# rTMS Discussion



## Jackk11 (May 9, 2018)

Ok so in my eyes rTMS is, so far, the most promising treatment option available and I think it should be discussed much more on this forum. I’m not too knowledgeable on the subject or the brain regions associated with DP, however I do know that emotional numbing in DP is associated with overactvivity in the VLPFC. If anyone has any experience with TMS stimulation to this area I’d like to hear how many sessions you had, and it’s effects.


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## Jackk11 (May 9, 2018)

Also. This is important. A double blind study is currently being conducted in France targetting the right angular gyrus with a decent number of participants. If the testing goes well we could be well on our way to depersonalization becoming an on label treatment with TMS. Just some good news.


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## gaddis (Sep 18, 2005)

My insurance company turned me down for covering rTMS, we're appealing.


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## Jackk11 (May 9, 2018)

Unfortunately the provider I’m trying to go to is out of network for my insurance but I’m applying for an appeal as well.


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## teal (Oct 9, 2019)

Jackk11 said:


> Also. This is important. A double blind study is currently being conducted in France targetting the right angular gyrus with a decent number of participants. If the testing goes well we could be well on our way to depersonalization becoming an on label treatment with TMS. Just some good news.


Oh, for the love of God, please let this be it.

It says it'll be finished in September, then it's safe to say it'll take many months from that date until publication. But, are there anyone here who knows more about the study. If it indeed is finished, and if there are some preliminary reports, even if it's just hearsay?


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## teal (Oct 9, 2019)

Estimated Study Completion Date: September 2019

https://clinicaltrials.gov/ct2/show/NCT02476435


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## 35467 (Dec 31, 2010)

Yes, these are estimates. Then they have to submit the article, it has to go though a pair review with risk of feedback that ask for changes ect. It will likely be published by the end of this year or the beginning of the new year.

The right angular gyrus can make dissociation like temporoparietal junction(TPJ) like out of body experiences, feeling alien. There has been a trail on the right TPJ and 50% responded with 70% reduction.50% had no effect at all. When they look closer at the reductions it was in symptoms of dissociation there was a reduction,- the emotional numbing was also slightly reduced. When they do rTMS at the right VLPFC the emotional numbing is reduced but not dissociation. So, there are some speculation if two related networks makes the disorder. The right angular gyrus is more important and a more central part of diffrent networks than TPJ. So, I expect a higher response than 50%. They should do functional scannings after rTMS and one might find out more about those who didn't respond and why emotional numbing is a separate cluster.


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## teal (Oct 9, 2019)

Mayer-Gross said:


> So, I expect a higher response than 50%.


THANK YOU!

I am running low on hope now.


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## 35467 (Dec 31, 2010)

rTMS at the VLPFC has a high response on emotional numbing -but not dissociation. You likely have to make a intervention on two locations in depersonalisation. Angular Gyrus for dissociation and VLPFC for numbing. both location are also involved in the brains cognition and regulation of emotions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801480/


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## teal (Oct 9, 2019)

Correct me if I am wrong, but rTMS isn't that some kind of localized version of ECT? So that if rTMS works, then ECT would surely work, albeit with more side effects.


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## 35467 (Dec 31, 2010)

No, they are not related at all. ECT is a short generalised epileptic seizure. rTMS works by stimulating or inhibition of locations in the brain and the networks that they are connected to. So, the correct locations are important. They usually gets ideas for these locations form studies of patients in functional scanners and what is known about the psychological properties of the overactive/under-active structures and their relation to other networks and structures. The location for depression with rTMS are not the same as with depersonalisation.https://www.psychiatrycentre.co.uk/blog/rtms-for-depression-busting-the-myths/


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## teal (Oct 9, 2019)

Oh, beautiful. I was talking with my doc about this, a while back, and was told that ECT "reboots everything", and thus if that wouldn't work, then rTMS wouldn't work. So, thanks, Mayer-Gross!

I have lost so much of my life to this disease, so if it's possible to try rTMS, I would go ahead. I will try Naloxone first. I see many, many people report zero effect, but I think I have come across (can't remember where) someone who had great effect from it, apart from the Russian study.


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## 35467 (Dec 31, 2010)

There is no overlapping between rTMS and ECT. ECT is be better for severe depression. ECT might work for some symptoms in psychotic states -rTMS do not. rTMS can be use for treatment of addiction,- ECT can not. rTMS can be use for some pain states,- ECT can not. rTMS can be used for OCD,- ECT can not.

But, rTMS is not rTMS. Most rTMS treatments are done on locations in the brain that is easy to locate with some simple methods. They usually only treat at 3-4.locations for depression and OCD. The locations for depersonalisation are not among them. All trails for depersonalisation uses neuronavigation. A MRI scan is done of the whole brain and is put into a computer and the coordinates for the locations (X,Y, Z) are put in and a calibration of the coil is made to find the location. 90-95% of rTMS clinics do not have the equipment to do those thing. Not the program, the calibration hardware ect. Most clinics only know about the limited disorders they can treat for their equipment. They know zero about depersonalisation disorder. Some clinics claim they can do it without this equipment and they treat on locations for depression with a often poor response.Those locations central to DP like the right VLPFC you need neuronavigation from a MRI scan. That is where the problem is right now. Even if you have a million dollars there is in reality almost no places that can give it a fair trail. You have to find a rTMS clinic that can make a location of the right VLPFC with the use of neuronavigation.

https://www.neurocaregroup.com/neuroconn-brainsight.html


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## teal (Oct 9, 2019)

Thanks a million, Mayer-Gross. Truly! I read the text at neuroCare, which says:

*Specification of the BrainsightTM 2 Navigation*


Definition of targets using either: Anatomy / MNI- or Talairach co-ordinates / MRI overlays (fMRI, EEG, NIRS, *PET*) / Data aquired from previous TMS sessions
Compatible with *all widely used MRI datasets including*: DICOM, PAR/REC, Analyze, NIfTI, MINC, BrainVoyager (VMR und VMP)

I did a PET scan which came out no abnormalities. But at the time of testing I had Ambien in my blood, which makes me, paradoxically, more foggy and clear. Basically intoxicated but also more present at the same time. Anyways, this is perhaps a digression as I guess they wouldn't rely on PET scan data to treat DPDR with rTMS anyways.

*But to the point*. I also have many MRI scans, and I actually got DVD plates with all the data. I guess if there indeed is a clinic which does rTMS they could use the data from the MRI scan to identify the brain structures in my cranium, so the rTMS machine would treat the right areas of the brain. I guess.

Mayer-Gross, have you considered rTMS for yourself? I certainly do, as it seems like a rather harmless procedure, and losing year after to this condition is most harmful. I see they have clinics with Brainsight TMS (looks like it anyways) in Germany and the Netherlands, at places where there are direct flights from where I live. Do you think that would be a viable option? To ask them to treat the same areas of the brain as in the French study that's getting close to completion https://www.neurocaregroup.com/neurocare-clinics.html


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## 35467 (Dec 31, 2010)

I dont know if the format of your MRI can be used. When i looked it up they didn't have neuronavigation at in Germany and the Nederlands -likely some of their US clinics . I have heard of people with DP in the Netherlands who got rejected by all rTMS clinics for DP except one who don't have neuronavigation. I only know of one clinic in Europe who have neuronavigation and they don't have depersonalisation on their list. I wrote to them more than 3.months ago and a professor who also do research with rTMS wrote they would look into to it and give me a reply. I have not heard anything from them and they might have replied me and i have ended in my spam-mail that auto-deletes after 30.days. But, i assume that they are waiting for the french trail.depersonalisation is not on their list of conditions and they treat 13.conditions. So, they are likely waiting. I will write with them the coming days to make sure they haven't tried to contact me. Your PET study has no relevance

As i wrote. Angular gyrus will likely take dissociation as TPJ did,- but not emotional numbing. rTMS at the right VLPFC will likely take emotional numbing but not dissociation. Some might not respond at all on these locations. The french study might explain why that is so. I have chosen to wait for the publication of that study because it is so large.


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## teal (Oct 9, 2019)

Hm, another opion for us would be to travel to France, I guess, to the place where they've conducted the study, given that the scientists would be open to treating (ofc, when it's published, and if it indeed works the way we wish).

Could you PM me the name of the clinic where they have neuronavigation? It would be nice to know if they could rely on my old MRI images when giving rTMS.

Btw, I just pinged neurocaregroup, asking for clinics with neuronavigation, in case there had popped up any since you were in touch with them.


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## 35467 (Dec 31, 2010)

No, the trail was done in a public french research hospital in Paris. You had to be a french national and live in the Paris area to be a part of the trail.It is not even a official treatment for french nationals -but it is a possibility for you if you go to france. In England you have to live in the same health region to get a referral to the depersonalisation reasech unit. People waits for years from other parts of England to get a referral because it cost money for the region to pay for a referral in other region. There has also been rTMS trails in England but that is not a treatment offered to people referred to the depersonalisation reeasech unit. They do not have the money for it for larger trails. rTMS , -but you could also go to England as you can go to France. No, problem

No, i will not give you the contact so you can ask questions in a relation to a disorder they officially don't treat. I will give the name when they have accepted me, treated me, made the disorder a official treatment they treat. and said to me they will accept foreigners. I have a dual citizenship and i am a national in that country too. Several people have asked my for that. Why should i contribute to spamming of them from people where i can only be the source of the spamming. Would it benefit my case to do so? Why do you ask?

Good luck with the neurocare group. I can see from photos and videos from their site that a very simple method that don't involve neuronavigation is used. That can be used to some depression protocols and OCD.That is also the only conditions they treat according to their site. They also have turned others down with depersonalisation as i wrote. If they used neuronavigation they would also have several other conditions they officially treat as they could make the correct locations. They do not use neuronavigation in Europe. I think it most be in the US as it is more used there than in Europe.

I have in all my replies to you tried to explain the situation and your fantasy think it can make other reality with other possibilities if you just ignore it. It will not.


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