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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. 



#15 Rmontgomery

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Posted 01 October 2020 - 07:41 PM

I just got this in response from one of the MagVenture clinics in my area that I reached out to. Does this sound right? I had previously thought that the OFC was the same as the VMPFC and not the same as the VLPFC. 

 

I have received some information about the areas and protocols you were asking about. Please see below (I am sorry for the delay)

 

“Dr. Downar reports having success with patients with a depersonalization diagnosis and referred us to a study done by Antonio Mantevini  in New York City.

Regarding the different treatment options, one option would be to target the TPJ which would require these of an algorithm to locate. The other option is to target the VLPFC as mentioned by the patient. This Target area is the same as the OFC (Orbitofrontal) target we use here at Salience. Should the patient be interested in treating the protocol we would use would be 1200 pulses 1 Hz targeting the right OFC. After 18 sessions we would reevaluate the patients case for response.”

 

That protocol can be done at any of our locations with the B-65 coil.



#16 Mayer-Gross

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Posted 01 October 2020 - 08:37 PM

No, everything is wrong. 
the right VLPFC is not same as VmPFC nor the Orbitofrontal cortex. I have recently written with a Canadian girl who have been seen and tried treated by Jonathan Downar. She tried the right DLPFC and the right Orbitofrontal cortex without any effect. I think his research clinic for depression is restricted and only approved for treatment at the left and right DLPFC, the dorsomedial prefrontal cortex and the right Orbitofrontal cortex. So, he can not go to other locations as he then makes an experiment he have no approval for. So, he has no experience in treatment of depersonalization with a clinical response. 

 

The coil they refers to is a normal flat 8-coil and it can not treat as deep as the Orbitofrontal cortex. They do likely not have neuronavigation for locations or planing to get a coil for deep rTMS.Have looked at their site. The setup for their treatment is only depression with a response rate of 60%. That is “normal” to write for a clinic that can only treat at the left and right DLPFC. All their treatment is likely built around these two locations. Very easy to find without neuronavigation and treat with a normal 8.coil.

 

This text by Jonathan Downar from addresses different locations in the prefrontal cortex and the dept of the locations and coils. 
 

http://dribrahimyilm...emik-Makale.pdf



#17 Mayer-Gross

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Posted 01 October 2020 - 08:54 PM

Look I myself is waiting for the publication of a very large French trail at the angular gyrus. It might be published within 3-6.months. It might have a high response rate in people with a recent outset of depersonalization. You can treat at the angular gyrus with the coil they write they have. I think that the design and size of the French trail might rise awareness about depersonalization and cast some light on the networks at play. I would wait until it was published.



#18 Mayer-Gross

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Posted 02 October 2020 - 07:57 AM

You are assuming that because a deep coil from Magventure is approved from OCD by the FDA a Clinic that uses Magventure intent to get such a coil. But, if you look at their site they only treat for depression. It can be related to insurance coverage. That insurances companies will only pay for rTMS treatment for depression at the left or right DLPFC. So, they only offers treatments that can get insurance coverage. FDA might have approved such a coil for the use in OCD but the insurance companies have not. So, many might not get it for that reason as long as it is the case. 






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