Transcranial Magnetic

Stimulation
By Karthick Raj.V BPT 2nd YEAR
What is TMS?

 Non-invasive method of
neurostimulation/neuromodulation
 Causes:
 Depolarization – makes a cell’s membrane potential
more positive
 Hyperpolarization – makes a cell’s membrane
potential more negative
 Induces controlled and controllable manipulations in
behavior
How it works:
 Uses a rapidly changing
magnetic field to induce weak
electric currents, through
pulses.
 Induced by
electromagnetic induction
 Generally reach no more
than 5cm into the brain

*Coil is held above the head;
pulses penetrate skin and
skull.
Plastic-enclosed wire coils deliver pulses

A. Figure-8 coil
B. Double-cone coil
C. Round coil

* Four-leaf coils are also used (not pictured)

B.
C.

A.
Kinds of TMS
 Single-Pulse TMS – Delivers one stimulus at a
time

 Paired-Pulse TMS – Pairs of stimuli separated by a
variable interval

 Repetitive TMS (rTMS) – Delivered in trains (can
be of low or high frequency)
Two Main Categories:

Diagnostic cases

Therapeutic cases
Diagnostic

 Used clinically to:
 Measure activity of certain brain circuits
 Survey the damage done to particular muscles following
stroke, multiple sclerosis, motor neuron disease, and other
injuries or disorders
 Locate tumors and other lesions to generate preoperative
motor maps
Therapeutic

 rTMS
 Used for both rehabilitation and symptom alleviating
purposes
 Possible therapy for tic disorders, autism, migraines, tinnitus,
and in the treatment of certain psychiatric disorders including
PTSD, schizophrenia, and, popularly, Major Depressive
Disorder
Risks/side effects

 Common side effects: local pain, headache, and mild
discomfort
 Could potentially displace ferromagnetic objects (e.g titanium
skull plates)
 Can induce voltages in nearby electronic devices/wires
 Temporary increases in auditory thresholds
 Induction of seizures
 Syncope
Discussion
Diagnostic:

 Diagnostically, the only FDA approval is the Navigated Brain
Stimulation System for pre-surgical planning in patients
undergoing brain surgery.

 Proven equally successful as traditional imaging methods in
producing preoperative motor maps.
 When compared to direct cortical stimulation (DCS), it was
found that TMS was able to recognize every motor site
mapped by DCS
Therapeutic:

FDA has currently only approved rTMS as a treatment for
Major Depressive Disorder (MDD) (under Class II restrictions –
special controls).

Generally inconsistent results:
 Ebmeier and colleagues - conducted a 5-day study with 15
patients that called for them to be treated twice per day. At the
end of the study, the participants saw a reduction of 44% on
Hamilton depression scales.
 Another trial testing 100 patients, however, saw most to be
treatment-resistant.
 Current trials include using TMS with: autism, MDD, improving
speech aphasia
References
 Hallet, Mark; Pascual-Leone, Alvaro ; Rossi, Simone; Rossini,
Paolo M. "Safety, ethical considerations, and application guidelines
for the use of transcranial magnetic stimulation in clinical practice
and research" Clinical Neurophysiology 120. 12 (2009): 2008-
2039. Web. US National Library of Medicine National Institutes of
Health. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260536/>
 <http://www.medscape.org/viewarticle/420840>
 < http://www.ncbi.nlm.nih.gov/pubmed/22579164>
 <http://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation#Dia
gnostic_use>
 <https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UH
C/en-
US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and
%20Resources/Policies%20and%20Protocols/Medical%20Policies/
Medical%20Policies/Transcranial_Magnetic_Stimulation.pdf>
 <http://www.sciencedaily.com/releases/2012/07/120726180305.htm
>