Cargando…

Transcranial Magnetic Stimulation for the Treatment of Chemo Brain

This pilot feasibility study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on chemotherapy-related cognitive impairment (CRCI), and we report here on the first patient. Background: Deleterious cognitive changes due to chemotherapy or CRCI are commonly referred to as “chemo...

Descripción completa

Detalles Bibliográficos
Autores principales: Kuo, Phillip H., Chen, Allison Yu-Chin, Rodriguez, Rudolph J., Stuehm, Carol, Chalasani, Pavani, Chen, Nan-Kuei, Chou, Ying-Hui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575384/
https://www.ncbi.nlm.nih.gov/pubmed/37836847
http://dx.doi.org/10.3390/s23198017
_version_ 1785120909621723136
author Kuo, Phillip H.
Chen, Allison Yu-Chin
Rodriguez, Rudolph J.
Stuehm, Carol
Chalasani, Pavani
Chen, Nan-Kuei
Chou, Ying-Hui
author_facet Kuo, Phillip H.
Chen, Allison Yu-Chin
Rodriguez, Rudolph J.
Stuehm, Carol
Chalasani, Pavani
Chen, Nan-Kuei
Chou, Ying-Hui
author_sort Kuo, Phillip H.
collection PubMed
description This pilot feasibility study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on chemotherapy-related cognitive impairment (CRCI), and we report here on the first patient. Background: Deleterious cognitive changes due to chemotherapy or CRCI are commonly referred to as “chemo brain”. With the increasing survival of cancer patients, this poorly understood and inadequately treated condition will likewise have an increasing toll on individuals and society. Since there is no approved treatment for chemo brain, we have initiated a therapeutic trial using transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique approved in many countries for the treatment of neurologic and psychiatric conditions like migraine and depression. Case presentation: A 58-year-old woman, diagnosed 7 years prior with left breast cancer, underwent partial mastectomy with sentinel lymph node biopsy. She then received four cycles of adjuvant chemotherapy followed by radiation therapy. Afterwards, she was on tamoxifen for 4 years and then switched to aromatase inhibitors. The patient’s CRCI started during chemotherapy and severely impaired her quality of life for an additional two years. In the third year after chemotherapy, the CRCI partially cleared to stabilize to the level at the time of presentation for this trial. The patient continues to have memory difficulties and decreased concentration, which makes multi-tasking very difficult to impossible. She is reliant on memory aids at work and at home. The participant underwent 10 consecutive sessions of TMS during weekdays for 2 weeks. Stimulation was directed to the left dorsolateral prefrontal cortex. After TMS, the participant significantly improved in memory function on neuropsychological testing. While she reported no subjective differences in concentration or memory, she did report an improvement in her sleep. Functional magnetic resonance imaging of the brain before and after TMS showed increased resting-state functional connectivity between the stimulation site and several brain regions. Remarkably, after 6 years of chemo brain and remaining in the same position at work due to her inability to concentrate and multi-task, she applied for and received a promotion 5–6 months after her TMS treatments. Conclusions: This first patient in the phase 1 clinical trial testing of TMS for the treatment of “chemo brain” provided important lessons for feasibility and insights into mechanisms of potential benefit.
format Online
Article
Text
id pubmed-10575384
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-105753842023-10-14 Transcranial Magnetic Stimulation for the Treatment of Chemo Brain Kuo, Phillip H. Chen, Allison Yu-Chin Rodriguez, Rudolph J. Stuehm, Carol Chalasani, Pavani Chen, Nan-Kuei Chou, Ying-Hui Sensors (Basel) Case Report This pilot feasibility study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on chemotherapy-related cognitive impairment (CRCI), and we report here on the first patient. Background: Deleterious cognitive changes due to chemotherapy or CRCI are commonly referred to as “chemo brain”. With the increasing survival of cancer patients, this poorly understood and inadequately treated condition will likewise have an increasing toll on individuals and society. Since there is no approved treatment for chemo brain, we have initiated a therapeutic trial using transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique approved in many countries for the treatment of neurologic and psychiatric conditions like migraine and depression. Case presentation: A 58-year-old woman, diagnosed 7 years prior with left breast cancer, underwent partial mastectomy with sentinel lymph node biopsy. She then received four cycles of adjuvant chemotherapy followed by radiation therapy. Afterwards, she was on tamoxifen for 4 years and then switched to aromatase inhibitors. The patient’s CRCI started during chemotherapy and severely impaired her quality of life for an additional two years. In the third year after chemotherapy, the CRCI partially cleared to stabilize to the level at the time of presentation for this trial. The patient continues to have memory difficulties and decreased concentration, which makes multi-tasking very difficult to impossible. She is reliant on memory aids at work and at home. The participant underwent 10 consecutive sessions of TMS during weekdays for 2 weeks. Stimulation was directed to the left dorsolateral prefrontal cortex. After TMS, the participant significantly improved in memory function on neuropsychological testing. While she reported no subjective differences in concentration or memory, she did report an improvement in her sleep. Functional magnetic resonance imaging of the brain before and after TMS showed increased resting-state functional connectivity between the stimulation site and several brain regions. Remarkably, after 6 years of chemo brain and remaining in the same position at work due to her inability to concentrate and multi-task, she applied for and received a promotion 5–6 months after her TMS treatments. Conclusions: This first patient in the phase 1 clinical trial testing of TMS for the treatment of “chemo brain” provided important lessons for feasibility and insights into mechanisms of potential benefit. MDPI 2023-09-22 /pmc/articles/PMC10575384/ /pubmed/37836847 http://dx.doi.org/10.3390/s23198017 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Kuo, Phillip H.
Chen, Allison Yu-Chin
Rodriguez, Rudolph J.
Stuehm, Carol
Chalasani, Pavani
Chen, Nan-Kuei
Chou, Ying-Hui
Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title_full Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title_fullStr Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title_full_unstemmed Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title_short Transcranial Magnetic Stimulation for the Treatment of Chemo Brain
title_sort transcranial magnetic stimulation for the treatment of chemo brain
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575384/
https://www.ncbi.nlm.nih.gov/pubmed/37836847
http://dx.doi.org/10.3390/s23198017
work_keys_str_mv AT kuophilliph transcranialmagneticstimulationforthetreatmentofchemobrain
AT chenallisonyuchin transcranialmagneticstimulationforthetreatmentofchemobrain
AT rodriguezrudolphj transcranialmagneticstimulationforthetreatmentofchemobrain
AT stuehmcarol transcranialmagneticstimulationforthetreatmentofchemobrain
AT chalasanipavani transcranialmagneticstimulationforthetreatmentofchemobrain
AT chennankuei transcranialmagneticstimulationforthetreatmentofchemobrain
AT chouyinghui transcranialmagneticstimulationforthetreatmentofchemobrain