Transcranial Magnetic Stimulation for Depression in Multiple Sclerosis

This trial explores whether a non-invasive treatment called repetitive transcranial magnetic stimulation (rTMS) can improve depression and fatigue in people with multiple sclerosis (MS). rTMS uses magnetic pulses to stimulate specific brain areas to relieve symptoms that haven't responded well to other treatments. It targets individuals with relapsing-remitting or primary-progressive MS who experience moderate to severe depression and significant fatigue. Participants will undergo daily brain stimulation sessions for five days and will be monitored for changes in mood and energy levels. The study aims to determine if rTMS is a safe and effective option for MS-related depression and fatigue. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the chance to be among the first to receive this innovative therapy.

The trial protocol does not specify if you need to stop your current medications. However, it requires that your immunotherapy be stable for at least 3 months and other medications for at least 4 weeks before joining the study.

Studies have shown that repetitive transcranial magnetic stimulation (rTMS) is generally a safe treatment for major depressive disorder (MDD). Research indicates that adults usually tolerate rTMS well, with most experiencing only mild side effects, such as headaches or slight discomfort at the treatment site. These side effects typically resolve quickly after the session.

rTMS is a non-invasive treatment, meaning it doesn't involve surgery or entering the body. It uses magnetic pulses to stimulate specific parts of the brain. Health Canada has approved rTMS as a first-choice treatment for MDD, indicating it has passed safety tests for this condition.

Repetitive Transcranial Magnetic Stimulation (rTMS) is unique because it directly targets the brain's left dorsolateral prefrontal cortex, a region associated with mood regulation. Unlike standard treatments for depression in multiple sclerosis, which often involve medications like antidepressants, rTMS uses magnetic fields to stimulate nerve cells non-invasively. This method offers a novel mechanism of action that could potentially show rapid improvements in mood without the systemic side effects commonly seen with pharmaceuticals. Researchers are excited about rTMS because it provides a targeted, personalized approach, as the treatment is tailored using MRI and electric field modeling to avoid areas with demyelinating lesions, ensuring safety and effectiveness.

Research has shown that repetitive transcranial magnetic stimulation (rTMS) can effectively treat major depressive disorder (MDD). Studies also suggest that rTMS might help reduce depression and fatigue in people with multiple sclerosis (MS). For example, one study found that rTMS often benefited MS patients with these symptoms. Another study showed that up to 74% of patients responded positively to rTMS, leading to significant mood improvements. The chances of achieving remission with rTMS were more than four times higher compared to a placebo, highlighting its potential effectiveness for depression. In this trial, participants will receive stimulation targeting the left dorsolateral prefrontal cortex to evaluate its safety, feasibility, and preliminary clinical effects.²³⁴⁶⁷