Therapeutic Brain Stimulation

 


Top Up PhD Scholarship in Clinical Neuroscience

This is an exciting and unique oppourunity for a high performing new PhD student to join our group and work on research investigating the mechanisms of therapeutic brain stimualtion in psychiatry.  For more information download the full advert HERE

 


 

The Therapeutic Brain Stimulation team focuses on using advanced neuroscience technology to investigate brain function and develop innovative treatments across a range of disorders. 

We use a range of advanced imaging techniques and novel treatments, including:

To find out more about our research and treatment tools see here.

Our research team is studying potential uses of these techniques in disorders such as:

To find out about current clinical research projects and investigative studies and how to be involved see our Treatment Studies and our Investigative Studies

 

Therapeutic Brain Stimulation team

Director 

Professor Paul Fitzgerald

Deputy Director
A/Prof Kate Hoy, Head Cognitive Therapeutics Program

Research Fellows
Dr Bernadette Fitzgibbon
Dr Richard Thomson
Dr Robin Cash
Dr Manreena Kaur
Dr Jerome Maller

Team Co-ordinator
Karyn Richardson

Research Registrars
 

Research Nurses
David Elliott 
Susan McQueen 
Lenore Wambeek

Research Assistants
Kirsten Gainsford
Caitlyn Rogers
Hannah Coyle
Laura Knox
Caley Sullivan
 
Doctoral Students
Rodney Anderson (PhD)
SungWook Chung (PhD)
Melanie Emonson (DPsych)
Aron Hill (PhD)
Melanie Emonson (DPsych)
Oscar Murphy (DPsych)
Karyn Richardson (DPsych)
Kirstyn Windsor (DPsych)
Hannah Coyle (DPsych)
Sin-Ki Ng (PhD)
Xianwei Che (PhD)
Ingrid Butterfield (PhD)

Honours Students

Research Placements
Greg Roebuck (MD)
 
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Research and Treatment Tools

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a technology which is an effective treatment for
depression and also showing substantial promise as a therapy for a range of other conditions.

TMS is a non-invasive treatment which works by using a magnetic field to stimulate nerve cells in superficial areas of the brain. A hand-held, plastic-coated coil is placed close to the scalp of the person receiving TMS treatment. An electrical current passes through the coil, creating a magnetic field that stimulates electrical activity in the nerve tissue below the coil.

The effect of the stimulation varies with the frequency and intensity of stimulation and the orientation of the stimulation coil. TMS stimulation has been shown to have effects on mood, motor (control of movement) and cognitive (thinking and planning) functioning.

As well as a therapeutic tool,TMS can be used as a method to investigate brain function.

 

TMS as a treatment method

Studies have been evaluating the use of TMS in the treatment of patients with depression for over 15 years. At MAPrc we have been at the centre of a worldwide research effort focused on evaluating and more recently improving the use of TMS treatment for patients with depression. We have conducted an extensive series of clinical trials that have contributed to robustly demonstrating that TMS is an effective treatment. We have also conducted extensive research evaluating the use of potentially new and improved forms of TMS treatment.

Because it is a non-invasive therapy that is carried out while the person receiving it is awake and alert, TMS has important advantages over older therapies such as electroconvulsive therapy (ECT). These include: low risk of side-effects or serious complications, avoidance of the need for anaesthesia and its associated risks, lower costs and less inconvenience to the patient, avoidance of the stigma that ECT sometimes carries, and the fact that TMS is suitable for use in medically unwell people who may not be able to tolerate certain medications or ECT.

TMS is now becoming a widely used treatment for depression around the world. There are clinical programs providing TMS treatment globally, including the US, and its place in clinical practice is gradually being refined.

In addition to using TMS in depression, studies are now exploring its use in other disorders including bipolar disorder, autism, Asperger's disorder and substance abuse. We have conducted, and continue to conduct innovative studies like these, including in depression, autism, schizophrenia, fibromyalgia and obsessive compulsive disorder. You can find more information about this research on the Psychiatric Neurotechnology: current projects page                          

Contact details
Email: tms-enquiry@monash.edu
Phone: 9076 6595

 

TMS as a probe of brain function 

TMS is widely utilised as a technique in studying normal and abnormal brain activity. When TMS pulses are applied to the muscle area of the brain, a muscle response is produced, for example in the hand, which can be measured and characterised accurately. This allows researchers to study the function of the motor control system. When TMS pulses are applied to other brain regions, they can be used to interfere with or temporarily augment other brain activities allowing study of these brain functions.

Researchers have also combined TMS with brain imaging methods such as EEG and NIRS as a method of studying brain function in non-motor brain regions. When EEG is recorded during a TMS pulse, we can measure the brain's electrical response to the TMS pulse, which reflects the normal functioning of the brain being stimulated. In a similar way, the brain's vascular response to stimulation can be measured with NIRS.

Researchers within MAPrc have extensively used TMS-EEG and TMS-NIRS methods to study brain function and the response to TMS in healthy subjects and in a number of illness states including depression, schizophrenia and addiction.

 

Transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) is a relatively new brain stimulation technique. It uses a very gentle electrical current (1-2 mA) to change the activity level of cells in specific areas of the brain. The low current is not enough to cause brain cell to fires, but it changes the environment around nerve cells in the area of the brain that is stimulated making them more or less likely to fire. 

Like TMS, tDCS is a non-invasive technique which does not require any anaesthetic and has minimal side-effects. It also has potential use as a way of investigating brain function but is mostly being explored in the possible treatment of conditions such as chronic pain, epilepsy, stroke, Parkinson's disease and depression. Currently, it is being investigated as a treatment for depression in people whose symptoms have not been resolved with medication (treatment-resistant depression). 

Over recent years, researchers within MAPrc have conducted a careful series of studies demonstrating that tDCS has the potential to modulate and improve aspects of brain cognition, including learning and memory. These studies are ongoing and hopefully will lead to the development of tDCS methods as treatments for disorders with cognitive dysfunction such as schizophrenia, head injury and Alzheimer's disease.  You can find more information about this research on our current Treatment Studies and Investigative Studies.

 

Magnetic seizure therapy

Magnetic seizure therapy (MST) is a very new treatment approach for severe depression that we are currently actively investigating. MST, like ECT, involves the induction of a seizure for therapeutic purposes. The major difference, however, is that in MST the seizure is induced using magnetic stimulation rather than the electrical current that is used in ECT. 

Magnetic fields are able to pass freely into the brain, making it possible to produce a very focused seizure in a specific area. The widespread nature of the seizures produced by ECT is thought to be responsible for the memory loss that people report following ECT. Therefore, by avoiding the use of direct electrical current and inducing a focal seizure, it is thought that MST will be able to improve depressive symptoms without the memory loss seen in ECT. 

MST is a medical procedure performed by doctors. It involves having a general anaesthetic and a muscle relaxant. The brain is then stimulated with a controlled series of magnetic pulses using a coil that is placed at a precise location on the head. The magnetic pulses cause a seizure in the brain which will last up to two minutes. Because of the muscle relaxants and the anaesthetic, patients do not convulse or 'fit' and do not feel any pain. Patients wake up five to ten minutes following the procedure. 

Initial studies, with MST have suggested that it might produce similar antidepressant effects to those seen with ECT but without the same side effects. We are currently conducting a randomised controlled trial to evaluate these propositions. You can find more information about this research on our current Treatment Studies and Investigative Studies.

 

Treatment Studies

The Therapeutic Brain Stimulation team is currently researching new treatments and conducting investigative studies for depression, bipolar, OCD, autism, schizophrenia, head injury and chronic pain. 

To read about our current research in these areas and to find out how to get involved, please see below. You can also view our Investigative Studies

 

Treatment Studies 

1. Accelerated TMS for depression

Aim: To see whether we can speed up the response to TMS. TMS response is usually slow, with a typical treatment course taking between four and six weeks. Over this time, patients are required to attend the hospital or clinic on a daily basis for a treatment that takes approximately 45 minutes. In this study we are investigating whether we can use a higher dose of treatment to get an accelerated treatment response, such that patient's symptoms improve in a much shorter period of time.

Participants: People with treatment-resistant depression  i.e. depression that has not adequately improved with antidepressant medications.

Project status: This project is currently underway.  

Contact details

Email: tms-enquiry@monash.edu

Phone: 9076 6595

 

2. DBS for treatment-resistant depression

Aim: To evaluate deep brain stimulation (DBS) in depression that has proved extremely resistant to standard treatments.

Methods: This study involves neurosurgical implantation of a neurostimulator in consenting patients who have severe depression that has proved extremely resistant to all less invasive antidepressant treatment options. 

Participants: As DBS is considered a treatment of last resort, only individuals who have trialled all less invasive antidepressant treatments and remained severely depressed can be considered for the procedure. This means having trialled multiple medications from all antidepressant drug classes, combinations of antidepressant medications, cognitive behavioural therapy, transcranial magnetic stimulation and extensive electroconvulsive therapy (ECT).

Project status: This project is currently in progress.

Contact details:

Email: maprc-dbs@monash.edu

Phone: 9076 6564

 

3. MST for treatment resistant depression   

Aim: To evaluate magnetic seizure therapy (MST) for patients with depression that has proved extremely resistant to standard treatments.

Participants: People with depression that have proved extremely resistant to standard treatments.

Project status: This project is currently in progress.

Contact details

Lenore Wambeek

Email: tms-enquiry@monash.edu

Phone: (03) 9076 5186

 

4. TMS for the treatment of fibromyalgia

Aim: The aim of this study is to investigate the use of transcranial magnetic stimulation (TMS) as a treatment for the symptoms of fibromyalgia. Fibromyalgia is a common condition producing substantial pain and disability. Preliminary research from overseas suggests that TMS may be effective in the treatment of fibromyalgia and other pain conditions.

Participants:To be involved, participants must be aged between 18 and 65 years and have a diagnosis of fibromyalgia. Participation will involve attending MAPrc for 20 TMS treatments over a four week period. Each treatment takes approximately 30 minutes. 

Project status: Recruitment underway.

Contact details

Dr Bernadette Fitzgibbon

Email: bernadette.fitzgibbon@monash.edu

Phone: (03) 9076 9860

 

5. Non-invasive brain stimulation in autism spectrum disorder (ASD)

Aim: We are currently conducting a number of studies that investigate whether transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) can be used to improve social and behavioural aspects of autism spectrum disorder.

Participants: Depending on the study, we are recruiting people aged between 14 and 40 who have a formal diagnosis of autism spectrum disorder.

Project status: Currently underway

Contact Details

A/Prof. Peter Enticott

Email: peter.enticott@deakin.edu.au

Phone: (03) 9244 5504

Investigative Studies

Investigative studies are key to improving our understanding of the nature of mental health disorders and often require healthy controls in addition to patient populations as volunteers.  

To read about our current investigative studies and to find out how to get involved, please see below. You can also view our Treatment Studies.

1. Non-Invasive Brain Stimulation: the Influence of Gender and Menstrual Phase

Aim: to assess the impact of gender, and within female gender stages of the menstrual cycle associated with high and low endogenous estrogen, on the effect of tDCS and rTMS. 

Participants: Healthy right-handed controls (18-40 years)

Project Status: Recruitment underway

Contact details

Cassandra Thomson

Email: cassandra.thomson@monash.edu

2. Optimising the use of Theta Burst TMS in Modifying Brain Activity

Aim: To better understand the optimal conditions for changing prefrontal cortical activity with Theta Burst Stimulation (TBS). Specifically, we will explore whether effects on cortical excitability are related to the intensity of stimulation, the frequency at which stimulation pluses are applied, the location of stimulation within the prefrontal cortex and repeated applications of stimulation.

Participants: Healthy controls.

Project status: Recruitment underway.

Contact details

Sung Wook Chung

Email: sung.chung@monash.edu

3. Enhancing cognitive processing in depression: An investigation of non-invasive electrical brain stimulation methods

Aim: To investigate the capacity of two different methods of non-invasive transcranial electrical stimulation to enhance cognitive processing, in both healthy individuals and those with major depression.

Participants: Healthy controls and individuals with major depression.

Project status: Recruitment underway

Contact details 

Oscar Murphy

Email: oscar.murphy@monash.edu

5. Inside the mind of an 'ultra'

Aim: To investigate the psychological, cognitive and psychophysiological attributes of ultra-runners.  Click here for more details

Participants: Healthy controls.

Project status: Actively recruiting participants  

 Contact details

Greg Roebuck

Email: gregory.scott.roebuck@monash.edu

 

 

 

 

 

Ultra-Runners

Honours projects

Within the Therapeutic Brain Stimulation team at MAPrc, there are a range of potential honours projects available for 2017 and beyond. These will most likely involve the use of brain stimulation techniques such as transcranial magnetic stimulation and transcranial direct current stimulation or neuroscience tools such as EEG or neuroimaging.

These include studies focused on the following areas:

  • Using TMS to study the role of expectancy and anticipation in motor cortical excitability
  • The role of stimulation duration in working memory enhancement using tDCS
  • Using near infra red spectroscopy (NIRS) to investigate brain changes following Transcranial Magnetic Stimulation
  • Cortical Inihibiton, Dorsolateral Pre Frontal Cortex and Working Memory: Using TMS/EEG to establish a neurophsyiological marker of working memory 

 

Cognitive Therapeutics Research Program

The Cognitive Therapeutics Research Program is headed by Associate Professor Kate Hoy. The group's research is focused on the development of novel biological treatments for cognitive impairment in both psychiatric and neurological illnesses. Information about our current research studies are provided below.

Current Treatment Trials:

Investigating the use of brain stimulation to treat the cognitive symptoms of mild to moderate Alzheimer's

We are seeking volunteers between 50 and 95 years of age with a diagonsis of mild to moderate Alzheimer's. We are investigating whether a form of Transcranial Magnetic Stimulation can improve the cognitive symptoms of Alzheimer's. Participation will involve visiting our research centre in Prahran for an initiial interview (2-3 hours), 21 treatments over a 6 week period (each lasting approximately 30 mintues), and two follow up interviews (2-3 hours each).  Participants will be provided compensation toward your travel and time costs.  If you think this sounds interesting and would like to know more please contact Caitlyn Rogers on 9076 9864 or email tms-enquiry@monash.edu

Examining the effects of brain stimulation on cognitive aging in healthy older adults between the ages of 65 and 80 years

We are seeking healthy volunteers between 65 and 80 years of age. We are testing whether gentle electrical stimulation, i.e. transcranial Direct Current Stimulation, can improve cognition in healthy older adults. Participation will involve visiting our research center in Prahran daily (Monday to Friday) for two weeks. The visits will involve an initial interview (2-3 hours), 16 stimulation sessions over 8 days (each visit including 2 stimulation sessions and lasting approximately 1 hour in total), and two follow up interviews (2-3 hours each). You will be provided compensation toward your travel and time costs. If you think this sounds interesting and would like to know more please contact Kirsten Gainsford on 9076 6952 or Kirsten.Gainsford@monash.edu  

 

Current Investigative Studies:

The relationship between cortical activity and cognitive function after head injury

We are seeking volunteers between the ages of 18 and 55 to help us investigate the relationship between changes in brain activity and symptoms after a concussion. We are using a non-invasive type of brain stimulation to learn more about changes post-concussion and during recovery. Participation will involve visiting our research centre in Prahran for three research sessions.  The first session will occur within 1 month since your concussion and take approximately 3 hours. The following sessions will occur 3 and 6 months post-concussion and will take approximately 2 hours each. Together we will complete an interview, do some thinking tasks, take a recording of your brain waves and give you a short session of non-invasive brain stimulation. If you think this sounds interesting and would like to know more please contact Ms Hannah Coyle on 9076 8649 or hannah.coyle@monash.edu

Investigating the use of brain stimulation to enhance neural plasticity and cognitive performance in younger adults, and older adults with or without memory complaints

Participants are currently being sought for a research project investigating the ability to enhance cognitive performance and neural plasticity following brain stimulation in younger adults, older adults, and older adults with memory complaints. Individuals must be aged between 18 to 35 years OR 56 to 80 years, be right-handed, and have no current or previous psychiatric or neurological diagnoses. Participation will involve completing a series of cognitive tasks both before and after administration of transcranial direct current stimulation (tDCS). tDCS is a safe, painless and non-invasive means of stimulating nerve cells in the brain. Changes in brain activity before and after tDCS will be measured through the use of Transcranial Magnetic Stimulation (TMS) and electroencephalography (EEG). Participants are required to attend our research centre in Prahran on two occasions (approx. 3 hours each), and will be provided compensation toward time and travel costs.  

If you are interested in participating or would like more information on the project, please contact Melanie Emonson on (03) 9076 9823 ormelanie.emonson@monash.edu.