Electromagnetic stimulation in psychiatry

One hundred years ago, D'Arsonval and Beer first described the effects of magnetic fields on human brain function. Placing one's head into a powerful magnet produced phosphenes, vertigo or even syncopes (George & Belmaker, 2000). However, only since 1985 has the technology of fast discharging capacitors developed sufficiently to generate reproducible effects across the intact skull, with peak magnetic field strengths of about 1–2 tesla (Barker et al, 1985). The headline-grabbing news has been about therapeutic applications of transcranial magnetic stimulation (TMS), but in the meantime a revolution in functional brain research has taken place, based on the manipulation of brain activity by focused magnetic fields. TMS applied in this way is, in a manner of speaking, brain imaging in the reverse. While common modes of functional brain imaging, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), demonstrate associations between brain metabolic activity and ‘brain tasks', the causal interpretation of such associations can be difficult. Is the frontal lobe activation observed during a memory task, for example, necessary for performing the task, or does it correspond to monitoring activity that runs parallel to task performance proper? If, on the other hand, focal brain activation during TMS results in a muscle twitch, there is no doubt that stimulation of at least some of the neurons within the magnetic field is sufficient cause for the observed movement. Functional neuroimaging is now often combined with TMS, carried out in the same session in order to exploit the complementary strengths of the methods. Although direct stimulation of association (as opposed to motor or sensory) cortex does not usually result in an observable response, TMS applied in repetitive trains can produce reversible ‘lesions'. By interfering with tasks that are dependent on the functioning of the stimulated neurons, it can thus contribute to the localisation of brain function.