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Found this series of videos of a guy who gets rTMS over the right VLPFC. He started with normal rTMS over the right VLPFC and was shifted to theta burst stimulation that is a lot quicker. Neuronavigation is used for location. Some texts says that theta burst over the right VLPFC can be difficult to tolerate for 50% due to contractions of the nerves around the eyes. In the video one gets theta burst at the right VLPFC and he has contractions. They do not seem to painful for the few min. it takes. In the video from 4.min he tells about changs in emotions, more energy, feeling more present. The video is here and is one of several on the subject. He will also get rTMS at the right TPJ. I would go to angular gyrus instead of that location. The treatment is done in Schweitzerland and costs around 400.dollars pr. session for him. So, that is a no go for me. I think 150-200.euros in normal in many europeans countries.

 

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He is asked in the last video if he fell any improvement and he replies; "I definitely have, especially in the emotional numbing department. I need to live my life for a while though to get a better picture of how much I've improved."

He said that the emotional numbing was reduced but rTMS at the TPJ first was done at the wrong location the first 3.session and he felt a change when it was change to another location at the TPJ. There was done 3.session. He also said in a video that they had debated whether they should do the TPJ or the angular gyrus and he mentions the french unpublished trial at the angular gyrus. They end up with the right TPJ. In the trial at the right TPJ 15.session was given and 50% had a response and was given 15.sessions more with a reduction of 68% in symptoms. So, it might not be the right location, i think the angular gyrus is more correct. Those who response to the right TPJ need many session to benefit and it might indicate a indirect effect it has. I personally would choose angular gyrus as it has a more significant role in emotional regulation and is are more central hub in many networks than the TPJ.

His treatment is very expensive at 400.euros pr session and i think he had around 10 -15.treatments in total. But, there was a reduction in numbing. The right VLPFC takes on average 44% of the symptoms, particularly numbing.
 

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Discussion Starter · #4 ·
One problem with rTMS at the right VLPFC and why it is not offered in most rTMS clinics in because it is difficult to localise with the methods used in 95% of clinics on the private market. You have to have a clinic that have neuronavigation from a MRI scan that can calibrate the rTMS equipment to you brain with a computer programme. The most used system is called "Localite" and there is in the system an option to use a "fake brain" based on a average of a 100.brains, then the cost a MRI scan is avoided and the right VLPFC can be found within a certain tolerance. They use that method on him. He explains that here in this video.

 

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Discussion Starter · #5 ·
One other thing is that in trials with normal rTMS on the right VLPFC a significant number sees a reduction in symptoms after one session. He doesn´t. He has several sessions of 40.min of normal rTMS on the right VLPFC and no effect. In the trail done at the right VLPFC at the "Depersonalisation research Unit" one didn't have any effect at all. One can question whether "theta burst" stimulation might work in those who are refractory to normal rTMS. Most new rTMS machines have the option to run both normal rTMS and theta burst stimulation.

I hope he will give the angular gyrus a try when the french trial is published. There are some problems with what might be the correct locations there and the % the rTMS is delivered. The french trial might give som coordinates and the % of the power of the delivery of rTMS in that area.
 

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Discussion Starter · #6 ·
He lives in Lausanne,Switzerland. I think he was treated at this clinic that says they are the first private rTMS clinic in Switzerland to use neuronavigation. The cost of 400.dollars pr session is absurd and one likely have to spend a similar amount a day to live in the city.You might end up with daily costs of 800.euros. I have found a private psychiatric hospital in eastern Europe that offers 20.session rTMS (1.hour each) and one psychiatric consultation for 1060 euro.They have neuronavigation so the cost of a MRI scan might be needed in addition to that. That is 50.euros for one rTMS session. Hotel is 50-60.euros pr.night.. I don't know it they take foreign patients and depersonalisation is not one their site. So, i might have to pay one of their psychiatrists to read into depersonalisation. A one hour consultation is 110.euros.But to pay them 800-1000.euros to read into the disorder still makes it cheap. I will like wait for the publication of the french trial before i contact them.

The clinic i think he tried is this one ; https://www.lcip.ch/transcranial-magnetic-stimulation-(tms).html
 

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Remy and I chat here and there. He has had dp for 7 years induced by weed. He told me that TRE has helped him the most out of the many treatment options he's tried, even more than rTMS and the myriad supplements (he is quite knowledgable when it comes to neurochemistry; he is currently studying to become a psychiatrist and as of now aspires to specialise in the treatment of depersonalization).
 

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Discussion Starter · #8 ·
Remy and I chat here and there. He has had dp for 7 years induced by weed. He told me that TRE has helped him the most out of the many treatment options he's tried, even more than rTMS and the myriad supplements (he is quite knowledgable when it comes to neurochemistry; he is currently studying to become a psychiatrist and as of now aspires to specialise in the treatment of depersonalization).
His videos are made between oct and the 10. dec 2019. He also have one video only on supplements form the same period. In the last video he says that it have benefited him the most and he also recommends other methods. Funny he don't mention TRE that is the most useful to him according to you.
 

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His videos are made between oct and the 10. dec 2019. He also have one video only on supplements form the same period. In the last video he says that it have benefited him the most and he also recommends other methods. Funny he don't mention TRE that is the most useful to him according to you.
not sure either why he hasn't mentioned it, but as you said his youtube channel is relatively new considering he had the condition since he was 15, he is 22 now.
 

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Discussion Starter · #10 ·
I know. But he is the first in Europe that has tried the right VLPFC on the private markedet because his provider had neuronavigation. Very few have it and that is why rTMS is so difficult to get on the right locations.
 

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he has never appeared since the last video he uploaded ... is he recovering? and run .. because lastly he said he would see the results as he walked
 

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I know. But he is the first in Europe that has tried the right VLPFC on the private markedet because his provider had neuronavigation. Very few have it and that is why rTMS is so difficult to get on the right locations.
he has never appeared since the last video he uploaded ... is he recovering? and run .. because lastly he said he would see the results as he walked
 

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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.frontiersin.org/files/Articles/173530/fpsyg-07-00432-HTML-r2/image_m/fpsyg-07-00432-g002.jpg
 
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