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
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