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FIGURE 27–1. Transcranial magnetic stimulation (TMS).TMS works by first passing a powerful electrical current through a coil, which creates a transient magnetic field. The current passes unimpeded through the skull, causing electrical current to flow in neurons.Source. Reprinted from George MS: "Stimulating the Brain." Scientific American 289:66–73, 2003. Copyright 2003, Bryan Christie Design, Maplewood, New Jersey. Used with permission.

FIGURE 27–2. Significant secondary effects of TMS (direct cortical stimulation), as seen on interleaved TMS/BOLD fMRI.Interleaved transcranial magnetic stimulation (TMS)/blood oxygen level–dependent (BOLD) functional magnetic resonance imaging (fMRI) reveals that left prefrontal TMS produces deeper transsynaptic effects. Shown are images from different slices of a common brain, where results from 14 medication-free depressed patients have been pooled. The areas in red are regions that have more blood flow when TMS is applied over the prefrontal cortex than when it is off. Note that although TMS directly stimulates only the left prefrontal cortex, there is also increased activity in many limbic and paralimbic regions connected to the frontal cortex.Source. Reprinted from Li X, Nahas Z, Kozel FA, et al.: "Acute Left Prefrontal Transcranial Magnetic Stimulation in Depressed Patients Is Associated With Immediately Increased Activity in Prefrontal Cortical as Well as Subcortical Regions." Biological Psychiatry 55:882–890, 2004. Copyright 2004, Society of Biological Psychiatry. Used with permission.

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