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Dificulties in developing algorithms for application of physical methods…
While developing therapeutic algorithms it would be neces-
sary to assign deinite signiicance to the issues listed above.
This, however, seems to be a very complex task.
New methods of electric and
magnetic stimulation
During the last two decades, several new physical methods were
subjected to clinical studies [17, 18]:
–
transcranial magnetic stimulation TMS,
–
magnetic seizure therapy/magnetic convulsive therapy
MST/MCT,
–
vagus nerve stimulation VNS,
–
deep brain stimulation DBS, and
–
transcranial direct current stimulation tDCS.
Among the above mentioned physical methods only the vagus
nerve stimulation VNS has been accepted for administration in
treatment of chronic, drug-resistant, recursive depressive dis-
orders. The remaining methods are recognized as experimental
and their administration is of cognitive rather than regular char-
acter - therefore they are not included in therapeutic algorithms.
Moreover, their actual effectiveness seems relatively low.
In the case of TMS, its effectiveness could be increased by
application of the very expensive and hardly accessible methods
of functional neuroimaging (in order to identify the metabolically
disturbed structure of the brain) and neuronavigation (that allows
for application of magnetic stimulation precisely over the disturbed
area of the brain).
Thus, there is little sense in evoking seizure activity with the
help of magnetic ield (which is a very hard task due to the high
current parameters of TMS stimulators) instead of using electric
stimulation, namely, ECT. The potentially higher safety of the
magnetic method is negligible in the face of its poorly investigated
(and probably lower than in ECT) effectiveness.
The current parameters applied in tDSC are so low (a few
Volt of direct current applied to the head) that the actual ef-
fectiveness of this method seems illusory and offering of such
a method - unethical.
vNS and DBS methods are the most invasive techniques
currently used in psychiatry: they require a surgical operation
on the peripheral or central nervous system. They are also (like
TMS and MST/MCT) exceptionally expensive, which limits their
application to a small number of centers in the world.
Literature studies have allowed for identiication of cer
-
tain contradiction in practical application of vNS. Due to its
highly invasive character it should be applied as the last choice
method. However, clinical investigations have shown that vNS
is most effective in treatment of mild and moderate forms of
depressive disorders [19]. These, however, can well be treated
with pharmacotherapy and it is hard to imagine a patient with
moderate symptoms of the disorder who can receive effective
pharmacological treatment and who would be ready to submit
to an invasive and hardly reversible procedure of implantation
of a vNS stimulator.
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BIO-ALGORITHMS AND MED-SYSTEMS
JOURNAL EDITED BY JAGIELLONIAN UNIVERSITY – MEDICAL COLLEGE
Vol. 7, No. 13, 2011, pp. 63-66
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