Notice bibliographique
Résumé
Researchers recently reported a naturalistic retrospective study of motor threshold (MT) data from 374 patients treated with TMS for depression from 2000 to 2019 [[1]Cotovio G. Oliveira-Maia A. Paul C. Viana F. da Silva D. Seybert C. et al.Day-to-day variability in motor threshold during rTMS treatment for depression: clinical implications.Brain Stimul. 2020; 14 (PMID: 34329797): 1118-1125https://doi.org/10.1016/j.brs.2021.07.013Abstract Full Text Full Text PDF Scopus (2) Google Scholar]. MT was measured each day of treatment, “using the visual method”. It is reported that compared to the baseline MT, for each patient, each day, the MT varied (increasing or decreasing) on average more than 5%. It was also stated that “more extreme variations (≥25% above or below the first MT)” could occur. The researchers’ conclusion was that when MT is only determined once, at the commencement of treatment, there is danger of “underdosing” and “overdosing” with potential therapeutic and safety consequences. In consequence the authors suggest “daily or at least weekly MT determination”. The recommended stimulation intensity range is 110–120% MT [[2]Milev R. Giacobbe P. Kennedy S. Blumberger D. Daskalakis Z. Downar J. et al.Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments.Can J Psychiatr. 2016; 61 (PMID: 27486154): 561-575https://doi.org/10.1177/0706743716660033Crossref PubMed Scopus (225) Google Scholar]. However, in blinded studies, successful treatment has been achieved at 80% [[3]George M. Wassermann E. Kimbrell T. Little J. Williams W. Danielson A. et al.Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression.Am J Psychiatr. 1997; 154 (PMID: 9396958): 1752-1756https://doi.org/10.1176/ajp.154.12.1752Crossref PubMed Scopus (456) Google Scholar], 90% [[4]Pascual-Leone A. Rubio B. Pallardo F. Catala M. Transcranial magnetic stimulation of the left dorsolateral prefrontal cortex in drug-resistant depression.Lancet. 1996; 348 (PMID: 8684201): 233-237https://doi.org/10.1016/s0140-6736(96)01219-6Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar] and 100% [[5]Theleritis C. Sakkas P. Paparrigopoulos T. Vitoratou S. Tzavara C. Bonaccorso S. et al.Two versus one high-frequencyrepetitive transcranial magnetic stimulation session per day for treatment-resistant depression: a randomized sham controlled trial.J ECT. 2017; 33 (PMID: 28445181): 143https://doi.org/10.1097/YCT.0000000000000412Crossref PubMed Scopus (8) Google Scholar] MT. Thus, if treatment is provided in the recommended stimulation intensity range, it is extremely unlikely that the variation in MT could be so great that the stimulation provided (according to the initial MT determination) could be too low to render clinical benefit. At the request of neurosurgeons who were planning to remove epileptic foci, we have attempted to induce seizure (to display foci) in conscious patients using standard therapeutic TMS devices. We have been unsuccessful, having to desist due to patient discomfort before any evidence of seizure activity whatsoever. There is no evidence to indicate that the individual's TMS MT and seizure threshold (should there be one for a particular individual) have a fixed relationship. It is probable they are independent, and the lowering of the MT does not mean there would be a lowering of any TMS seizure threshold. Thus, there is no evidence that variability leading to the lowering of the TMS MT increases the risk of TMS induced seizure. Members of the Clinical TMS Society participated in a survey to clarify the risk of TMS induced seizure [[6]Taylor J. Newberger N. Stern A. Phillips A. Feifel D. Bentensky R. et al.Seizure risk with repetitive TMS: survey results from over half a treatment sessions.Brain Stimul. 2021; 14 (PMID: 34133991): 965-973https://doi.org/10.1016/j.brs.2021.05.012Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. The overall rate was 0.31 seizures per 10 000 treatments. For apparatus using generic figure- 8 coils the rates were lower (for example, the Neuronetics device the estimated rate was 0.03 seizures per 10 000 treatments). We accept that during a course of TMS for the treatment of depression, day to day variation in MT of at least 5% (and perhaps more) may occur. However, in our opinion, the risk of inadequate treatment or increased risk of seizure due of this variation is not substantiated. Daily re-determination of MT would be expensive and given the current evidence, unjustified. This work did not receive any specific grand from funding agencies in the public, commercial, or not-for-profit sectors.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».