21 May 2013
EASY TO ADMINISTER TREATMENT CAN BENEFIT SCHIZOPHRENIA, ALZHEIMER’S PATIENTS
A new treatment for various neuro-psychological disorders promises to improve the quality of life of those suffering from these conditions and also help them respond better to conventional medical therapies. Called trans-cranial direct current stimulation (tDCS), doctors claim the technique is safe, non-invasive, painless, easy to administer and also relatively inexpensive.
The new treatment, being offered in the city since two months ago, uses direct electrical currents to stimulate specific parts of the brain and is found useful in many disorders such as schizophrenia, depression, obsessive compulsive disorder, Alzheimer’s, migraine and Parkinsonism.
“I have treated more than 20 schizophrenia patients with refractory hallucinations and severe negative symptoms. About 40-45 % of them showed excellent improvement and about 20 % showed moderate improvement, while marginal improvement was seen in 15 -20 % patients,” said psychiatrist Rohan Jahagirdar, director of Pune-based Introspectrum Psychological Services, that started tDCS treatment in the city for the first time two months ago.
Jahagirdar said that tDCS was not the first line treatment for neuro-psychological disorders. “It is only a complimentary treatment which is given along with other forms of conventional treatment and therapies,” he said.
When contacted, senior psychiatrist Vidyadhar Watve confirmed the benefits of tDCS as a complimentary treatment modality. “The technique (tDCS) enhances prospects of conventional treatment response and is found beneficial especially in neuro-psychological symptoms such as refractory hallucination and negative symptoms which are usually seen in patients with schizophrenia. It is economical, affordable and more importantly it is non-invasive. Senior psychiatrist Chittaranjan Andrade from NIMHANS has done lot of work with this treatment modality,” Watve said.
Jahagirdar said that compared to electro-convulsive treatment, tDCS is better with no side effects at all. “People who do not wish to undergo electro-convulsive treatment and have certain reservations may go for tDCS as it is safe and non-traumatic in terms of experience,” he said. Jahagirdar has taken an extensive training in tDCS Treatment at Bangalore-based National Institute of Mental Health and Neuroscience (NIMHANS).
According to Jahagirdar, earlier studies carried out to evaluate the efficacy of tDCS found it very effective in schizophrenia patients with antipsychoticrefractory auditory. He added that a similar study was also conducted at NIMHANS in 2012 to assess how effective is the modality. “The doctors found dramatic improvement within five sessions and improvement in negative symptoms preceded improvement in hallucinations.”
The effects of tDCS remain active long after the stimulation has ended. “Treatment using tDCS technique is safe, non-invasive, painless, easy to administer and also relatively inexpensive,” he said.
“The basic treatment consists of a series of 15 consecutive sessions of 15 minutes each. Sometimes a second series of sessions may be necessary to obtain maximum improvement,” he added.
There are other newer modalities like rapid trans-magnetic stimulation (RTMS) and deep-brain stimulation (DBS). “But compared with tDCS, RTMS is a costlier modality and has more or less same success rate. Deep brain stimulation is not easily available in India. Its current use is more in academic form,” Jahagirdar said.
WHAT IS TDCS?
TRANS-CRANIAL DIRECT CURRENT STIMULATION (tDCS) is a non-invasive technique that is mainly used to modulate the brain function with the help of electric current, enhancing it and subsequently modifying human behavior
THIS TREATMENT IS DIFFERENT THAN CONVENTIONAL ELECTROSHOCK THERAPY
- It benefits in treating many disorders such as schizophrenia, depression, obsessive compulsive disorder, Alzheimer’s, migraine, Parkinsonism
- It is also effective in reducing impulsivity and distractibility in persons with attention deficit disorder
- In many countries, tDCS is used by healthy people with no mental disorder, to boost verbal and motor skills, to enhance the cognitive skills such as learning, memory and even general functionality of their brains
HOW DOES TDCS FUNCTION?
- A tDCS machine passes small electric current, using non-metallic rubber electrodes with saline soaked sponges placed at desired areas on the head
- The current passes through the scalp to modulate the brain function. The skin and the electrodes need to be prepared
- Careful placement of electrodes is a critical process of tDCS
- The duration of the change brought in by tDCS depends both on the length of stimulation and the intensity of stimulation
HOW DIFFERENT IS TDCS FROM ELECTROSHOCK THERAPY (ECT)?
- tDCS does not require anesthesia, unlike ECT and can be administered with a patient sitting in any comfortable chair at the doctor’s clinic
- ECT uses electrical currents a thousand times greater than tDCS. Patients receiving tDCS generally report nothing more than a mild tingling or itchy feeling from under the electrode during the stimulation. These sensations also disappear immediately after the current is turned off
- tDCS only influences the area of the cortical brain directly beneath the electrode, whereas ECT affects the functioning of the entire brain
- The known side effects of ECT may include confusion or memory loss to some degree. tDCS has shown no such side effects and hence is a lot safer method of treatment
THE CURRENT IS
- Direct (cathode to anode), not alternating
- Uninterrupted, not in pulses
tDCS IS CURRENTLY USED FOR
- Studying brain functioning
- Treating neuropsychiatric disorders
IT CAN BE USED FOR TREATING
- Depression (most RCTs)
- Refractory auditory hallucinations
- Negative symptoms
- Chronic pain, neuralgia, fibromyalgia
- Parkinson’s disease
- Rohan Jahagirdar | PSYCHIATRIST
- Vidyadhar Watve | PSYCHIATRIST