Mayer-Gross

Just a follow up to this story. I have tried rTMS at the right VLPFC for 12.session without effect. So, I have looked into the research in depersonalization and also rTMS. A general problem is that allmost all locations found overactive in the prefrontal cortex in depersonalization are too deep in the prefrontal cortex for a normal coil to stimulate. The rTMS used and approved is called a 8.coil and can go 1.cm deep into the prefrontal cortex. In depersonalization both sides of the medial prefrontal cortex have been found active in brain scans but this location is too deep to stimulate. The depersonalization research unit likely chose the right VLPFC because parts of it can be stimulated by a normal 8.coil. Like 20% of the right VLPFC. They do not address this problem in their publications and it is in many ways a huge error. The rTMS researcher, Jonathan Downar wrote a text about stimulation of different locations in the prefrontal cortex in 2013 that the VLPFC only can be superficially stimulated by a normal coil. A deep coil is needed for this location. A more recent publication about doing rTMS at the right VLPFC says that the location is to deep for normal coil and a deep coil is needed. Deep coils for rTMS is only in process for being approved in clinical use. So, rTMS right now as it stands might not be optimal for depersonalization. Too many limitations.

Here are some brain images from fMRI scans done in depersonalization and the first picture on the top shows the activity of the right VLPFC. Actually one can see that the active part of the right VLPFC is not the part that is on the surface of the cortex. The active part is deeper than one cm. It might explain the problems with this location. Both sides of the dorsomedial prefrontal cortex is also very active and can be seen in the center Of the brain. https://www.frontier...-00432-g002.jpg

The French angular gyrus trail will if they follow their design do a follow up in the 50.pataints given the active rTMS with a fMRI scanner. They might be able so see why some have had full response, a partial and none, i think that locations in the prefrontal cortex might play a central role for it, it is much more of value than a personal fMRI scan that might be close to useless. Such a large trail also brings awareness about depersonalization among psychiatrists working with rTMS. It can open some doors.

where can i make a brain scan to figure out which parts of my brain are responsible to the symptoms?

No, you can not. The dream of a brain scan and doctor looking at the scanning and saying “there is depersonalization” is naive. All brain scans done in depersonalization are almost free for all to read. There is nowhere despite they have both a patient and normal group to compare with where they can say that this is the location. There are simply to many differences in activity. There is also conflicting data between studies about these activities. You will never as a private person or a patient have access to scannings equipment more advanced than the one they use. You can get a SPECT scan that have not been used in psychiatric research for 30. Year with a charlatan saying that there is the location and give me your money. Fact is that fMRI scanner is 20.times or more sensitive than a SPECT. If systematic brain studies can not give answers when studying groups it can not do it either in single persons. 
 

Some have said that the best research that could be done in depersonalization was an open trail that was explorative where rTMS with deep coil was used combined with fMRI scanners. You could try to stimulate some locations that shows up as active and stimulate them with rTMS and see if there was a reduction in some symptoms and what is still there. Then try other locations . You would find productive locations and also get some insight into emotional regulation in depersonalization. It would isolate and exclude many things.

In the UK there is the first depersonalization charity called “Unreal UK”. Two central persons around this charity have said that rTMS do not work in depersonalization. They really do not know anything about rTMS. Their statements are based on experiences from who have consulted a very expensive and poorly equipped rTMS chain in the UK called “Smart TMS”. It operates from 10.locations in the the UK and are charging prices 2-3.times higher that Western Europe. They are poorly equipped and do not have neuronavigation. They claim on their site that they treat depersonalization but can in reality not make the locations for depersonalization. The other aspect is that there could potentially be other locations in depersonalization that are the “core” in the disorder like the dorsomedial prefrontal cortex or the ventromedial prefrontal cortex. So, we need more brain scannings. So, their claim that rTMS doesn’t work in depersonalization is correct with the equipment the average rTMS clinic have. But, to claim that rTMS have been tried and is not a potential treatment is wrong. There are so many locations that have never been tried.

thanks for your reply.

im being afraid of my symptoms going worse. i did wanted to make any treatment as early as possible.. but youre right. i live in germany, maybe one day that deep coil comes to germany.

Very few have neuronavigation in Germany and not a deep coil. I think if Magventure gets their deep coil approved in Europe those who acquire it will likely also get neuronavigation. This clinic have neuronavigation and uses a normal coil. You could contact them. More than a year ago a wrote to them because they wrote they have neuronavigation and also on their site they mentioned depersonalization and had tree references, primarily to the right TPJ trail. I can not find it. They might have dropped working with depersonalization. I was also in contact a year ago with an Italian rTMS clinic in Europe that have both a deep coil and neuronavigation from Magventure. A professor  replied that they would look into into and answer me shortly. They never did and did not reply me when I contacted that. I think the problem is the many locations coming up and small trails. If you then look into brain scannings done then there are many possibilities of locations. I think they do not like such insecurities into a disorder. https://www.wege-aus...ession.de/rtms/