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Brain Effects of TMS Delivered Over Prefrontal Cortex in Depressed Adults

Role of Stimulation Frequency and Coil–Cortex Distance

Received May 9, 2000; revised October 9, 2000; accepted October 26, 2000. From the Brain Stimulation Laboratory, Functional Neuroimaging Research Division, Departments of Psychiatry, Radiology, and Neurology, Medical University of South Carolina, Charleston, South Carolina; and the Ralph H. Johnson Veterans Hospital, Charleston, South Carolina. Address correspondence to Dr. Nahas, MUSC, Institute of Psychiatry, Room 502 North, 67 President Street, Charleston, SC 29403. E-mail: nahasz{at}musc.edu Address correspondence to Dr. George, MUSC Department of Radiology, 171 Ashley Avenue, Charleston, SC 29425.

Relative regional brain blood flow was measured in 23 clinically depressed adults by using ECD SPECT at baseline and again during actual prefrontal transcranial magnetic stimulation (TMS) following 5 daily sessions of TMS. TMS over prefrontal cortex caused increased activity in cortex directly under the stimulation (inversely correlated with distance from scalp to cortex) and decreased activity in remote regions (anterior cingulate and anterior temporal poles). High-frequency rTMS (20 Hz) caused more relative flow immediately below the TMS coil than did low-frequency rTMS (5 Hz). Confirming the hypotheses tested, repeated daily TMS over the prefrontal cortex in medication-free depressed adults appears to change both local and remote blood flow in a manner that may also depend on the frequency of stimulation and coil to outer cortex distance.

Key Words: Transcranial Magnetic Stimulation • Brain Imaging • Limbic System

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