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Repetitive Transcranial Magnetic Stimulation (rTMS)

What is rTMS?

Repetitive Transcranial magnetic stimulation or rTMS is a noninvasive procedure for magnetic stimulation of various area of brain and other neural tissue, such as motor cortex, cortico-spinal tract or frontal cortex. rTMS uses alternating magnetic wave to induce generating of electric currents in targeted nerve tissues. This electrical pulse then pass through the functional brain and spinal nerve tract through nerve root, peripheral nerves and eventually reach the target at motor end plates. Since the generated magnetic wave can be aimed more than two inches deeper from the outer bony skull, clinicians can target deeper to the specific area in the brain that need to be treated. The generated magnetic pulses are of the same type and strength as those used in magnetic resonance imaging (MRI) machines, so it is quite safe.

How rTMS is administered?

An insulated large electromagnetic coil is placed over the patient’s scalp directing to a focused area of the brain according to the treatment plan. A pre -selected mode of stimulation and treatment plan are decided based on condition, MRI or CT images and other medical information of the patients. Once the patient’s setup is completed, the technician will turn on the machine and the surface electromyography on specific area of body, arm or leg will be monitored to ensure the proper signal transfer to designated area according to plan. During the session the electromagnetic coil may be moved to more than one area to treat different parts of stimulation, depending on the physician’s order. rTMS treatments are non-invasive by nature. Patients are comfortably seated in a treatment chair during the whole treatments and remain awake throughout the procedure. A typical session usually last between fifteen to thirty minutes unless otherwise specified by the ordering physician.

What is the benefit of rTMS and how does it work?

rTMS has been proving clinically to be effective in treating many neurological conditions as well as mood and mental disorders. Although the mechanism of action is not yet clearly understood, there are enough supportive evidences for the U.S. FDA and the U.K. NHS to approve the device for clinical use. According to Dr. Rogers, a neuroscientist from Northwestern University, rTMS may work by activating neuronal cells at the molecular level and lowering the threshold that some neurons require to produce certain types of signals. This lowered inhibition could be spread through neural connections. "If you think of your brain like a really bad driver, which is constantly using the gas and brake at the same time, the rTMS procedure may be helping by taking off some of that pressure on the brake pedal." By stimulating nerves cell and conditioning its excitability, rTMS is able to help with the following conditions, such as chronic neuronal pain, movement disorders, Parkinson’s disease, depression, stroke, multiple sclerosis, epilepsy, Alzheimer’s disease, autism spectrum disorder, tinnitus, anxiety disorder, neuromuscular degenerative diseases, and schizophrenia. Although the results may vary between individuals the new emerging data showed that most qualified patients will likely benefit certain degree of improvement from the procedure.

What are some of the TMS side effects?

Although TMS is regarded as safe there are still small amount of patients who may respond negatively to the treatment. Some of adverse side effects of TMS include scalp discomfort, headache, dizziness, transient cognitive changes, transient hearing loss, transient impairment of working memory, seizure, and syncope. A recent large-scale study on the safety of TMS found that when used appropriately most side effects, such as headaches or scalp discomfort, were mild to moderate, and no seizures were reported.

Why choose BBH Hospital?

At BBH Hospital we have been using and integrating rTMS into our treatment and rehabilitation plan for the past couple years. BBH is one of the very few hospitals in the world to use rTMS in treating wide range of neurodegenerative disease, cerebrospinal rehabilitation, and motor neuron disease as new supportive studies begin to emerge. We are one of the leaders in the cutting edge technology in the field of chronic disease. Our principles are always scientifically sound with best practice approach. All of our physicians are registered, board certified, internationally trained, and very experienced in their specialty area. Our team at BBH Hospital will make sure that you will have a good experience and great result.




References:

Kobayashi, M. & Pascual-Leone, A. (2003). Transcranial magnetic stimulation in neurology. The Lancet Neurology, Volume 2, Issue 3, March 2003, Pages 145-156

University of Michigan Health System. (2015). Repetitive transcranial magnetic stimulation. Electronically retrieved from: http://www.psych.med.umich.edu/tms/treatment.asp

Burt, T., Linsby, S. & Sackeim, H. (2002). Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. International journal of neuropsychopharmacology, 73-103 First published online: 1 March 2002.
Floyd, A., Yu, Q., Piboolnurak, P.,  et al. (2009). Transcranial magnetic stimulation in ALS: Utility of central motor conduction tests. Neurology. 2009 Feb 10; 72(6): 498–504.
Award, B., Carmody, M., Zhang, W. et al. (2015). Transcranial magnetic stimulation after spinal cord injury. World Neurosurg. 2015 Feb;83(2):232-5.

Loannidas, A., Liu, L., Khurshudyan, A., et al. (2002). Brain activation sequences following electrical limb stimulation of normal and paraplegic subjects. Neuroimage. 2002 May;16(1):115-29
Herkewitz, W. (2014). Scientists Are Zapping the Brain to Enhance Memory:
New research shows transcranial magnetic stimulation on the surface of the brain can affect regions deep within. Electronically retrieved from: http://www.popularmechanics.com/science/health/a11160/zapping-the-brain-to-enhance-memory-17145124/

Nardone, R., Holler, Y., Brigo, F., et al. (2014). Descending motor pathways and cortical physiology after spinal cord injury assessed by transcranial magnetic stimulation: a systematic review. Brain Research 2014. http://dx.doi.org/10.1016/j.brainres.2014.09.036


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