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#13 Mayer-Gross

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Posted 31 August 2020 - 05:02 PM

It only need neuronavigation for location. You shall be aware that everything in research done into depersonalization is small. The number of patients scanned in different examinations. so, there can be error or conflicting data. 

The rTMS trails are also very small with no follow up months after the trail so we do know if people became symptomatic after some time. The locations found like angular gyrus and the right TPJ are partly based  on brain scan but also that neurological patients with epilepsy or a tumor can have derealisation from these locations. At the time that the depersonalization research unit did their trail in 2014 there was no coils that could go deeper than 1.5 cm. So, they where likely forced to think in locations they could stimulate and that excludes some locations. 
 

In the model used for depersonalization in PTSD it starts at the ventromedial prefrontal cortex that suppresses that amygdala, limbic system and insula and activate the ventral part of the periaqueductal. The periaqueductal gray will release opiopates that will affect areas like the right TPJ and angular gyrus. Some the activation of these locations is likely in the finial stange of a process. So, prefrontal cortex is likely where it starts. 



#14 Mayer-Gross

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Posted 31 August 2020 - 06:16 PM

I have by the way tried rTMS at both the right VLPFC and the right TPJ without any effect, 12.session with 900.stimulations at each location with 1.mz at 120% power each time and each location. In the trail at depersonalization research unit they only treated 7.patients and that is a very small group. The reason they choose the right VLPFC was because in some brains scans this location was active in the depersonalization group and not in the control group when show aversive pictures. But, depersonalization is constant and not only related to stimulation. So, the location might not show up as active to stimulation as it might be active all the time. In structural scanners the ventromedial shows to be active as the area is much larger as it is used more compared to normal. The ventromedial cortex is also active when we sleep, when the left ventromedial is active the parasympathetic system is stimulated and when the right is active in sympathetic system is suppressed. It have connections to the periaqueductal gray so it can likely make a chronic immobilization response. 






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