This document discusses several neuromodulation techniques for treating neurological conditions like depression. It describes transcranial magnetic stimulation (TMS), which uses magnetic fields to stimulate brain regions involved in mood control. Deep brain stimulation involves implanting electrodes in the brain to regulate abnormal impulses through electrical stimulation. Vagus nerve stimulation stimulates the vagus nerve with electrical impulses to treat epilepsy and depression. All three methods aim to improve symptoms but have risks like infection, side effects from stimulation, and require follow up surgeries as batteries need replacement over time.

1. Anas zaitoun
5th year medical student
Jourdan university of science
and technology

2. definition of TMS :
 Transcranial magnetic stimulation (TMS) is a procedure that
uses magnetic fields to stimulate nerve cells in the brain to
improve symptoms of depression. Transcranial magnetic
stimulation may be tried when other depression treatments
haven't worked.
 With TMS, a large electromagnetic coil is placed against your
scalp near your forehead. The electromagnet used in TMS
creates electric currents that stimulate nerve cells in the
region of your brain involved in mood control and depression

4. Precautions :
 Tell your doctor or mental health provider if:
 You're pregnant or thinking of becoming pregnant.
 You have any metal or implanted medical devices in your
body. Due to the strong magnetic field produced during TMS,
some people who have the following devices cannot have TMS:
 Aneurysm clips or coils
 Stents
 Implanted stimulators
 Electrodes for monitoring brain activity
 Any magnetic implants
 Bullet fragments
 Any other metal device or object implanted in your body

5. Result :
 If TMS works for you, your depression symptoms may
improve or go away completely. Symptom relief may take
a few weeks of treatment.
 TMS may be less likely to work if:
1- Your mental illness causes detachment from reality
( (psychosis)
2- Your depression has lasted for several years
3-Electroconvulsive therapy (ECT) hasn't worked to
improve depression symptoms
 It's not yet known if TMS can be used to treat depression
for the long term, or whether you can have periodic
maintenance treatments to prevent depression symptoms
from returning.

6. Deep brain stimulation :
 Deep brain stimulation involves implanting electrodes within certain areas of
your brain. These electrodes produce electrical impulses that regulate
abnormal impulses. Or, the electrical impulses can affect certain cells and
chemicals within the brain. The amount of stimulation in deep brain
stimulation is controlled by a pacemaker-like device placed under the skin in
your upper chest. A wire that travels under your skin connects this device to
the electrodes in your brain.
 Deep brain stimulation is used to treat a number of neurological conditions,
such as:
 Essential tremor
 Parkinson's disease
 Dystonia
 Deep brain stimulation is also being studied as a treatment for epilepsy,
cluster headaches, Tourette syndrome, chronic pain and major depression.
Many candidates for deep brain stimulation are participants in clinical trials.

8. Surgery risks :
 Deep brain stimulation involves boring small holes in the skull to implant the
electrodes, and surgery to implant the device that contains the batteries under
the skin in the chest. Complications of surgery may include:
 Bleeding in the brain (hemorrhage)
 Stroke
 Infection
 Breathing problems
 Nausea
 Heart problems
 Incision scarring
 With deep brain stimulation, surgery isn't a one-time procedure. The batteries
that are implanted in the chest have a limited life span, and when they run out,
your symptoms may quickly return. Replacing the batteries requires another
surgery. It's also possible for a wire connecting the batteries to an electrode to
break or for other malfunctions to occur.

9. Possible side effect after surgery :
 Seizure
 Infection
 Headache
 Insomnia
 Memory problems
 Temporary pain and swelling at the
implantation site

10. Possible side effects of stimulation
 Numbness or tingling sensations
 Muscle tightness of the face or arm
 Speech problems
 Balance problems
 Lightheadedness
 Unwanted mood changes, such as mania and
depression

11. Preparation :
 Before surgery, you need to have medical
tests to make sure that deep brain stimulation
is safe for you and is a good option in your
case. You also need brain-imaging studies,
such as an MRI, before the surgery, to map
the areas of your brain where the electrodes
will be implanted.

12. Result :
 Deep brain stimulation won't cure your
disease, but it may help lessen your
symptoms. If deep brain stimulation works,
your symptoms will improve significantly, but
they usually don't go away completely. In
some cases, medications may still be needed
for certain conditions. Deep brain stimulation
isn't successful for everyone

13. Vagus nerve stimulation
 Vagus nerve stimulation is a procedure that stimulates the vagus nerve
with electrical impulses. Vagus nerve stimulation can be used to treat
epilepsy when other treatments haven't worked. Vagus nerve
stimulation is also a treatment for depression, and it's being studied for
conditions such as multiple sclerosis, migraine and Alzheimer's
disease.
 There's one vagus nerve on each side of your body, running from your
brainstem through your neck to your chest and abdomen.
 With vagus nerve stimulation, a device is surgically implanted under the
skin on your chest. A wire is threaded under your skin connecting the
device to the left vagus nerve. When activated, the device sends
electrical signals along the vagus nerve to your brainstem, which then
sends signals to certain areas in your brain

15. Risks :
 Pain where the cut (incision) is made to
implant the device
 Infection
 Incision scarring
 Difficulty swallowing
 Vocal cord paralysis, which is usually
temporary, but can be permanent

16. Side effects :
 Voice changes
 Hoarseness
 Throat pain
 Cough
 Headache
 Chest pain
 Breathing problems, especially during exercise
 Difficulty swallowing
 Abdominal pain or nausea
 Tingling or prickling of the skin

17. When vagus nerve stimulation may
be a good option :
 The Food and Drug Administration (FDA) has approved vagus
nerve stimulation for people who:
 Are 12 and older
 Have focal (partial) epilepsy
 Have seizures that aren't well controlled with medications
 In addition, the FDA has approved vagus nerve stimulation for the
treatment of depression in adults who:
 Have chronic, hard-to-treat depression (treatment-resistant
depression)
 Haven't improved after trying four or more medications or
electroconvulsive therapy (ECT), or both
 Continue standard depression treatments along with vagus nerve
stimulation

18. Result :
 Vagus nerve stimulation isn't a cure for epilepsy. Most
people with epilepsy won't stop having seizures
altogether. But many people will have fewer seizures,
as many as 30 to 50 percent fewer. Seizure intensity
may lessen as well.
 It can take as long as two years of vagus nerve
stimulation before you notice any significant reduction
in the number of seizures. Vagus nerve stimulation may
also shorten the recovery time after a seizure. People
who've had vagus nerve stimulation to treat epilepsy
generally have an improved quality of life.