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Depressed Patients with Comorbidities

may need extra treatment

…Stimulation Locations

1. Inferior Frontal Gyrus

Autism, Alexithyma & Aphasia (both Excitatory)

Inferior Frontal Gyrus

AKA Broca’s Area

Brodmann’s Area 44, 45

 CustomTMS

…Stimulation Locations

2. OrbitoFrontal Cortex (OFC)

OCD (right) Addiction (left) (both Inhibitory)

(Brodmann’s Area 11)

…Stimulation Locations

3. TPO

(Temporo-Parieto-Occipital Junction)

Tinnitus, Auditory Hallucinations

(both Inhibitory)

Brodmann’s Area 41,42 (AKA TPJ)

…Stimulation Locations

4. Inferior Parietal Lobule (IPL)

Autism (Left) Excitatory, Depression (Right) Inhibitory

(Brodmann’s Area 39,40)

…Stimulation Locations

Quick look (save to photo favorites)

…Protocol Options

E X C I T A T O R Y ••••••••••••••••••••••••••••••••

10Hz: Left DLpfc (Depression, ADD, Pain, etc)

4 sec on 11 sec off

20 minutes

5 sec on, 10 sec off

(George-Stein Suicide Protocol)

30 minutes, pause 60 minutes, repeat

(3 times per day, 3 days in a row)

20Hz: Left DLpfc (Depression, ADD, Pain, etc)

3 sec on 12 sec off

20 minutes

5Hz/50Hz iTBS Left DLpfc (Depression, ADD, Pain, etc)

(intermittent Theta Burst Stimulation)

2 sec on 8 sec off

3 minutes, 6 minutes, or 10 minutes

I N H I B I T O R Y ••••••••••••••••••••••••••••••••

1 Hz:

1200 sec on, 20 minutes

5Hz/50Hz cTBS (continuous Theta Burst Stimulation)

40 sec on

3 min on

2 minutes ON, 1 minute OFF, 2 minutes ON (Hanlon protocol)

Inhibitory can be used (here) for this…

(Right DLpfc) Depression, Anxiety, Bipolar

(Right OFC) Depression, Anxiety, OCD

( Left OFC ) Addiction, Alcohol

(Left TPO) Tinnitus, Auditory Hallucinations

(Right TPO) Tinnitus

(Right IPL) Depression

Excitatory can be used (here) for this…

(Left DLpfc) Depression, Anxiety, Bipolar

(Left & Right IFG) Autism, Aphasia

(Left IPL) Autism

(DMpfc) Depression

(midline 30% nasion-inion)

(SMA) OCD, Tourette’s, Parkinsons

(midline 40% nasion-inion)

(M1) Pain, Parkinsons

(midline 50% nasion-inion)

(PreCuneus) Dissociation

(midline 70% nasion-inion)

Cerebellum Parkinsons

(midline 100% = inion)

 CustomTMS pocket reference

The following contains unnecessary details and I recommend that you ignore unless you are skeptical or confused about TPO & IPL:

let’s get detailed:

MNI BA cm from midline

-57.-20,1 BA41, 42 13 cm

-53,-33,33 BA40 8 cm

-46,-60,33 BA39 10 cm

(these coordinates were obtained from the Yale MNI ←→ Talairach Converter with Brodmann Areas for which i am grateful)

I entered those MNI coordinates into our NeuroNav software and here are the scalp locations

Yellow = TPO TemporoParietoOccipital Junction

Blue = Supramarginal Gyrus

Green = Angular Gyrus

Inferior parietal lobule = (Supramarginal Gyrus + Angular Gyrus)

Strictly speaking when we say TPO, we really mean to target the Posterior Superior Temporal Gyrus

which is mor BA22 vs BA41,42, that is the cortex between primary auditory cortex (Heschl's gyrus BA41, 42 and Wernicke's area (Receptive Language BA 22/39)

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