTMS protocols involving different frequencies were applied to rats, and 16-channel local field potentials (LFPs) and spikes were recorded from the prefrontal cortex (PFC) of rats in each group during the WM task. First, the behavior of rats during the T-maze task was analyzed, and then, the firing rate of spikes and the energy of the θ-band and γ-band in LFPs when rats performed the WM tasks were calculated. Finally, the spectral coherence between LFPs and spikes was analyzed by wavelet transform.

Findings

The results showed that rats in the stimulation groups needed fewer days than those in the control group to reach the task correction standard during the WM experiment (p < 0.05). High-frequency rTMS increases the firing rate of spikes and the degree of synchronization of LFPs-spikes in the θ-band and γ-band in the WM process.

Originality/value

This study showed that high-frequency rTMS can improve the spatial learning ability of rats, which might be due to the increased neuronal excitability of the PFC and the enhancement of co-coding between different modes of neural signals. This study is helpful for understanding the neuroregulatory mechanism of rTMS and will provide a reference for the selection of a suitable frequency for TMS treatment.

Details

COMPEL - The international journal for computation and mathematics in electrical and electronic engineering , vol. 42 no. 1
Type: Research Article
ISSN: 0332-1649

Keywords

Case study
Publication date: 18 February 2014

Fatima Mohsen Al Faqeeh and Syed Zamberi Ahmad

Total quality management, logistic, entrepreneurship, management and small business management.

Abstract

Subject Area

Total quality management, logistic, entrepreneurship, management and small business management.

Study level/applicability

The case is relevant for undergraduates specializing in business. The case incorporates courses such as entrepreneurship and small business management.

Case overview

This case study outlines the factors behind the success of the Royal Transportation Management Systems Company. This company was established in 2007 and has become one of the most successful valet parking companies in Abu Dhabi. The case study will also highlight the company's core concept which is quality as baseline towards success of the business and how this has influenced the success of the company.

Expected learning outcomes

The case can be used to understand management concepts in entrepreneurship, small business management, and total quality management concepts in the provision of high-quality services, and help students to understand marketing strategies for developing a successful small business.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Article
Publication date: 1 February 1998

W.H. Ip

This paper describes a process to implement manufacturing strategies that are consistent with a particular company’s overall business strategies. The company is situated in Hong…

1642

Abstract

This paper describes a process to implement manufacturing strategies that are consistent with a particular company’s overall business strategies. The company is situated in Hong Kong and its manufacturing plants are in China. It specializes in the design and manufacturing of telecommunication equipment. The production site is located in China while customers and suppliers are distributed in many countries. Information regarding production machinery and performance, quality, workers’ performance are found to be inadequate. A methodology is proposed and used to identify and implement an integrated manufacturing strategy which consists of two major horizons: a real‐time monitoring system (RTMS) and manufacturing resources planning (MRP II). RTMS which can provide up‐to‐date information for the planning and scheduling of manufacturing orders, monitoring quality, improving communication and increasing productivity is implemented and is integrated with an MRP II system.

Details

Integrated Manufacturing Systems, vol. 9 no. 1
Type: Research Article
ISSN: 0957-6061

Keywords

Abstract

Details

Mental Illness, vol. 11 no. 1
Type: Research Article
ISSN: 2036-7465

Keywords

Open Access
Article
Publication date: 28 November 2019

Shawna Chan and Robert Bota

Noninvasive brain stimulation (NIBS) such a transcranial magnetic stimulation, intermittent theta burst stimulation, transcranial direct current stimulation and electroconvulsive…

Abstract

Purpose

Noninvasive brain stimulation (NIBS) such a transcranial magnetic stimulation, intermittent theta burst stimulation, transcranial direct current stimulation and electroconvulsive therapy have emerged as an efficacious and well-tolerated therapy for treatment-resistant psychiatric disorders. While novel NIBS techniques are an exciting addition to the current repertoire of neuropsychiatric therapies, their success is somewhat limited by the wide range of treatment responses seen among treated patients.

Design/methodology/approach

In this study, the authors will review the studies on relevant genetic polymorphisms and discuss the role of RNA genotyping in personalizing NIBS.

Findings

Genome studies have revealed several genetic polymorphisms that may contribute for the heterogeneity of treatment response to NIBS where the presence of certain single nucleotide polymorphisms (SNPs) are associated with responders versus nonresponders.

Originality/value

Historically, mental illnesses have been arguably some of the most challenging disorders to study and to treat because of the degree of biological variability across affected individuals, the role of genetic and epigenetic modifications, the diversity of clinical symptomatology and presentations and the interplay with environmental factors. In lieu of these challenges, there has been a push for personalized medicine in psychiatry that aims to optimize treatment response based on one’s unique characteristics.

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