TMS Adolescent Project

About the Project

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As part of this project I am leading an effort to examine adolescents and parental attitudes toward the use of repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) in adolescent depression.

The attitudes and concerns of adolescents and their parents are important as they can influence the uptake of the interventions, with adolescents playing an important role in assenting to the intervention, and parents consenting to treatment.  As TMS research and use continues to expand in this population, an enhanced understanding of the views and concerns of the use of TMS in young patients and their parents will provide a critical and timely perspective on the responsible use of this neuropsychiatric intervention and inform future study designs.

This project aims to:

1.         Examine the attitudes and ethical concerns regarding rTMS and TBS among adolescents with depression

2.         Characterize the attitudes of their parents

3.         Compare the attitudes and ethical concerns for rTMS and for TBS among users and their parents

We will conduct semi-structured interviews with 20 adolescents (12-17 years old) with depression and one of their parents. Interviews will be carried out separately. We are currently recruiting depressed adolescents and their parents. If you are interested in participating, follow this link:

 

Link to Study Form

 

You can also contact us to schedule your interview or find more about the project at:

Email: TMS_Ethics@psu.edu   

 Phone: (814) 863-2092 

Technologies

Transcranial Magnetic Stimulation (TMS) is a minimally invasive brain stimulation technique approved by the U.S. Food and Drug Administration (FDA) since 2008 for the treatment of adults with Major Depressive Disorder who have failed prior antidepressant medication therapy. Therapy with TMS for children and adolescents with Major Depressive Disorder has been studied previously but is still considered investigational.  During a TMS session, which is often administered in an outpatient setting, a TMS-certified physician places an electromagnetic coil against the patient’s scalp. Side effects of TMS are generally mild to moderate and include headaches, pain or discomfort under the treatment coil, twitching of facial muscles, dizziness, and blurred vision. Not all patients experienced one of these side effects and, when present, they tend to decrease after the first weeks of treatment. Though rare, TMS has the potential for serious side effects including seizures, induction of mania, worsening of depression and hearing loss. In the case of adolescents, there may be other risks that are currently unknown.  
involves passing an electrical current through a magnetic coil placed superficial to the scalp, producing a high-intensity magnetic field that passes through the scalp and skull to excite neuronal tissue. Treatment sessions typically last around 30-40 minutes. A typical course of TMS is done five times a week for 6 weeks. rTMS appears to be a relatively safe and reasonably well-tolerated treatment.  
is a newer kind of rTMS that delivers the magnetic pulses in fast patterns, shortening the duration of rTMS treatment sessions from 37 minutes to 3 minutes with equivalent antidepressant response. Theta burst was FDA-cleared in 2018 after it was shown that both the efficacy and side-effect profiles were the same as standard 10 Hz rTMS treatment. TBS courses also involve daily stimulation sessions for 6 weeks. 
A few studies have come out which have tried administering multiple sessions of TBS in one day (e.g., 3 sessions per day over 10 days or 10 session per day over five consecutive days), which is called Accelerated TMS. Although research and knowledge in this area is growing it is not known if accelerated TMS is effective than the standard 6-week course. 

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Faculty Team Members

Laura Y. Cabrera, PhD, Associate Professor Neuroethics at Penn State University.

Paul E. Croarkin, DO, MS-Professor of Psychiatry at the Mayo Clinic College of Medicine and Science

Undergraduate Team Members

Angelina Wilton, Graduate Research Education Program at Mayo Clinic

Manisha Kodavatiganti, Health Policy and Administration Undergraduate, PSU.

Logan A. Wincott, Criminology and Sociology Undergraduate, PSU.

Project Manager

Patricia Henegan, MPH-Project Manager at Penn State University

Presentations

Undergraduate students, Logan Wincott and Manisha Kodavatiganti, presented at the 2023 PSU Undergraduate Exhibition, about their work on this TMS and adolescent project,

Miss Wincott poster “The attitudes, perceptions, and ethical concerns around the use of neuromodulation. Examining unique issues in children and adolescents,” was selected for a $50 honorable mention award for the University Libraries Undergraduate Research Award.

Miss Wincott (Top), Miss Kodavatiganti (bottom).

Dr. Cabrera presented updates on this project at the 2022 National Network of Depression Centers Annual Meeting.

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