1. 4th Annual
Computational
Neurosciences
Workshop
Marseille
Brain stimulation:
Neuro-computational, Experimental, and Clinical approaches
May 31st – June 1st 2012
rTMS Treatment in Psychiatry:
Stimulation or Interaction?
Jean-Arthur MICOULAUD-FRANCHI
M.D. Chef de Clinique - Assistant
Ph.D. Student in Neuroscience

2. The talk will propose an historical point of view
Specifically for the case of Major Depressive Episode
(depression), the first major therapeutic goal set for rTMS
With 3 historical steps
From
Step 1 18th Century: Historical Background
Electrical Brain “Stimulation” in Psychiatry
P
L
A
N
End of the 20th Century :
Step 2
Validation of rTMS treatment as a focal brain stimulation
To
Step 3 21-22th Century: Future Proposition
Electrical Brain “Interaction” in Psychiatry

3. The talk will propose an historical point of view
Specifically for the case of Major Depressive Episode, the first
major therapeutic goal set for TMS
With 3 historical steps
From
Step 1 18th Century: Historical Background
Electrical Brain “Stimulation” in Psychiatry
P
L
A
N
Step 2 End of the 20th Century :
Validation of rTMS treatment as a focal brain stimulation
To
Step 3
21-22th Century: Future Proposition
Electrical Brain “Interaction” in Psychiatry

4. Is Electro Convulsive Therapy (ECT)
the first use of Electrical Brain Stimulation in Psychiatry?
ECT is traditionally presented as the first
use of electrical device for brain stimulation
in psychiatry
Hoy et Fitzgerald 2010,
Nature Reviews Neurology
S
T
E
P
1
ECT 1930s tDCS 1960s TMS 1990s
ECT was referred to the supposed protective effect of seizures induce by some
epileptics drugs: Camphor and Metrazole (Cerletti and Benetti, 1938)
But not, to previous research on Electrical Brain Stimulation in psychiatry.
Beaudreau et Finger, 2006

5. In 18th century, Aldani the nephew of Galvani, used
Electrical Brain Stimulation on patients with melancholia
Following Galvani’s classic
experiments establishing that
electric currents were capable of
stimulating neuronal tissues
S
Pile Volta was used to stimulate T
E
some brain region in patients P
1
Note that
Aldani used Electrical stimulation
(painfull stimulation) and not
Magnetic stimulation
Finger et Zaromb, 2006

6. At the end of the 19th century,
D’Arsonval developed the principle of TMS
Following the discovery of the unified
and interchangeable nature of
electric and magnetic forces
 TMS use externally generated
changing magnetic field to induce
electric current intracranially
S
T
E
P
1
Note that
TMS is not the application of magnets
used controversially by some psychiatrists
since the work of Mesmer (1784)
This is not TMS This is TMS
Higgins et George, 2006

7. In 1985, first use of modern TMS on human brain
Barker et al., first described the use of a
pulsed (i.e. changing) magnetic field
focused over specific brain regions to
induce non painful cerebral cortex
activation and muscle action potential
Barker S
T
The Hand-Held Coil shaped E
as a circular disc P
(more recently as a figure-8)
1
The power-source which generates an
electric current that is switched on
and off repeatedly
Electromyogram (if motor stimulation)
Switch to induce the pulse
Barker et al. 1985

8. Beaudreau et Finger, 2006
Hoy et Fitzgerald 2010, First step :
Birth of Focal Brain Stimulation ?
ECT 1930s tDCS 1960s TMS 1990s
S
T
Electrical Brain Focal E
Stimulation in psychiatry P
1
Pile Volta 18th Century TMS 1990s
Electrical Brain Global
Camphor Stimulation in psychiatry
Metrazole
End 19th Century ECT 1930s