# i will try next week neuronavigated tms



## leminaseri (Jul 1, 2020)

hello

i will try next week neuronavigated tms in istanbul. i want to try all the locations those were related to a response in the studies (rlvpfc, tpj, angular gyrus)

i think 2 sessions per location will be enough to figure out, if i do respond or not.

i will also try the ocd helmet from brainsway because mg said it could work alternatively due to its impact to the anterior cingulate and dorsomedial prefrontal cortex.

i will update you guys.


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## AnnaGiulia (Feb 4, 2020)

Best of luck!


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## leminaseri (Jul 1, 2020)

AnnaGiulia said:


> Best of luck!


thank you <3


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## 35467 (Dec 31, 2010)

Form where do you know that 2.seesions will be enough to see if there is a response?

In the very small trial done at the depersonalization research unit they write that response came within 5.sessions. Then symptoms started to fluctuate and more sessions was given until it became stabil.

There is no publication on angular gyrus yet. You just know that the trial has been going on and comes with assumptions from that. 
I have recommended that people waited until the publication of the French trail as there might be much more information and considerations in the publication related to the trail.

The "Brainsway" protocol from OCD is treatment for 5-6.weeks. They expect response between week 2-3. So, between 10-15.sessions. I mention the anterior cingulate and dorsomedial prefrontal cortex because it's locations that also comes up in many brain scans. In reality we don't know anything as nothing has been tried. There is a gab between the rTMS trail done and the development of rTMS technologies. Most brain studies and rTMS trails where done prior to 2015. At that time it was very limited at what locations you could intervene in as rTMS coil only could stimulate at 1.cm dept. So, many locations was not an option to intervene in and try back then as the technology to do it was not there.


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## leminaseri (Jul 1, 2020)

Mayer-Gross said:


> Form where do you know that 2.seesions will be enough to see if there is a response?
> 
> In the very small trial done at the depersonalization research unit they write that response came within 5.sessions. Then symptoms started to fluctuate and more sessions was given until it became stabil.
> 
> ...


you said once, you talked with a french girl and the response rate was at 50%, hence.

well, then i will be the first one who tries the ocd coil from brainsway. and it doesnt matter how many sessions i will need. i will go through the tms route, and try all locations. i just thought, i read somewhere, that the effect shows up just after 1 session. but it seems like i was wrong.


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## Want2lifeagain (Jun 20, 2020)

Good luck a luckyman ... I will be soon


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## Want2lifeagain (Jun 20, 2020)

Where you from ?


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## leminaseri (Jul 1, 2020)

Want2lifeagain said:


> Where you from ?


germany


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## tomenko (Jun 9, 2015)

Mayer-Gross said:


> Form where do you know that 2.seesions will be enough to see if there is a response?
> 
> In the very small trial done at the depersonalization research unit they write that response came within 5.sessions. Then symptoms started to fluctuate and more sessions was given until it became stabil.
> 
> ...


hi mayer,

how can I contact you through PM?

bye

tom


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## 35467 (Dec 31, 2010)

tomenko said:


> hi mayer,
> 
> how can I contact you through PM?
> 
> ...


You can't. I have disabled the messenger function this summer and it will never be activated again. I had several contacts at that time close to 2-3.a day. I have used much time in reply's to many only to see that many didn't read my replies, asked about the same thing again and again. I had replied one person with 7.pages within 24.hours. So, You are ending up in conversations with many that only cause frustrations.


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## Phantasm (Jul 16, 2017)

Mayer-Gross said:


> You can't. I have disabled the messenger function this summer and it will never be activated again. I had several contacts at that time close to 2-3.a day. I have used much time in reply's to many only to see that many didn't read my replies, asked about the same thing again and again. I had replied one person with 7.pages within 24.hours. So, You are ending up in conversations with many that only cause frustrations.


If you have a lot of correspondence regarding the same material, you could start a blog, or a FAQ thread you can direct people to. Just a suggestion.


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## leminaseri (Jul 1, 2020)

a few updates:

i have done a rohrschach test and it came out i have somatization, depression and great anxiety tendencies. that the somatization was made out through the test astonished me because, i have problems with muscle pain and various limbs goes often deaf. sometimes my movements are slowed. i would never think that such a psychological test can make out such things.

i have done a qeeg. it came out highly normal with only very slight decreased activity in the back of the brain. the doc said this is often seen in patients with depression.

i will try first the rvlpfc. i have to wait like 2 days i think for an appointment because someone from the university has to come to adjust and set up the machine for the rvlpfc location. for tpj the doctor said, the study from mantovani et al is not really promising. the improvements there could be also placebo. i will pay for 10 sessions 715 euros. i think its a little expensive compared with other tms-centers.

but one big question for me is, if its the anxiety and the depression in the primary position, what are causing my depersonalization symptoms, wouldnt it be smarter to try a depression or anxiety protocol? i am a little confused right now.

to mg: the doc said to me, they have coils that can reach until 5 cm deep to the brain. that confused me also because you said, such coils are not developed yet.


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## 35467 (Dec 31, 2010)

There are no coils that can go 5.cm into the brain. There are several scientific articles about locations for stimulation, other about coil design for deeper stimulation. The coil used for the rTMS approved in Europe, USA and elsewhere have a stimulation depth of 1.cm. Coils that can go deeper was not developed until 5.years ago and are yet not approved for clinical use. They have been used for research until now and one have just been approved in the USA for OCD. The response rate for depression with normal rims is around 50% at two locations with the coil used. Research have shown that other with depression have regulation of emotions in structures deeper in the prefrontal cortex and when they are given rTMS at these two other locations with a deep coil they have a response. So, you might cure 85% of depressions if you also use a deep coil at other locations. There is only one place in Europe where they use such a coil. Because it is not approved for clinical use they are breaking the law in a way by using it. I think they might have said that the size of the trials in depression where such a coil is used makes it sufficient for them to use. It has been approved in the US to use this year for OCD. I have seen videos by a psychiatrist in New York from 2017 with such a coil used on a patient. It was not legal then. I think they have got these coil though connections to research facilities at universities. So, it is a research facility that have ordered from the producer and not a rTMS clinic. It might explain why the are almost absent elsewhere.

The rTMS researcher who works with depression, Jonathan Downar have addressed this problem about stimulation depth, locations and coils years ago. He writes this about the right VLPFC;

"The VLPFC also presents a challenging target for conventional rTMS, *as much of it lies deep within the frontal operculum,* or along the orbital surface of the prefrontal cortex. However, even for superficial VLPFC regions, tolerability remains a problematic issue, due to the proximity of the extraocular and temporalis muscles. There are several alleviating measures that may be effective in improving the tolerability of stimulation at this region, as reviewed in detail below. With appropriate measures to alleviate discomfort, *conventional **fi**gure-8 coils may be suitable for stimulating some VLPFC regions, and newer coil designs should be able to address the depth-of-target issue in future. *Hence, the VLPFC could also serve as a practical target in future studies of rTMS for depression, with appropriate refinements to technique."

https://dribrahimyilmaz.com/wp-content/uploads/Depresyonda-TMS-Tedavisi-Akademik-Makale.pdf

You psychiatrist might mean that the effects of stimulation might go as deep as 5.cm. There he is right. When you stimulate an area it will have affects on areas It is in networks with that is much deeper into the brain. But, a direct stimulation might that can go 5.cm might never be possible to develop as it will diffuse from the areas it shall pass (it will affect them too) and the stimulation will also spread over a larger area and become weak. Around 2-2,5.cm for a coil for deep rTMS is likely maximum and H-coils design for a specific locations might go close into 3,5-4.cm the brain.

In Western Europe a rTMS session can very in price between 100.euros to 300.euros. In the UK it close to 300.euros. In Eastern Europe from 50-55. euros.

He is right to call out a placebo effect. But, the TPJ trial was much larger is size than the right VLPFC. In depersonalization the placebo effect is much smaller than in depression. To see reductions of 20-50% in depression trials relate to placebo is normal. That is also why many says that SSRIs don't work for depression because the response rate in placebo group is very high in in many trials. But, the placebo effect in other conditions is much smaller. In obsessive conplusive disorder the placebo effect is much less and a response of 25% is regarded as valid. It is not the case in depression trials. Depersonalization placebo effect is similar to obsessive compulsive disorder. It is there but low and likely not sustainable over time. You can see it on the posts of this forum. Some tries a drug and makes a post here a day after about feeling better. It is often drug that are normally many weeks to work and in larger doses than tried. But, people feel better. Here on the forum they can not understand a week or two later that is stopped working. It is the placebo effect that stopped working. Many posts about feeling better on something also changes within weeks. So, the placebo effect is there but it do not last for a very long time. Never take posts from anyone who have taken a drug for a very few weeks seriously.

But, the reductions in a TPJ trial is much larger in those who respond. The problem with all trials in depersonalization is they are very small and not placebo controlled. Likely due to lack of funding into research into depersonalization. That is a problem. A bias from the researcher can also play a role. They hope their patients gets better and want to see a response. So, their perceptions can color the trail.

I think that that the right TPJ might play a role but is not the "core" location. It is likely in network with it and it might have some effect in some. The angular gyrus trial is with a 100. patients and half of them will get placebo. So, it the first real trial in depersonalization ever. If the rumor holds that the response rate is 50% it might again be related to networks connections. There is a locations that turns up in many studies with drugs that can make depersonalization and that is also found larger in people with symptoms with depersonalization. It is also connected to and close to angular gyrus and the TPJ. That is a location called "Precuneus". In a PET study from 2000 it came out as active along with the angular gyrus and TPJ. It is found larger in in MRI study at the depersonalization research unit. In people with borderline disorder with dissociation it is also affected. When people are given sedation and lose consciousness, it is turn off. Drugs like ketamine and cannabis that can make depersonalization highly effects this location. But almost all drugs that have affect the the consciousness affect the precuneus. It plays a centrai role in consciousness and self-awareness.

There was a publications in "Nature" this year about a experiment where mouse was given ketamine and immobilized into dissociative state. They found an area changes the frequencies in the brain called "Retrosplenial" in mouse. The same area in humans are called "posteromedial cortex" and coveres two locations; precuneus and posterior cingulate cortex. In publication about the effect of cannabis those who experienceed a bad trip with depersonalization, anxiety, ego death found to have changes in frequencies in the precuneus and prosterior cingulate/posteromedial cortex.

https://www.ecnp.eu/presentationpdfs/68/P.1.b.009.pdf

I hope that angular gyrus trial might go into the role that the precuneus might play. You need a deep coil to stimulation of this area.


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## leminaseri (Jul 1, 2020)

Mayer-Gross said:


> There are no coils that can go 5.cm into the brain. There are several scientific articles about locations for stimulation, other about coil design for deeper stimulation. The coil used for the rTMS approved in Europe, USA and elsewhere have a stimulation depth of 1.cm. Coils that can go deeper was not developed until 5.years ago and are yet not approved for clinical use. They have been used for research until now and one have just been approved in the USA for OCD. The response rate for depression with normal rims is around 50% at two locations with the coil used. Research have shown that other with depression have regulation of emotions in structures deeper in the prefrontal cortex and when they are given rTMS at these two other locations with a deep coil they have a response. So, you might cure 85% of depressions if you also use a deep coil at other locations. There is only one place in Europe where they use such a coil. Because it is not approved for clinical use they are breaking the law in a way by using it. I think they might have said that the size of the trials in depression where such a coil is used makes it sufficient for them to use. It has been approved in the US to use this year for OCD. I have seen videos by a psychiatrist in New York from 2017 with such a coil used on a patient. It was not legal then. I think they have got these coil though connections to research facilities at universities. So, it is a research facility that have ordered from the producer and not a rTMS clinic. It might explain why the are almost absent elsewhere.
> 
> The rTMS researcher who works with depression, Jonathan Downar have addressed this problem about stimulation depth, locations and coils years ago. He writes this about the right VLPFC;
> 
> ...


there is a little probability i can get a fmri. it will be fucking expensive but i dont care. if i wont respond to the stimulation of the rvlpfc, a fmri can maybe make out, which other locations i can stimulate.

do you think a pet or spect can also make out activities in the brain? maybe its cheaper than fmri.

3 people in this forum have very abnormal qeegs. mine was highly normal. what do you think is the difference? maybe mine is pure psychological?


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## 35467 (Dec 31, 2010)

as it stands and from what we know about depersonalization a scan will likely not be of any use like it could be in depression. The problem is that many locations show up as active. You do not know with is the "core" location among them. That is also why a review of brain imaging studies from this year recommended a study where a combination of fMRI with rTMS was done. You could then pick some of these locations a make a stimulation and see if it makes a difference in symptoms and in a new brain scan. That knowledge about depression comes form a decade of research where a combination of rTMS and fMRI was done in many hundreds of patients . In depression there are 3-4.networks affected and locations. So, you can scan a depressed and see what kind they are as you know what to look for. That we do not know in depersonalization. A SPECT is almost not used in psychiatry but neurology as it is not sensitive enough. Psychiatric symptoms are much "softer" than neurological symptoms. But, the problem is also can you intervene in these locations. Conventional rTMS have the limitation of stimulation depth of 1.cm and that rules out many areas for stimulation that are central in many states. Many with depression can not be treated with conventional rTMS as the emotional regulation in the prefrontal cortex is too deep. Many locations showing up in depersonalization as active is too deep for conventional rTMS.


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## 35467 (Dec 31, 2010)

in SPECT and PET scans you used a radioactive tracer that have a brief short life that is out of the body with some hours. This tracer has to be made prior to the scan. This tracer is given as a infusion or a tablet. In a fMRI you don't need that. It can measure the use of oxygen in the brain.


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## 35467 (Dec 31, 2010)

a conventional rTMS 8.coil that can stimulate at 1.cm depth that is the one approved with look flat like this.

https://www.magventure.com/tms-research/products-overview/research-coils/coils/c-b70-2-2

coil for deeper stimulation at a depth of 2.cm will look like this. It has been used for research in 5-6.years but is not approved for clinical used in Europe yet. Just been in the US. Magventure rTMS machines only.

https://www.magventure.com/tms-research/products-overview/research-coils/coils/cool-d-b80


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## 35467 (Dec 31, 2010)

You can in a way divided rTMS into 2.generations.

The first generation with conventional rTMS will use a flat 8.coil with a stimulation depth of 1.cm. The machines are primarily made for stimulation of either the left or right DLPFC. It can only location these two locations so there are no navigation system used as it is restricted to two locations.

2. generation will use both a conventional coil and a deep coil for deeper stimulation . It will have a computer based navigation system that is either based on MRI of the patient or a computer algorithm. It will be able to locate all areas on the brain surface. It will use theta burst as stimulation. Normal rTMS typically takes between 25.min to 45.min. With theta burst stimulation it can be done in 3.min. It gives another economy to rTMS treatment. So, the cost a treatment should also be reduced with 50% or more. It will the time of calibration of the equipment and not the treatment that takes time. This equipment will be able to treat 85% of depression, many mental disorders, reduce symptoms in neurological disorders.

95% of rTMS machines used today are the first generation. There are some places where there are some features used in 2.generation like neuronavigation or theta burst stimulation.


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## tomenko (Jun 9, 2015)

Mayer-Gross said:


> You can't. I have disabled the messenger function this summer and it will never be activated again. I had several contacts at that time close to 2-3.a day. I have used much time in reply's to many only to see that many didn't read my replies, asked about the same thing again and again. I had replied one person with 7.pages within 24.hours. So, You are ending up in conversations with many that only cause frustrations.


ok.

if I well remember you said there was a clinic in Italy that used the neuronavigation system.

you remember the name of the clinic?

take care

tom


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## Numb_1993 (Jul 22, 2020)

Good luck laminaseri ..i can't wait to hear your report !


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## 35467 (Dec 31, 2010)

tomenko said:


> ok.
> 
> if I well remember you said there was a clinic in Italy that used the neuronavigation system.
> 
> ...


That is right. I was in contact with them in 2019. A professor who is an adviser to the clinic replied me and said he would look into depersonalization and reply me shortly. He never did. Depersonalization is not on their site either. I think, they have looked into the rTMS case reports and trials done. These are based of two small trials at two different location and two case reports at another location; The right TPJ, right VLPFC and the right DLPFC. If they are aware of the angular gyrus trials then it is 4.different locations. Conclusion; we will not try to treat depersonalization as the disorder is purely understood as seen in 4.different locations tried.The risk of non-response is too high. The publication of the French trial might change that if is has more information. If the French trial follow their design they should also do some fMRI scans in some of the patients and they might come up with some information that does they might be open to try it.


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## 35467 (Dec 31, 2010)

The location in Italy has four centers and one of them have equipment you only find in a research facility. Neuronavigation system from "Localite", deep coil for deep stimulation, use of theta burst that is likely why the take 100.euros pr. session. They treat people with depression with 2.session a day the first week and one session a day the 2.week. They are the only clinic in Europe that can stimulate the dorsomedial prefrontal cortex and the right orbitofrontal cortex. So, they can likely treat 85% of depressions. Not, 50%.

There is a German on this site with depression who have the obsession that he has depersonalization disorder. He have been seen by a German professor who have done research into depersonalization and written two books about depersonalization. He have said to him that he suffers from major depression with secondary symptoms of depersonalization. I have written to him that he should contact the Italian clinic as they could likely treat him. He have tried the right DLPFC so two other locations with a deep coil could be tried. He would not do that and asked me for the rTMS clinic in Hungary and I said to him that they for depression could not offer him what he already had tried and he should try other locations for depression. He said "are your a doctor?" since I said he should be treated for depression. No, but a professor who knows about depersonalization have said you have depression and I have tried to help you with that. They would likely have taken him in for depression but he have the idea of having depersonalization so they would likely have rejected him for that.

It is my estimate that 20-30% active on this site do not have depersonalization as a primary disorder but a secondary symptom to another condition.


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## leminaseri (Jul 1, 2020)

first session done. nothing noticeable


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## leminaseri (Jul 1, 2020)

second session done. no benefits.


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## 35467 (Dec 31, 2010)

what location?


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## leminaseri (Jul 1, 2020)

rvlpfc


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## tomenko (Jun 9, 2015)

Mayer-Gross said:


> That is right. I was in contact with them in 2019. A professor who is an adviser to the clinic replied me and said he would look into depersonalization and reply me shortly. He never did. Depersonalization is not on their site either. I think, they have looked into the rTMS case reports and trials done. These are based of two small trials at two different location and two case reports at another location; The right TPJ, right VLPFC and the right DLPFC. If they are aware of the angular gyrus trials then it is 4.different locations. Conclusion; we will not try to treat depersonalization as the disorder is purely understood as seen in 4.different locations tried.The risk of non-response is too high. The publication of the French trial might change that if is has more information. If the French trial follow their design they should also do some fMRI scans in some of the patients and they might come up with some information that does they might be open to try it.


hi mayer,

you remember if the clinic was in Florence?

something you remember that can help find them,

thanks

take care

bye

tom


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## RunToMe (May 30, 2019)

Hey Leminaseri,

what is your impression about the quality of equipement and docs ? They are well informed ?

What have you pay there for the sessions ?

Best Luck

Dieter


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## 35467 (Dec 31, 2010)

tomenko said:


> hi mayer,
> 
> you remember if the clinic was in Florence?
> 
> ...


I might have mentions a prof. in psychiatry located in Florence who also have been a prof. at two American universities. He has a private hospital and research center in Florence. I have never contacted him partly because I think the prices might be very high and partly because Florence is an expensive city to be in. I can see that he just a conventional rTMS equipment with neuronavigation added. You can risk if he is a serious person that his does the ethical thing: That is to reject a patients with depersonalization in the grounds that the trials done are also very small, not placebo controlled with no follow up of patents. So, those who have response you have no idea how quickly they had setbacks.

The largest rTMS clinic in Italy and be equipped in Europe have rejected depersonalization/me and depersonalization dispite they have 13.disorders on their site and can offer interventions at 3.locations in depression because they have a deep coil. Others can only offer the right and left DLPFC.

I have referered "RUNTOME/Dieter" to this clinic as he have major depression. They will likely not take depersonalization with the trials and locations done to date that gives the impression that depersonalization is purely understood to offer a rTMS intervention.

As it pointed out the right VLPFC is too deep for a conventional coil to stimulate. You might only be able to stimulate 30% with a conventional coil. That might be the reason for some do not respond or the location might not be right. You really need a deep coil to try this location properly.

I myself is waiting for the publication of the French angular gyrus trial as they also should do some fMRI scans and might put some more lights on emotional regulation in depersonalization, locations and networks.As I wrote it might do that the Italian clinic might go into the disorder and give it a try after the publication of the French trail I also hope that a rTMS clinic with Magventure equipment as a deep coil and navigation system from Localite will open in Eastern Europe.A MRI scan can also be done in Eastern Europe for a fair price for neuronavigation. I got my brain on a disc for 80.euros. It took 25. min in a Siemens MRI with 1.5. Tesla. The prices will likely be 50-60.europs pr. session, high quality and cheap to stay. Right now everything is closed down due to covid. So, there is nothing that can be done now.

Here is one who could not wait for brain stimulation and found a doctor to help him. He got brain stimulation "all over the head".


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## Want2lifeagain (Jun 20, 2020)

How are you lemin ? Do you have tms on tpj ??


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## leminaseri (Jul 1, 2020)

Want2lifeagain said:


> How are you lemin ? Do you have tms on tpj ??


no, im getting the stimulation of the rvlpfc. i had have 2 sessions until now and i cant feel any benefits.


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## 35467 (Dec 31, 2010)

what are they using for locations of the right VLPFC. A MRI scan of you or an computer algorithm?


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## leminaseri (Jul 1, 2020)

Mayer-Gross said:


> what are they using for locations of the right VLPFC. A MRI scan of you or an computer algorithm?


mri scan.


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## Numb_1993 (Jul 22, 2020)

Any updates ?


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## Numb_1993 (Jul 22, 2020)

Any updates ?


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## leminaseri (Jul 1, 2020)

had my 5th session today. i dont feel any significant change. the only thing i can register is i fall much easier asleep, and it feels good to be tired and know i will fall asleep soon. i will do 10 sessions of this location so 5 more.. lets see what it will do


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## Want2lifeagain (Jun 20, 2020)

Lemin have you any feel weak muscle and fatigue ?


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## 35467 (Dec 31, 2010)

Want2lifeagain said:


> Lemin have you any feel weak muscle and fatigue ?


I think I have interacted with you on youtube about a guy experiences with rTMS at the right VLPFC. You live in Jakarta, Indonesia and plans to go to Hungary for rTMS. Here you made and identical complaint about being psychically weak, having fatigue, pain in extremities. I wrote to there that these symptoms are not symptoms of depersonalization disorder. When I was in Hungary there was a guy from Norway who was active on this forum too who thought he had depersonalization; "it has to be depersonalization". He had depersonalization symptoms in addition to other symptoms like fatigue, feeling weak. He formal diagnosis was the functional disorder "chronic fatigue syndrome" were the nervous system acts like in is fighting with a virus infection or something similar. The nervous system is in a immobilization state due to this and it gives the depersonalization related symptoms. The Norwegian guy is not active on this site anymore as if he have given up on the idea of having depersonalization. Going to Hungary to replicate a very small experimental trial for a disorder you might not have seems to me as being not well considered from you part.


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> I think I have interacted with you on youtube about a guy experiences with rTMS at the right VLPFC. You live in Jakarta, Indonesia and plans to go to Hungary for rTMS. Here you made and identical complaint about being psychically weak, having fatigue, pain in extremities. I wrote to there that these symptoms are not symptoms of depersonalization disorder. When I was in Hungary there was a guy from Norway who was active on this forum too who thought he had depersonalization; "it has to be depersonalization". He had depersonalization symptoms in addition to other symptoms like fatigue, feeling weak. He formal diagnosis was the functional disorder "chronic fatigue syndrome" were the nervous system acts like in is fighting with a virus infection or something similar. The nervous system is in a immobilization state due to this and it gives the depersonalization related symptoms. The Norwegian guy is not active on this site anymore as if he have given up on the idea of having depersonalization. Going to Hungary to replicate a very small experimental trial for a disorder you might not have seems to me as being not well considered from you part.


But I feel disconnect realy .. are you have any feel fatigue weakmuscle and restless like me ???


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> I think I have interacted with you on youtube about a guy experiences with rTMS at the right VLPFC. You live in Jakarta, Indonesia and plans to go to Hungary for rTMS. Here you made and identical complaint about being psychically weak, having fatigue, pain in extremities. I wrote to there that these symptoms are not symptoms of depersonalization disorder. When I was in Hungary there was a guy from Norway who was active on this forum too who thought he had depersonalization; "it has to be depersonalization". He had depersonalization symptoms in addition to other symptoms like fatigue, feeling weak. He formal diagnosis was the functional disorder "chronic fatigue syndrome" were the nervous system acts like in is fighting with a virus infection or something similar. The nervous system is in a immobilization state due to this and it gives the depersonalization related symptoms. The Norwegian guy is not active on this site anymore as if he have given up on the idea of having depersonalization. Going to Hungary to replicate a very small experimental trial for a disorder you might not have seems to me as being not well considered from you part.


But I feel disconnect realy .. are you have any feel fatigue weakmuscle and restless like me ???


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## 35467 (Dec 31, 2010)

no, i dont have those symptoms. Those are not symptoms related to depersonalization disorder. I sounds to me that you might have some DP/DR secondary to another condition. I thought that it might be related to "Chronic fatigue syndrome"/CFS. There are several posts on this site with people with CFS who have DP/DR secondary to it. https://www.dpselfhelp.com/forum/index.php?/topic/28402-cfsme/?hl=cfs


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> no, i dont have those symptoms. Those are not symptoms related to depersonalization disorder. I sounds to me that you might have some DP/DR secondary to another condition. I thought that it might be related to "Chronic fatigue syndrome"/CFS. There are several posts on this site with people with CFS who have DP/DR secondary to it. https://www.dpselfhelp.com/forum/index.php?/topic/28402-cfsme/?hl=cfs


i have cfs and brainfog from 2010 but in 2020 it got worse (derealized) after i got severe tightness anxiety ..

do you think my derealization is still cfs related or a new problem?

which part of the brain plays a role in this?


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## 35467 (Dec 31, 2010)

I think it is related. There can be setbacks in CFS from what I have read. Likely that. There is a structure deep in the brain called the "periagueductal gray" that regulates different stages of the anatomic functions in the nervous system. In people with PTSD and dissociation (DP/DR) this structure have shifted into a immobilization state. In CFS this structure have also shifted towards immobilization but more in reaction to a psychical state in the body and not a psychological threat. You can have derealisation/depersonalisation to a fever too. So, you likely get overlapping symptoms to a state that are not related.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462926/


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## 35467 (Dec 31, 2010)

You likely suffer from fibromyalgia. Along with pain you also develop problems with depression and anxiety. There have been some rTMS trials done in fibromyalgia at locations that is very easy to replicate with a conventional rTMS equipment. Both the left DLPFC have been tried with stimulation high frequency for fatigue and low frequency at the right DLPFC for pain.

Here is the low frequency trial at the right DLPFC: https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-020-00135-7

Here is the high frequency at the left DLPFC:https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1213

Any rTMS provider should be able to do a replication of these trials without any problems. There are rTMS providers in Jakarta.

You likely have to try 10.sessions at one locations to see if you have any benefits. If so then take 15-20.session. If not try the other location.


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> You likely suffer from fibromyalgia. Along with pain you also develop problems with depression and anxiety. There have been some rTMS trials done in fibromyalgia at locations that is very easy to replicate with a conventional rTMS equipment. Both the left DLPFC have been tried with stimulation high frequency for fatigue and low frequency at the right DLPFC for pain.
> 
> Here is the low frequency trial at the right DLPFC: https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-020-00135-7
> Here is the high frequency at the left DLPFC:https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1213
> ...


You're nice boy .. I will try learn from your link


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> You likely suffer from fibromyalgia. Along with pain you also develop problems with depression and anxiety. There have been some rTMS trials done in fibromyalgia at locations that is very easy to replicate with a conventional rTMS equipment. Both the left DLPFC have been tried with stimulation high frequency for fatigue and low frequency at the right DLPFC for pain.
> 
> Here is the low frequency trial at the right DLPFC: https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-020-00135-7
> Here is the high frequency at the left DLPFC:https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1213
> ...


But I don't have pain .. I have is fatigue, the left eye is more unclear .. weak muscle especially on the right side .. arm hand foot legs feel hot like burning chilies


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> You likely suffer from fibromyalgia. Along with pain you also develop problems with depression and anxiety. There have been some rTMS trials done in fibromyalgia at locations that is very easy to replicate with a conventional rTMS equipment. Both the left DLPFC have been tried with stimulation high frequency for fatigue and low frequency at the right DLPFC for pain.
> 
> Here is the low frequency trial at the right DLPFC: https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-020-00135-7
> Here is the high frequency at the left DLPFC:https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1213
> ...


And agitation restless legs


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## 35467 (Dec 31, 2010)

Want2lifeagain said:


> But I don't have pain .. I have is fatigue, the left eye is more unclear .. weak muscle especially on the right side .. arm hand foot legs feel hot like burning chilies


If a neurologist cannot find anything abnormal it typically with the group of disorders called "functional disorders" where people have neurological like symptoms that can not be explained neurologically . "Chronic fatigue syndrome" and "fibromyalgia" is within functional disorders. This is rTMS for "Chronic fatigue syndrome" that is easy to replicate . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216154/


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## 35467 (Dec 31, 2010)

Want2lifeagain said:


> And agitation restless legs


Restless leg sympdrome should be common about people with "chronic fatigue syndrome" and "fibromyalgia"


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## 35467 (Dec 31, 2010)

There is a development of new rTMS technology that might open up for interventions in areas and networks in the brain that can currently not be stimulated. It is the hope that many psychiatric conditions that currently can not be treated can be helped with this development. It can likely also be of benefits for functional disorders where abnormal brain networks can be inhibited and more normal networks be stimulated. I think when these machines starts to come out there will be done more research with the use of brain scanners and rTMS to treat and understand these conditions better. But, it is a development that likely with start 3.years from now when the technology is developed and they start doing trials with it in different conditions. So, you have to find out what is done currently.


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> Restless leg sympdrome should be common about people with "chronic fatigue syndrome" and "fibromyalgia"


do you have those symptoms too?


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## Want2lifeagain (Jun 20, 2020)

Mayer-Gross said:


> There is a development of new rTMS technology that might open up for interventions in areas and networks in the brain that can currently not be stimulated. It is the hope that many psychiatric conditions that currently can not be treated can be helped with this development. It can likely also be of benefits for functional disorders where abnormal brain networks can be inhibited and more normal networks be stimulated. I think when these machines starts to come out there will be done more research with the use of brain scanners and rTMS to treat and understand these conditions better. But, it is a development that likely with start 3.years from now when the technology is developed and they start doing trials with it in different conditions. So, you have to find out what is done currently.


Yes I always find out about dissociate


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## 35467 (Dec 31, 2010)

Want2lifeagain said:


> do you have those symptoms too?


No, I have no body related symptoms.https://www.healthline.com/health/depersonalization-disorder#symptoms


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## Numb_1993 (Jul 22, 2020)

Hey there..is there any updates on your rtms treatment ? What location are you trying after the vlpfc ? Best regards


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## 35467 (Dec 31, 2010)

Numb_1993 said:


> Hey there..is there any updates on your rtms treatment ? What location are you trying after the vlpfc ? Best regards


it is a place with conventional rTMS+neuronavigation so it really cannot stimulate that deep and work with so many locations. Around 30% of the right VLPFC can be stimulated with a conventional 8.coil.


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