Podcast
Questions and Answers
What neuromodulators are believed to be released throughout the cortex as a result of vagus nerve stimulation (VNS)?
What neuromodulators are believed to be released throughout the cortex as a result of vagus nerve stimulation (VNS)?
- Acetylcholine and Norepinephrine (correct)
- GABA and Glutamate
- Dopamine and Serotonin
- Histamine and Epinephrine
According to the passage, TMS was initially contraindicated in patients with VNS but was later deemed safe.
According to the passage, TMS was initially contraindicated in patients with VNS but was later deemed safe.
True (A)
What is the typical approach of TMS providers regarding VNS devices during TMS treatment?
What is the typical approach of TMS providers regarding VNS devices during TMS treatment?
leave the VNS device on
A new development with TMS for depression involves using intermittent ________ patterns.
A new development with TMS for depression involves using intermittent ________ patterns.
Match the following treatments with their respective purposes in the case study described.
Match the following treatments with their respective purposes in the case study described.
Why might pairing accelerated iTBS with VNS theoretically improve the antidepressant effects of TMS?
Why might pairing accelerated iTBS with VNS theoretically improve the antidepressant effects of TMS?
The patient described in the passage experienced adverse events when accelerated iTBS was paired with VNS.
The patient described in the passage experienced adverse events when accelerated iTBS was paired with VNS.
At what age did the patient described experience the initial onset of depression?
At what age did the patient described experience the initial onset of depression?
Prior to the TMS course, the patient's PHQ-9 score was ________.
Prior to the TMS course, the patient's PHQ-9 score was ________.
Match the treatment with the age of the patient.
Match the treatment with the age of the patient.
What was the patient's condition that led to the adjustments of VNS settings and medications before the TMS course?
What was the patient's condition that led to the adjustments of VNS settings and medications before the TMS course?
The patient had no prior history of electroconvulsive therapy (ECT) before receiving VNS implantation.
The patient had no prior history of electroconvulsive therapy (ECT) before receiving VNS implantation.
How many rounds of ECT did the patient need over the six years before VNS implantation?
How many rounds of ECT did the patient need over the six years before VNS implantation?
The patient’s VNS battery died and was ________ at age 50.
The patient’s VNS battery died and was ________ at age 50.
Match the TMS method with its description.
Match the TMS method with its description.
Which factor contributed to the decision to attempt paired iTBS with VNS in the described patient?
Which factor contributed to the decision to attempt paired iTBS with VNS in the described patient?
The patient was able to discontinue all medications after VNS implantation.
The patient was able to discontinue all medications after VNS implantation.
What prompted the TMS treatment in the described case?
What prompted the TMS treatment in the described case?
The patient was hospitalized and required a course of ________ electroconvulsive therapy (ECT), with good response.
The patient was hospitalized and required a course of ________ electroconvulsive therapy (ECT), with good response.
Match the result with the action.
Match the result with the action.
Flashcards
Vagus Nerve Stimulation (VNS)
Vagus Nerve Stimulation (VNS)
Stimulation of the vagus nerve can cause the short-term release of chemicals that promote plasticity in the brain.
Cervical VNS
Cervical VNS
A treatment option for medication-resistant epilepsy and treatment-resistant depression, involving the stimulation of the vagus nerve.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS)
A brain stimulation technique used to treat depression, where magnetic pulses are delivered to specific areas of the brain.
Intermittent Theta Burst Stimulation (iTBS)
Intermittent Theta Burst Stimulation (iTBS)
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Accelerated, High Dose Protocols
Accelerated, High Dose Protocols
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PHQ-9
PHQ-9
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Study Notes
- Vagus nerve stimulation (VNS) can trigger the release of neuromodulators like acetylcholine and norepinephrine in the cortex, promoting plasticity.
- Cervical VNS effectively treats medication-resistant epilepsy and treatment-resistant depression over many years.
- Some VNS patients with depression still experience episodes requiring other treatments like medications, electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS).
- Although the FDA initially contraindicated TMS in patients with VNS, it was later proven safe.
- TMS providers initially deactivated VNS devices during TMS, similar to ECT, but now often leave the VNS device on during TMS, disregarding the firing pattern.
- Intermittent theta burst (iTBS) patterns and accelerated, high-dose protocols are new TMS developments for depression.
- Accelerated iTBS treatments show promise in treatment-resistant patients.
- Synchronously delivering accelerated iTBS with cervical VNS might improve TMS's antidepressant effects due to VNS phase-dependent plasticity.
- A 55-year-old woman with a history of treatment-resistant depression was the patient in question.
- The patient's initial onset of depression was at age 15, with treatment starting at age 24
- At age 36, the patient was hospitalized and received bilateral electroconvulsive therapy (ECT), with a positive response.
- The patient required three more rounds of ECT over the next six years.
- Cervical VNS was implanted at age 43, eliminating the need for further hospitalizations or ECT.
- At age 50, the patient's VNS battery was replaced.
- The patient remained on multiple medications, and was able to continue working for most of this time.
- The patient's depression worsened a year before the TMS course, leading to an inability to work.
- Adjustments to the patient's VNS settings and medications were ineffective.
- The patient's pre-treatment PHQ-9 score was 22.
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