How do we get higher remission rates with rTMS?
TMS researchers such as Jonathan Downar are making progress in identifying subtypes of depression based on functional connectivity of networks associated with symptom domains that occur across the spectrum of diagnoses in the DSM. If we can identify the pathological networks, and target their nodes on the surface of the cortex, we can make neuroanatomical-clinical formulations of our patients and more effectively treat patients with TMS.
But how do we know where to treat each patient?
In order to individualize treatment of patients, we must identify the subtype of depression that each patient has, according to which netowork is not funcitoning properly, and then stimulate the pathological network, rather than our current method of stimulating everybody over the DLPFC.
How does TMS work, on the network level?
The brain is complicated, and processing the signals of circuits is what the brain does to carry out its functions. Typically, in rTMS, we stimulate the DLPFC, which is connected to the striatum & basal ganglia, which is connected to the thalamus, which projects back up to the DLPFC, a loop.
Read the full story here: https://www.clinicaltmssociety.org/newsletter/article/its-all-about-remission-jonathan-downar-md-lecture-recap-2017-annual-meeting