Background. For urinary incontinence there are different treatment options available and among them we are in favor of those, which are the least aggressive and are similarly efficient at the same ...time. In the last decade there has been an increasing body of evidence suggesting that the functional magnetic stimulation (FMS) might be a new and promising treatment modality for treating of women with urinary incontinence. FMS has been applied to pelvic floor therapy and the treatment of urinary incontinence for the first time in 1999. Contrary to electrical stimulation, FMS aims to stimulate the pelvic floor muscles without insertion of a vaginal probe. During the treatment patient is positioned in a special chair. Under the seat is a magnetic field generator which is producing a pulsating magnetic field which is penetrating the perineum. Structures such as pudendal nerves can therefore be magnetically stimulated without patient’s discomfort or inconvenience of probe insertion as it may be true for electrical stimulation. One of the drawbacks of FMS with magnetic chair is the need for repeated office-based treatment, what may represent a major burden for patients and also for national healthcare system. Therefore we developed a new small magnetic stimulator producing electromagnetic pulses which penetrate either the perineum or pubic bone and thus stimulate the pelvic floor and detrusor muscle. One of advantages of this small portable stimulator apart of its clinical eficacy is a continuous 24-hours stimulation which can be performed either at home/work or during different activities. Conclusions. In this article we are presenting the literature overview regarding magnetic stimulation including our initial experiencies with this new treatment method. Based on our clinical results we feel that FMS represents a new and noninvasive treatment method for urinary incontinence.
Provider: - Institution: - Data provided by Europeana Collections- Objectives. The main aim of this study was to evaluate potential synergistic
antidepressant effect of two therapies: repetitive ...transcranial magnetic
stimulation (rTMS) applied at 1 Hz associated with partial sleep deprivation
(PSD) in patients with treatment resistant major depression. Besides the
long- term (during the next 6 months) evaluation of efficacy of this
treatment, potential predictive role of brain-derived neurotrophic factor
(BDNF) Val66Met genetic polymorphism in rTMS treatment response was analyzed,
as a factor of neuronal plasticity, also involved in patogenesis of major
depression Subjects and methods Twenty patients with diagnoses of treatment
resistant major depression, at fixed doses of antidepressants, were treated
with combination of rTMS and PSD. rTMS was applied during two consecutive
weeks (5 days/week) with frequency of 1Hz, at 110% intensity of resting motor
threshold, over the right dorso-lateral prefrontal cortex (DLPFC), in the
morning hours. Partial sleep deprivation was applied once during every week,
as late partial sleep deprivation (patients were woke up at 01.30 a.m.).
Patients were randomly assigned to receive rTMS+PSD, or sham+PSD. Clinical
evaluation was done using the following rating scales: the modified Hamilton
depression rating scale (HDRS-24), Montgomery-Asberg rating scale (MADRS )
and Clinical global impression scale (CGI-S), at baseline, after 2 weeks of
treatment and one week after treatment, as well as long-term follow-up (only
patients treated with active rTMS). Results. Study results suggest clinically
relevant response, lasted up to 6 months in patients with unipolar major
depression at fixed doses of antidepressants. After 2 weeks of treatment,
patients treated with active rTMS had the average improvement of 39% score
reduction on HDRS. Total antidepressant response (defined as HDRS score
reduction ≥ 50%) had 36% of patients treated with active arm. Another 45% of
patients showed only partial clinical response (HDRS score reduction ≥ 25%).
However, in 3 months follow-up period 64% of patients had significant
improvement, and was sustained in 55% of patients after 6 months. Total
clinical remission (defined as HDRS ≤ 10 ) was achieved in 5 of 11 patients
treated with active rTMS. Taking into account the obvious drawback of this
study related to the small number of patients in the active treatment arm,
it`s still interesting to point out that all BDNF Val66Val patients treated
with active rTMS had significant improvement, but also criteria of remission,
with only one exception. In contrast, only one of BDNF Val66Met patients had
significant improvement and in another one with this genotype rTMS was
totally unsuccessful, and patient was excluded from this study and treated
with another therapies. Conclusions. This study suggest high antidepressant
efficacy of combined rTMS and PSD in patient with treatment resistant major
depression. Antidepressant effect was obvious immediately after treatment and
was sustained during the long-term follow-up. BDNF Val66Met genetic
polymorphism is possible predictor of unsuccessful treatment response.- Cilj rada. Cilj ovog rada je procena efekata kombinovane primene repetitivne
transkranijalne magnetne stimulacije (rTMS) niske frekvencije (1 Hz) i
parcijalne deprivacije spavanja (PDS) kod osoba obolelih od major depresije,
koje prethodno pokazuju nezadovoljavajući odgovor na dva različita
antidepresiva (ispunjavaju kriterijume terapijske rezistencije). Uporedo sa
dugoročnim praćenjem (do 6 meseci) efekata ovog tretmana, analiziran je i
genetički BDNF Val66Met polimorfizam, kao mogući perimisivni faktor
plasticiteta odgovoran za predikciju efikasnosti primenjenih terapijskih
strategija. Ispitanici i metode. Ukupno 20 osoba obolelih od major depresije,
koje su ispunjavale kriterijume terapijske rezistencije tretirano je na
navedeni način kombinacijom rTMS i PDS, uporedo sa njihovom prethodnom
medikamentoznom terapijom. Kombinovani protokol rTMS i PDS sprovodio se tokom
dve uzastopne nedelje, i za to vreme su ispitanici svakog dana, izuzev pauze
za vikend dobijali stimulaciju rTMS (frekvencija 1 Hz, intenzitet 110% praga
izazivanja motornog odgovora) primenjivanu iznad desnog dorzolateralnog
prefrontalnog korteksa (DLPFK), u jutarnjim časovima. U svakoj nedelji po
jednom, opisanoj rTMS, prethodila je redukcija noćnog spavanja uz buđenje u
pola 2. Ispitanici su randomski podeljeni u grupu koja je primala rTMS+PDS i
grupu koja je primala placebo (sham) rTMS stimulaciju + PDS. Procene efekta
vršene su standardnim instrumentima kliničke procene (modifikovana
Hamiltonova skala za procenu depresivnosti - HDRS-24; Montgomery-Asberg skala
za procenu depresivnosti - MADRS, i skala opšteg kliničkog utiska), i to: pre
početka primene protokola, neposredno po završetku, jednu nedelju kasnije,
tri i šest meseci kasnije (dugoročna praćenja sprovedena su isključivo kod
ispitanika koji su bili podvrgnuti aktivnom tretmanu). Rezultati. Primenjeni
protokol stimulacije pokazao je antidepresivni efekat, kod osoba obolelih od
unipolarne depresije na nepromenjenoj dozi antidepresivnih lekova koji se
održavao tokom čitavog šestomesečnog perioda praćenja. Neposredno nakon 2
nedelje protokola ispitanici koji su primali aktivni rTMS imali su prosečno
poboljšanje od 39% (mereno HDRS-om). Međutim, relevantno poboljšanje
(arbitrarno definisano kao smanjenje HDRS ≥ 50%) imalo je 36% ispitanika
tretiranih rTMSom. Dodatnih 45% ispitanika pokazalo je manje značajan,
odnosno delimičan odgovor (definisan kao smanjenje HDRS ≥ 25%). Međutim,
analizom efekata, nakon tri meseca od započinjanja stimulacije, značajno
poboljšanje postojalo je kod 64% ispitanika, a čak i nakon šest meseci
praćenja, ovaj efekat se održavao kod 55%. Takođe, tzv. potpuna remisija
(povlačenje simptoma bolesti, definisano kao HDRS ≤ 10 poena) postignuto je
kod 5 od 11 ispitanika. Poštujući ograničenja procene koja se zasniva na
malom uzorku, ipak je zanimljivo navesti da su svi aktivnom rTMS stimulacijom
tretirani pacijenti sa Val66Val BDNF genotipom postigli kriterijum značajnog
poboljšanja, a sa jednim izuzetkom i kriterijum remisije. Suprotno ovome,
samo jedan od njih sa Val66Met BDNF genotipom, postigao je značajno
poboljšanje, a kod jednog stimulacija u potpunosti nije imala efikasnost,
nakon čega je preveden na drugu terapiju. Zaključak. Primena kombinovane
terapije rTMS i PSD kod obolelih od terapijski rezistentne unipolarne
depresije, pokazuje visoku efikasnost, kako neposredno, tako i nakon
dugoročnog praćenja. Genetički BDNF polimorfizam Val66Met mogući je prediktor
nezadovoljavajućeg odgovora na primenu ove metode.- All metadata published by Europeana are available free of restriction under the Creative Commons CC0 1.0 Universal Public Domain Dedication. However, Europeana requests that you actively acknowledge and give attribution to all metadata sources including Europeana
Napredak u neuroznanosti i tehnologiji donio nam je nekoliko metoda s potencijalom nefarmakološkog utjecaja na mozak. Najveći broj tih metoda razvijen je sa svrhom tretiranja poremećaja, ali također ...imaju pogodne učinke na kogniciju i raspoloženje kod zdravih osoba, te potencijal za korištenje u svrhe poboljšavanja. Dvije kategorije metoda koriste se za tretiranje mozga; metode koje primjenjuju magnetsko polje i metode koje primjenjuju električno strujanje kroz skalp. Razvijeno je nekoliko metoda koje se služe jednim od tih principa, od kojih su najvaž- nije transkranijalna magnetska stimulacija (TmS) i transkranijalna stimulacija istosmjernom strujom (tDCS). Cilj ovog pregleda je dati kratak pregled različitih aspekata najšire korištenih nefarmakoloških tehnika koje mogu biti korištene u svrhe poboljšavanja te istaknuti najvažnije etičke probleme vezane za sigurnost, utjecaj na osobnost, pravdu te autonomiju upotrebe. Bez obzira na količinu informacija o mehanizmima i oblicima upotrebe metoda, mogući opseg i domet nuspojava i implikacija primjene nisu dovoljno naglašeni. Izvan kliničkih uvjeta uređaji nisu regulirani i ne postoji sustav osiguranja. Nadalje, sveprodiruća tehnologija koja okružuje naše življenje i manjak javnog dijaloga štete razvoju sporog i razumnog postupka implementacije i rezultiraju širenjem i komercijalizacijom njihove upotrebe.
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