This study proposes to design and build a neural imager/stimulator which will let us obtain information about brain circuits and pathways by acquiring electrical and fMRI signals from the brain at the same time. By adding magnetic stimulation to the instrument we will be able to perturb these circuits at precise times and locations in order to both improve how TMS is used as an anti-depression treatment as well as to better understand how our brains function. This research has the potential to revolutionize our understanding of how best to use TMS as a treatment as well as learning how our brains function. This study simply proposes to develop the combined instrument. The use of the new instrument as a anti-depressive treatment will be presented independently after we have developed a working instrument.
Over the past 30 years we have discovered that both the efficacy and the side effects of ECT come not only from the induced seizure, but by the currents of electricity and where they go in the brain. In all patients we now determine, at the first treatment session, the minimum dose of electricity needed to produce a seizure. This is called the seizure threshold. Subsequent treatments are then given at 6 or 9 times this number. The method of titrating has not been fully explored. We propose to titrate with two different currents, one of which is much lower than standard clinical practice. We need to do this twice in each patient, on the first and second treatment sessions, and compare the difference. If we find that that lower currents are paradoxically better, then this will change ECT practice around the world. Patients will receive less overall electricity, with likely fewer side effects.