Transcranial Magnetic Stimulation is a new non-invasive procedure-Prof. Aftab Asif


 Proceedings of Prescription for Wellness Conference
Transcranial Magnetic Stimulation is a new
non-invasive procedure-Prof. Aftab Asif
Indications for TMS procedure include resistant
depression, OCD, Anxiety disorders including PTSD
Borderline Personality Disorders are here to stay and let us start
talking about it without wasting time-Prof. Farid Aslam Minhas

LAHORE: The session devoted to “Wellness across the Life Span” during the international psychiatric conference on “Prescription for Wellness” held at Lahore from 2-3rd August 2019 was jointly chaired by Prof. Waqar Azeem, Prof. Mowadat H. Rana, Dr. Rubina Aslam, Dr. Ajmal Kazmi and Dr. Moammad from UK. Prof. Aftab Asif, Head of the Dept. of Psychiatry at King Edward Medical University was the first speaker who talked about Transcranial Magnetic Stimulation (TMS).

Prof. Aftab Asif

Prof. Aftab Asif pointed out that there are different options to improve mood of the patients. Various modalities were available in the past. Transcranial Magnetic Stimulation is a non-invasive procedure. Through this electric current is induced in that depolarized neuron in focal area of cortex or deeper brain structures. The whole procedure lasts for more than six months. It is effective in many resistant diseases. It was generated after fMRI. Brain, he said, has different areas involved with different emotions. When the antidepressants, SSRIs and psychotherapy fail, they start using TMS. This treatment is effective and it was approved by FDA of United States in 1984-85. It was first developed by Anthony Barker and is known as brain stimulator. Currently it is being used for major resistant depression, Obsessive Compulsive Disorders (OCD), Anxiety disorders including PSTD. It is also being used for research in brain mapping. Some of the countries where it is being used successfully with excellent results include USA, Canada, New Zealand, Australia, and European Union.

Continuing Prof. Aftab Asif said that FDA approved it for resistant depression in 2008, for migraine headache in 2013. TMS is advocated by stimulating and it is a focused treatment. The procedure has to be done daily in male as well as females for three minutes. The treatment is three thousand pulses per session. In acute cases treatment lasts for four to six weeks and it does take time to show results just like antidepressants or psychotherapy. Brain activity is detected by changes associated with blood flow. This TMS treatment can be combined with other treatment modalities like EEG. It uses functional MRI and is more effective in resistant depression. Speaking about its benefits Prof. Aftab Asif mentioned that it is an OPD procedure. There is no need for anesthesia; the whole procedure lasts for three to four minutes. During the first visit of the patients, it may take forty five minutes. There is no memory deficit. It is safe and well tolerated. Some of the adverse effects include headache scalp pain or generalized seizures which are 0.2 to 0.5%.

Photographed during the International Conference on Prescription for Wellness recently
held at Lahore from (L to R) are Dr. Duree Shahwar, Prof. Shazia Maqbool, Dr. Nazish
Imran, Prof. Waqar Azeem, Mr. shaukat Ali Jawaid, Ms. Shamaila, Dr. Mohsina Najeeb,
Dr. Aesha Minhas and Dr. Rukhsana Shah

Prof. Naim Siddiqui from SIUT Karachi was the next speaker who discussed different ingredients for wellness. These ingredients, he said, are overlooked or under estimated. Studies have shown that train or aircraft nose impair cognitive development of children. These children have increased hyperactivity, lower level of physical activity. Traffic noise is also related to development of hypertension. He also referred to the Railway and Aircraft noise and their related physical side effects. He discussed in detail the noise pollution and its related physical consequences. Referring to the Air Quality Index, he said that traffic noise and air pollution are risk factors for hypertension and diabetes mellitus. Greenness is protective. Air pollution is related to many diseases. Studies have showed that life style changes improve health by 58% compared to Metformin which shows positive effects in 31%. Life Style Changes delay the development of diabetes for three years. It also leads to reduction in weight coupled with sensible choice in diet. But we have too many excuses not to change and poverty is one such excuse. However, it is not the poverty alone but traditional sweets as we do not use fruits. We are used to high intake of salt, refined food and junk food. He also referred to meal size and the frequency of food. Children suffer from learning disability. If the child is not healthy, we cannot think of wellness. It is essential that the mothers should have appropriate diet. Let us accept what cannot be changed. It is the courage to change which can be used to distinguish between others. One Banana, few Almonds, one cucumber, charter lemon is what we need daily to remain physically active in adult life. It is the health beliefs which matter and it is not still too late to practice this, Prof. Naim Siddiqui remarked.

Prof. Waqar Azeem presenting mementoes to Dr. Ayesha Minhas and Dr. Nazish Imran
at workshop on Children in a Digital World during the International Conference on
Prescription for Wellness recently held at Lahore.

Prof. Farid Aslam Minhas from Rawalpindi discussed the Borderline Personality Disorders and the birth of different interest groups in Paksitan. He started his presentation by paying rich tributes to late Prof. Ijaz Haider and late Prof. Mohammad Sharif the two renowned psychiatrists who passed away few months ago. They were the pioneers in the field of psychiatry and both of them have contributed a great deal to the promotion of psychiatry and mental healthcare in Pakistan, he added.

He then discussed in detail the assessment and management of borderline personality disorders, assessment and management of cognitive dysfunctional depression in old age and the parental guidance- prevention of childhood traumas. He disclosed that they have formed these interest groups. Some of these disorders are difficult to treat and manage. They require personalized management. Childhood trauma patients have serial physical abuse. Most of them have suffered abuse in their early life and it inflicts more damage. Children who are well looked after by the parents have good effect. Some of these patients have mix of intense emotions regarding self harm and suicide. They also suffer from other co-morbid disorders like depression, anxiety disorders, sleep disorders, substance abuse. It is a long term chronic disorder. The period of stress is much longer.

Speaking about the goals of treatment, Prof. Farid Aslam Minhas mentioned emotional regulation, muscles and emotional reactivity. They may not be fully cured but it can be controlled. There is need to secure bond with mental healthcare professionals. Borderline Personality Disorders, he said, are here to stay and let us start talking about it without wasting any further time. However, it is extremely important that mental healthcare professionals should know how to say, what to say and how much to say. Unfortunately some of the professionals lack knowledge, skills and have no time to effectively address patient’s needs. The therapists and families of the patients also need support. We need understanding. For this we plan to organize different workshops and Certificate Courses, he remarked. He concluded his presentation by showing a picture of late Prof. Haroon Rashid Chaudhry and said that let us remember all these people and I had decided that whenever I make a presentation in Lahore I will show this picture of late Prof. Haroon Rashid Chaudhry.

In their concluding remarks Dr. Ajmal Kazmi said that TMS is an expensive treatment modality but it gives better results in carefully selected cases. It is heartening to note that this facility has been made available by Prof. Aftab Asif in Lahore.

Prof. Waqar Azeem referred to the issues related to the off label use of different treatment modalities and the legal issues involved. That is why it cannot be prescribed for emotional disturbances. To do that, we need data and evidence, till then we cannot use. He suggested that the local data should be compiled and its results should be presented at the next conference. It is important that the therapeutic efficacy of all new treatment modalities, procedures are presented at professional forums. We all remember what happened to Prozac which later became known as the “Happy Pill”. Interventions like TMS are for serious disorders. It should be used with caution and not misused like ECT. Referring to Prof. Naim Siddiqui’s presentation, Prof. Waqar Azeem said that we all know what is good for us but we do not eat it. Prof. Farid Aslam Minhas dealt at length on assessment and management of borderline personality disorders which is a reality and we need to know how to effectively manage it.