How is response to rTMS assessed?

The standard assessment scales used among the research community for assessing depression and anxiety symptoms are employed at the MUHC-rTMS Neuromodulation Unit:

• Hamilton Depression Scale (HAM-D), also referred to as the Hamilton Depression Rating Scale (HDRS)
• Beck Depression Inventory (BDI-II)
• Hamilton Anxiety Scale (HAM-A)

These scales are recognized throughout the medical community as valid and reliable measurements for patients with depression and have been used to assess mood states in numerous studies published on rTMS and depression.

 Traumatic brain injury (TBI)

While some patients with mild TBI recover within days, many display persistent post-concussive symptoms (PCS) including depressed mood and problems with attention and concentration that may suggest brain damage, despite the absence of findings on routine clinical imaging (i.e. CT scan or MRI). The cognitive, emotional, behavioural and physical impairments experienced by MTBI survivors produce substantial disability and costs. 

Currently there are few standards for treatment and management of MTBI and limited studies concerning treatment interventions exist. These consist of pharmacotherapy, cognitive rehabilitation and patient education.

We are currently investigating whether rTMS has the potential to accelerate symptom resolution (including depression) and facilitate return to normal instrumental activities of daily living (IADL) .rTMS sessions will target the LDLPFC, one of the cortical regions where we have observed with functional neuroimaging a significant reduction in brain activation after mTBI.

rTMS is known to produce localized changes in cortical activity through an increase in local prefrontal cortical excitability. In addition, recent evidence has shown that rTMS can modulate distal brain regions and potentially strengthen connections between brain regions.