A most stimulating Robot

In his Blog Dr Shock was critical about the effects of rTMS on depression. The published results of RCT studies at 4 and 6 weeks are indeed not very robust and do not withstand a harsh analysis. Being critical in the face of hyped reporting is much needed as these devices are not low cost. On the other hand "classical" rTMS is not to be compared to its neuronavigated robot guided offspring (cfr ANT's VISOR). In classical rTMS the DLPFC zone (dorsolateral prefrontal cortex BA 46) is reached by moving the coil (often hand held) 5 cm anterior in a parasagittal plane from the starting motor "hot spot". A recent study in 22 subjects showed that this procedure only targets the DLPFC zone in 7 out of 22 patients (30%). So 70% of the stimulations are totally off target !! That will no doubt negatively impress on clinical outcome studies with classical rTMS or explain large part of the variance in meta studies. So we urgently need new evidence using the latest devices in rTMS. Especially the results on therapy resistant depression should allow us a faster judgement on the validity of non invasive neurostimulation treatment. It is said that new results will be shown at the Neuromeeting (jan 2009) in Beane. We will keep You posted. To be continued....