***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Objective : We previously reported a r and omized , sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation ( rTMS ) in 48 participants with a medically refractory major depressive disorder . Depression improved most with right-side cranial stimulation , both rTMS and sham , and to a lesser degree with left rTMS . Because depression is often associated with cognitive impairment , in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition , which cognitive domains ( language , executive , visuospatial , verbal episodic memory , attention ) were affected , and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables , such as right versus left treatment and rTMS versus sham . Methods : We used hierarchical regression analyses to determine how variables measured at baseline or associated with treatment affected changes in neuropsychological functions . The variables were neuropsychological function in the 5 domains , severity of depression , change in depression with treatment , rTMS versus sham , laterality of stimulation , and  rTMS-laterality interaction . Results : Compared to sham , right rTMS was associated with 1.24 st and ard deviations greater gain in language function , 1.09 st and ard deviations greater gain in visuospatial function , and 2.38 st and ard deviations greater gain in verbal episodic memory than left rTMS . These improvements did not appear to be directly related to the relief from depression . Conclusions : Our results suggest that disorders of cognition and mood in depression may have different mechanisms , but right rTMS may treat both . We propose potential mechanisms underlying the right-side rTMS effect . Clinical Trial Registration : Clinical trials.gov NCT00711568 High frequency ( > 1 Hz ) repetitive transcranial magnetic stimulation ( rTMS ) applied to the left prefrontal cortex and low frequency ( ≤1 Hz ) rTMS applied to the right prefrontal cortex have shown antidepressant effects . However , the clinical significance of these effects has often been modest . It was hypothesized that a combination of these two techniques might act synergistically and result in more clinical ly relevant antidepressant effects . Sixty-two subjects with treatment-resistant major depression ( an average of 8 failed medication trials ) were r and omized to receive combination right low frequency ( 1 Hz)/left high frequency ( 10 Hz ) rTMS over the dorsolateral prefrontal cortex at 110 % of the motor threshold vs sham rTMS . Subjects were treated for 2 weeks ( 10 weekday sessions ) and received 1600 stimulations during each treatment session . Subjects receiving combination treatment were further r and omized to receive different orders of treatment : right low frequency first ( Slow Right ) vs left high frequency first ( Fast Left ) . There were no statistical differences in the active vs sham treatment arms in the primary outcome variable , the Hamilton Depression Rating Scale ( HDRS ) . However compared with subjects in the Sham and Slow Right arms , there was a trend for subjects in the Fast Left arm to show improvement in the HDRS , the Beck Depression Inventory , and the Brief Psychotic Rating Scale with increased number of treatments . The Fast Left arm also showed significant improvement in both blinded clinician and self-ratings of global improvement . These differences were hypothesized to be due to the decreased number of failed medication trials for subjects in Fast Left arm . Neuropsychological performance was not significantly different between the sham and active rTMS arms . Future studies should increase the number of treatment sessions and focus on subjects with moderate treatment resistance Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Based on several open-label and case studies , repetitive transcranial magnetic stimulation ( rTMS ) seems to have an antidepressive effect on patients with Parkinson 's disease ( PD ) . However , this hypothesis requires further confirmation . We conducted a r and omized , double-blind placebo-controlled study to evaluate the effect of rTMS over the left dorsolateral prefrontal cortex ( DLPFC ) on depression and various motor and nonmotor features of PD . Twenty-two PD patients with mild or moderate depressive episodes were assigned into two groups , one receiving real-rTMS ( 90 % of resting motor threshold , 5 Hz , 600 pulses-a-day for 10 days ) over the left DLPFC , and another group receiving sham-rTMS . An investigator blinded to the treatment performed three video-taped examinations on each patient : before stimulation ( baseline ) , 1 day ( short term ) , and 30 days after treatment session ended ( long-term effect ) . Mini-Mental State Examination , Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Hoehn-Yahr , Epworth Sleepiness , Visual Analog and Montgomery-Asberg Depression Rating Scales ( MADRS ) , Beck Depression Inventory ( BDI ) , and Trail making and Stroop tests were applied . In the actively treated group , not only depression rating scales showed significant improvement 30 days after treatment ended ( BDI by 44.4 % and MADRS by 26.1 % ) , but also the accuracy of Stroop test ( by 16 % ) . We could also demonstrate an insignificant improvement in UPDRS-III by 7.5 points ( 31.9 % , P = 0.06 ) . In the sham-treated group none of the examined tests and scales improved significantly after sham stimulation . Our study demonstrated the beneficial effect of the left DLPFC rTMS on depression in PD lasting at least 30 days after treatment . However , this result should be confirmed in patients with severe depression by further clinical trials BACKGROUND Few studies have investigated the efficacy of repetitive transcranial magnetic stimulation ( rTMS ) treatment for negative symptoms of schizophrenia , reporting inconsistent results . We aim ed to investigate whether 10 Hz stimulation of the bilateral dorsolateral prefrontal cortex during 3 weeks enhances treatment effects . METHOD A multicenter double-blind r and omized controlled trial was performed in 32 patients with schizophrenia or schizo-affective disorder , and moderate to severe negative symptoms [ Positive and Negative Syndrome Scale ( PANSS ) negative subscale ⩾15 ] . Patients were r and omized to a 3-week course of active or sham rTMS . Primary outcome was severity of negative symptoms as measured with the Scale for the Assessment of Negative Symptoms ( SANS ) and the PANSS negative symptom score . Secondary outcome measures included cognition , insight , quality of life and mood . Subjects were followed up at 4 weeks and at 3 months . For analysis of the data a mixed-effects linear model was used . RESULTS A significant improvement of the SANS in the active group compared with sham up to 3 months follow-up ( p = 0.03 ) was found . The PANSS negative symptom scores did not show a significant change ( p = 0.19 ) . Of the cognitive tests , only one showed a significant improvement  after rTMS as compared with sham . Finally , a significant change of insight was found with better scores in the treatment group . CONCLUSIONS Bilateral 10 Hz prefrontal rTMS  reduced negative symptoms , as measured with the SANS . More studies are needed to investigate optimal parameters for rTMS , the cognitive effects and the neural basis BACKGROUND Studies of repetitive transcranial magnetic stimulation ( rTMS ) in depression have mostly involved once-daily treatment , with positive but modest clinical results . This study tested the efficacy and safety of twice-daily rTMS over 2 weeks . METHOD Thirty-eight depressed subjects enrolled in a double-blind , sham-controlled trial of twice-daily rTMS ( left prefrontal cortex , 10 Hz , 110 % intensity , 1500 stimuli per session ) over 2 weeks . Mood and neuropsychological functioning were assessed weekly by blind raters , using the Montgomery-Asberg Depression Rating Scale ( MADRS ) as the primary outcome measure , plus the Hamilton Rating Scale for Depression ( HRSD ) and self-report measures . After the blind period , 22 subjects continued with once-daily rTMS to receive a total of 6 weeks of active rTMS . RESULTS Subjects were moderately treatment resistant .  Active treatment result ed in significantly greater improvement than sham over the 2-week blind period on one outcome measure only ( MADRS p<0.05 ) . Subjects showed further improvement over the 6 weeks of active rTMS .  Neuropsychological test scores did not change significantly . CONCLUSIONS rTMS given twice daily was effective and safe , with no adverse neuropsychological effects Objectives . Neurobiologically , panic disorder ( PD ) is supposed to be characterised by cerebral hypofrontality . Via functional near-infrared spectroscopy ( fNIRS ) , we investigated whether prefrontal hypoactivity during cognitive tasks in PD- patients compared to healthy controls ( HC ) could be replicated . As intermittent theta burst stimulation ( iTBS ) modulates cortical activity , we furthermore investigated its ability to normalise prefrontal activation . Methods . Forty-four PD- patients , r and omised to sham or verum group , received 15 iTBS-sessions above the left dorsolateral prefrontal cortex ( DLPFC ) in addition to psychoeducation . Before first and after last iTBS-treatment , cortical activity during a  verbal fluency task  was assessed via fNIRS and compared to the results of 23 HC . Results . At baseline , PD- patients showed hypofrontality including the DLPFC , which differed significantly from activation patterns of HC . However , verum iTBS did not augment prefrontal fNIRS activation . Solely after sham iTBS , a significant increase of measured fNIRS activation in the left inferior frontal gyrus ( IFG ) during the phonological task was found . Conclusion . Our results support findings that PD is characterised by prefrontal hypoactivation during cognitive performance . However , verum iTBS as an “ add-on ” to psychoeducation did not augment prefrontal activity . Instead we only found increased fNIRS activation in the left IFG after sham iTBS application . Possible reasons including task-related psychophysiological arousal are discussed BACKGROUND We tested whether transcranial magnetic stimulation ( TMS ) over the left dorsolateral prefrontal cortex ( DLPFC ) is effective and safe in the acute treatment of major depression . METHODS In a double-blind , multisite study , 301 medication-free patients with major depression who had not benefited from prior treatment were r and omized to active  ( n = 155 ) or  sham TMS  ( n = 146 ) conditions . Sessions were conducted five times per week with TMS at 10 pulses/sec , 120 % of motor threshold , 3000 pulses/session , for 4 - 6 weeks . Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale ( MADRS ) . Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale ( HAMD ) and response and remission rates with the MADRS and HAMD . RESULTS Active TMS was significantly superior to sham TMS on the MADRS at week 4 ( with a post hoc correction for ine quality in symptom severity between groups at baseline ) , as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6 . Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6 . Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales ( but not the HAMD17 scale ) . Active TMS was well tolerated with a low dropout rate for adverse events ( 4.5 % ) that were generally mild and limited to transient scalp discomfort or pain . CONCLUSIONS Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported . It offers clinicians a novel alternative for the treatment of this disorder Abstract Early studies of transcranial magnetic stimulation ( TMS ) have shown no adverse effects on neuropsychological function . However , further research using higher TMS intensities as well as a greater number of TMS pulses and with larger sample sizes is needed . We studied 68 patients with major depressive disorder who were r and omized to receive either 15 sessions of sham or real TMS at 110 % of the estimated prefrontal cortex threshold to the left dorsolateral prefrontal cortex . Each session consisted of 32 5-second trains of 10-Hz repetitive TMS at 110 % adjusted motor threshold . A total of 24,000 pulses were given . Neuropsychological function was assessed before and immediately after TMS treatment with a battery of 8 tests . Using a higher TMS intensity as well as a greater number of pulses and having a larger sample size compared with most previous studies , this study found no negative neuropsychological effects of TMS . Changes in neuropsychological function were unrelated to changes in depression BACKGROUND High and low frequency repetititve transcranial magnetic stimulation ( rTMS ) are both effective in treating depression but have contrary effects on motor cortical activity . This study aim ed to underst and further the mechanisms of action of high and low frequency rTMS by examining their acute effects on regional cerebral blood flow ( rCBF ) in depressed patients . METHOD Eighteen depressed subjects underwent brain single photon emission computerized tomography ( SPECT ) scanning 
    Output:
    
Active rTMS treatment was unassociated with generalised gains across the majority of domains of cognitive functioning examined .
Therapeutic rTMS when administered to the DLPFC in patients with neuropsychiatric conditions does not result in robust cognitive enhancing effects