Promoting patient safety during COVID-19 through international efforts

COVID-19 has led to the careful scrutiny of in-person treatments for mental health. While some therapies can be done virtually, others like brain stimulation with transcranial magnetic stimulation (TMS) need to be done in-person in a clinic. If you or someone you know has benefitted from TMS and transcranial direct current stimulation (tDCS) in the past, or is considering it for the future, this month’ IMPACT paper could have a direct impact on how your treatment is delivered in the future. It provides important new guidelines for the safe administration of these important therapies during pandemics.

Vice Chair of Basic and Clinical Science @KristaLanctot interviewed author Daniel M. Blumberger, who got together with other experts to develop international guidelines for safe, non-invasive brain stimulation.

DB: Non-invasive brain stimulation encompasses several technologies that are used to stimulate the brain as a means of treatment.  A number of emerging treatment options for brain disorders are classified as NIBS. Some of the more common forms include transcranial magnetic stimulation and transcranial direct current stimulation.
 
KL: What has been the biggest challenge for researchers and clinicians utilizing NIBS during this pandemic?  

DB: All of the NIBS treatments involve close contact between the patient and a treatment provider.  As a result of this close contact there is an increased risk of virus transmission..
 
KL: What did your group do to address this situation?

DB: Our centre uses NIBS as both a treatment and an investigational tool in trials.  All of our investigations have had to stop for now, as they are involved experiments that involved prolonged contact with subjects.  However, transcranial magnetic stimulation is an an essential, evidence-based treatment for depression.  We are using a brief form of treatment called intermittent theta burst stimulation. A treatment session is less than 5 minutes, minimizing contact between treatment providers and patients.  We have also received funding to use an intensive treatment schedule in patients with severe depression.
 
KL:     What are the specific guidelines for lab and clinic reopening that patients should be aware of?

DB: Proper personal protective equipment for treatment providers and masks for patients are the foundation of being able to deliver in-person care.  In addition, repeated screening of participants is a must.  The advent of brief treatments such as theta burst stimulation combined with virtual assessments of symptoms have allowed in-person care and treatment to continue while being as safe as possible for patients and providers. 
 
KL: Any next steps?

DB: Designing safe practices for the longer interactions needed to study new treatments is the next major hurdle and challenge.  The re-opening of other parts of the health care system should include an approach to resuming clinical trials and intervention research; otherwise we risk delaying important advances in treatment.

Guidelines for TMS/tES clinical services and research through the COVID-19 pandemic 
Brain Stimul . Jul-Aug 2020;13(4):1124-1149.  doi: 10.1016/j.brs.2020.05.010. Epub 2020 May 12. 

Marom Bikson, Colleen A Hanlon, Adam J Woods, Bernadette T Gillick, Leigh Charvet , Claus Lamm, Graziella Madeo, Adrienn Holczer, Jorge Almeida, Andrea Antal  , Mohammad Reza Ay, Chris Baeken, Daniel M Blumberger, Salvatore Campanella, Joan A Camprodon, Lasse Christiansen, Colleen Loo, Jennifer T Crinion, Paul Fitzgerald, Luigi Gallimberti, Peyman Ghobadi-Azbari, Iman Ghodratitoostani, Roland H Grabner, Gesa Hartwigsen, Akimasa Hirata, Adam Kirton, Helena Knotkova, Evgeny Krupitsky, Paola Marangolo, Ester M Nakamura-Palacios, Weronika Potok, Samir K Praharaj, Christian C Ruff, Gottfried Schlaug, Hartwig R Siebner, Charlotte J Stagg, Axel Thielscher, Nicole Wenderoth, Ti-Fei Yuan, Xiaochu Zhang, Hamed Ekhtiari.