Non-invasive brain stimulation techniques have been developed to address the large number of patients who may be non-responsive to traditional pharmacological and psychotherapeutic treatment.
Therapeutic brain stimulation is particularly relevant for depressive disorders. This is because the treatment can be delivered as necessary to address the frequency and severity of the disorder. According to some estimates, up to 20% of the world-wide population is affected by depressive disorders. This includes chronic and recurring progression of the disorders resulting in a relatively high mortality rate.
The intracranial and non-invasive procedures in addition to transcranial brain stimulation procedures that are currently available offer meaningful options to supplement the spectrum of treatments used in psychiatry.
In therapeutic brain stimulation, a distinction is made between convulsive procedures, such as electroconvulsive therapy (EKT) or magnet seizure therapy (MST) and non-invasive procedures, to include repetitive transcranial magnetic stimulation >> (rTMS) and transcranial direct current therapy (tDCS >>). Invasive techniques, such as deep brain stimulation (DBS) and vagus nerve stimulation (VNS), are a third option for therapeutic brain stimulation.
Electroconvulsive therapy has been used for many decades and has been highly effective for treating severe depressive disorders.
Since the beginning of the 1990s and the development of well-engineered magnetic stimulation, the further development of the techniques to include repetitive transcranial magnet stimulation (rTMS), as a non-invasive method for brain stimulation, has become the focus of research. As a result and based on substantial evidence, especially for depressive disorders, rTMS is now considered as a treatment option for non-invasive brain stimulation.
A number of controlled studies on the use of the non-invasive method of transcranial direct current therapy (tDCS) have delivered promising results.
Regional cortical activities can be modulated with non-invasive brain stimulation using rTMS or tDCS methods. The therapeutic effects of using non-invasive transcranial brain stimulation include the potential for normalisation of dysregulations, which occur with depression, especially in the area of the prefrontal cortex.
The advantage of rTMS and tDCS as non-invasive brain stimulation methods, is that they are pain-free, well-tolerated and highly accepted by patients and these techniques are comparatively highly effective.
The German Society for Brain Stimulation in Psychiatry (DGHP) indicates in the statement issued by its management board on 15.08.2014 "that the German Institute for Medical Documentation and Information (DIMDI) […] defined a OPS Code for the rTMS (8-632) under the non-invasive therapeutic measures (https://www.dimdi.de/)."
The DGHP sees this as a meaningful step in the development of non-invasive brain stimulation rTMS as a treatment method in psychiatry and expressly welcomes it.
Literature: See the DGHP's recommendations such as
Plewnia C, Padberg F. Transcranial and invasive brain stimulation for depression. Der Nervenarzt 2012;83:1006-1012
Lefaucheur JP, Andre-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014
transcranial direct current therapy (tDCS >>)