Magnetic Stimulation Treatment Research Articles

Role of Repetitive Transcranial Magnetic Stimulation in Treatment of Fibromyalgia: A Randomized Controlled Trial.

Fibromyalgia syndrome (FMS) is a chronic disease characterized by widespread, persistent musculoskeletal pain in association with impaired health-related quality of life. Repetitive transcranial magnetic stimulation (rTMS) is an emerging tool for the management of fibromyalgia. There is no standardized protocol of rTMS for the treatment of FMS, and both low- and high-frequency stimulation of the dorsolateral prefrontal cortex (DLPFC) are described in the literature with variable efficacy. The objective of this study was to determine the effectiveness of rTMS in people with fibromyalgia and compare the response of low- and high-frequency stimulation with sham stimulation. This study was a single-blinded, randomized, placebo-controlled trial. Ninety patients with the diagnosis of FMS were randomly allocated into one of the following three groups: low-frequency (1 Hz) group, high-frequency (10 Hz) group, and sham group. Pain, depression, anxiety, and quality of life were measured using the Numerical Pain Rating Scale (NPRS), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HDRS), and Revised Fibromyalgia Impact Questionnaire (FIQR) immediately following treatment as well as at 1 and 3 months after treatment. The data was statistically analyzed using Statistical Package for the Social Sciences version 23 software. P value < 0.05 was considered statistically significant. Intergroup analysis revealed a significant improvement in NPRS, HAM-A, HDRS, and FIQR scores in both low- and high- frequency groups immediately following treatment and for 3 months after treatment. No significant difference in the efficacy of low- and high-frequency stimulation was noticed. rTMS is an effective mode of treatment in people with FMS. Both low and high frequencies of stimulation at DLPFC are equally effective in reducing pain and associated symptoms.

Effect of rTMS intervention on upper limb motor function after stroke: A study based on fNIRS.

Stroke is a disease with a high fatality rate worldwide and a major cause of long-term disability. In the rehabilitation of limb motor function after stroke, the rehabilitation of upper limb function takes a long time and the recovery progress is slow, which seriously affects the patients' self-care ability in daily life. Repeated transcranial magnetic stimulation (rTMS) has been increasingly used to improve limb dysfunction in patients with stroke. However, a standardized reference for selecting a magnetic stimulation regimen is not available. Whether to increase the inhibition of the contralateral hemispheric motor cortex remains controversial. This study has evaluated the effects of different rTMS stimulation programs on upper limb function and corresponding brain functional network characteristics of patients with stroke and sought a new objective standard based on changes in brain network parameters to guide accurate rTMS stimulation programs. Thirty-six patients with stroke were selected and divided into control group and treatment group by number table method, with 18 patients in each group, and 3 patients in the control group were turned out and lost due to changes in disease condition. The treatment group was divided into two groups. TMS1 group was given 1 Hz magnetic stimulation in the M1 region of the contralesional hemisphere +10 Hz magnetic stimulation in the M1 region of the affected hemisphere, and the TMS2 group was given 10 Hz magnetic stimulation in the M1 region of the affected hemisphere. The control group was given false stimulation. The treatment course was once a day for 5 days a week for 4 weeks. The Fugl-Meyer Assessment for upper extremity (FMA-UE) sand near-infrared brain function were collected before treatment, 2 weeks after treatment, and 4 weeks after treatment, and the brain function network was constructed. Changes in brain oxygenated hemoglobin concentration and brain network parameters were analyzed with the recovery of motor function (i.e., increased FMA score). Meanwhile, according to the average increment of brain network parameters, the rTMS stimulation group was divided into two groups with good efficacy and poor efficacy. Network parameters of the two groups before and after rTMS treatment were analyzed statistically. (1) Before treatment, there was no statistical difference in Fugl-Meyer score between the control group and the magnetic stimulation group (p = 0.178).Compared with before treatment, Fugl-Meyer scores of 2 and 4 weeks after treatment were significantly increased in both groups (p <0.001), and FMA scores of 4 weeks after treatment were significantly improved compared with 2 weeks after treatment (p < 0.001). FMA scores increased faster in the magnetic stimulation group at 2 and 4 weeks compared with the control group at the same time point (p <0.001).TMS1 and TMS2 were compared at the same time point, FMA score in TMS2 group increased more significantly after 4 weeks of treatment (p = 0.010). (2) Before treatment, HbO2 content in healthy sensory motor cortex (SMC) area of magnetic stimulation group and control group was higher than that in other region of interest (ROI) area, but there was no significant difference in ROI between the two groups. After 4 weeks of treatment, the HbO2 content in the healthy SMC area was significantly decreased (p < 0.001), while the HbO2 content in the affected SMC area was significantly increased, and the change was more significant in the magnetic stimulation group (p < 0.001). (3) In-depth study found that with the recovery of motor function (FMA upper limb score increase ≥4 points) after magnetic stimulation intervention, brain network parameters were significantly improved. The mean increment of network parameters in TMS1 group and TMS2 group was significantly different (χ 2 = 5.844, p = 0.016). TMS2 group was more advantageous than TMS1 group in improving the mean increment of brain network parameters. (1) The rTMS treatment is beneficial to the recovery of upper limb motor function in stroke patients, and can significantly improve the intensity of brain network connection and reduce the island area. The island area refers to an isolated activated brain area that cannot transmit excitation to other related brain areas. (2) When the node degree of M1_Healthy region less than 0.52, it is suggested to perform promotion therapy only in the affected hemisphere. While the node degree greater than 0.52, and much larger than that in the M1_affected region. it is suggested that both inhibition in the contralesional hemisphere and high-frequency excitatory magnetic stimulation in the affected hemisphere can be performed. (3) In different brain functional network connection states, corresponding adjustment should be made to the treatment plan of rTMS to achieve optimal therapeutic effect and precise rehabilitation treatment.

The Clinical Study on Short-Term Efficacy of Pelvic Magnetic Stimulation Combined with Pelvic Muscle Biofeedback on Female Idiopathic Overactive Bladder.

To evaluate the short-term efficacy of pelvic magnetic stimulation combined with pelvic muscle biofeedback on female Idiopathic Overactive Bladder (IOAB). 96 cases of IOAB females were randomly divided into control group (magnetic stimulation treatment n=48) and observation group (magnetic stimulation with biofeedback n=48). All the patients were dealt with the sacralneuromagnetic stimulation (once, qod), with 5 times in total. Then the patients in observation group were processed with biofeedback (10 times). Overactive Bladder Symptom Score (OABSS), Patients Perception Bladder Condition (PPBC) and Incontinence Quality of Life Scale (I-QOL) were evaluated as the indexes. The effective rate of control group and observation group respectively were 89.58% and 93.75%. There were significant differences (P=0.67). The OABSS and PPBC of two groups were decreased, I-QOL were increased after treatment (P<0.05). Difference was statistically significant in OABSS three months after treatment between the two groups (P=0.00).The recurrence rate of three months after treatment of the two groups were 18.75% and 6.38% (P=0.04). Both magnetic stimulation alone and magnetic stimulation with biofeedback were effective and safe in female patients with IOAB. Magnetic stimulation with biofeedback may reduce the recurrence rate and continue to improve the symptoms in a certain extent.

Effect of priming on adjunctive repetitive transcranial magnetic stimulation in treatment of late life depression: Protocol of a prospective randomized sham-controlled study.

AbstractObjectivePriming stimulation, which involves high-frequency repetitive transcranial magnetic stimulation (rTMS) followed by low-frequency, has been shown to enhance neural response and is one of the novel paradigms found beneficial in adult patients with depression and has not been studied in late-life depression (LLD). This study aims to compare the effect of adjunctive priming vis-a-vis no priming rTMS over right dorso-lateral prefrontal cortex (DLPFC), on treatment of LLD.MethodsThis trial is registered in Clinical Trial Registry-India (CTRI) on www.ctri.nic.in. CTRI registration number: CTRI/2020/08/027230. Forty patients of LLD who are symptomatic after an adequate antidepressant trial will be randomized into 2 groups (active priming and sham priming rTMS); each receiving 10 sessions of rTMS over 2 weeks. Patients will remain blind to treatment allocation. Assessments will be done using Hamilton rating scale for depression, Geriatric Depression Scale, Hamilton rating scale for Anxiety, Somatic Symptom Severity Scale 8, Hindi Mental Status Examination, and Clinical Global Impression scale at baseline, week 1, 2, and 4. Side effect checklist will be applied after each session in both groups and at the end of 4 weeks.ResultData will be analyzed using statistical software Statistical Package for Social Sciences. Both the groups (active and sham groups) will be compared at the four given timepoints. Also, the baseline characteristics will be compared with the 3 follow-up points for any change.ConclusionThe findings of the study will give an insight to the possible role of priming to augment the effect of low-frequency rTMS in LLD.

Sequential Prefrontal and Temporoparietal Repetitive Transcranial Magnetic Stimulation (rTMS) for Treatment of Tinnitus With and Without Comorbid Depression: A Case Series and Systematic Review.

BackgroundTinnitus distress is related to both the loudness and intrusiveness of the tinnitus percept. Treatment approaches targeting both attentional/limbic and auditory systems may better alleviate tinnitus distress than approaches targeting the auditory system alone.Materials and MethodsTen subjects with chronic tinnitus received sequential rTMS treatment involving: 1) excitatory stimulation administered to the left dorsolateral prefrontal cortex (DLPFC) or inhibitory stimulation administered to the right DLPFC, followed by 2) inhibitory stimulation administered to primary auditory cortex (Heschel's gyrus or HG). A systematic literature review was performed to evaluate the existing literature on sequential repetitive Transcranial Magnetic Stimulation (rTMS) treatment approaches for tinnitus. Results of the case series are interpreted in the context of tinnitus neurobiology and the extant literature.ResultsSubjects experienced a significant decrease (average 21.7%) in symptoms on the Tinnitus Functional Index (TFI). Those with tinnitus alone experienced a greater mean symptom reduction than those with comorbid MDD (27.7 vs. 17.0%, respectively). Adverse effects were transient and minor. Literature review confirmed that sequential approaches had some advantages compared to single site rTMS; in general, the addition of 1 Hz treatment at DLPFC was superior to single site rTMS in the short term (1–12 weeks), while the addition of 20 Hz treatment at DLPFC appeared superior in the long term (90–180 days).ConclusionsSequential rTMS approaches for the treatment of tinnitus—particularly those administering low-frequency treatment at left DLPFC—merit further investigation.

Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients.

The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

The Effectiveness of the Repetitive Transcranial Magnetic Stimulation (rTMS)with high frequency (20 Hz) on Auditory Hallucinations, Inner Speech and Working Memory in Schizophrenic Patients

Background: The purpose of the present study was to investigate the effectiveness of high frequency transcranial magnetic stimulation (rTMS) treatment (20 Hz) on auditory hallucinations, inner speech and working memory in schizophrenic patients. Materials and Methods: This study was a pretest-posttest experimental design with control group. The statistical population of this study consisted of all schizophrenic patients referring to the outpatient department of Imam Hossein hospital in 2019, 12 of whom were selected by available sampling based on inclusion and exclusion criteria then were assigned randomly into two groups of 6 each. High frequency transcranial magnetic stimulation (r TMS) treatment (20 Hz) was used for experimental group but the control group received no intervention during the study. The instruments were the positive and negative syndrome scale in schizophrenia, the inner speech questionnaire, and the Daneman and Carpenter working memory questionnaire before and after the intervention. The data were analyzed by descriptive statistics, and one-way covariance analysis (ANCOVA) and multivariate covariance analysis (MANCOVA) were used to analyze the data. Results: The results showed that there were significant differences between experimental and control group (p&lt;0.005). The rate of auditory hallucinations and inner speech significantly decreased in comparison with pretest and control group, but the rate of active memory increased. Conclusion: Repetitive transcranial magnetic stimulation (r TMS) treatment (20 Hz) significantly reduced auditory hallucinations, inner speech and improved active memory.

Repeated Transcranial Magnetic Stimulation for Improving Cognition in Alzheimer Disease: Protocol for an Interim Analysis of a Randomized Controlled Trial.

BackgroundMany clinical trials investigating treatment efficacy require an interim analysis. Recently we have been running a large, multisite, randomized, placebo-controlled, double-blind clinical trial investigating the effect of repetitive transcranial magnetic stimulation (rTMS) treatment for improving or stabilizing the cognition of patients diagnosed with Alzheimer disease.ObjectiveThe objectives of this paper are to report on recruitment, adherence, and adverse events (AEs) to date, and to describe in detail the protocol for interim analysis of the clinical trial data. The protocol will investigate whether the trial is likely to reach its objectives if continued to the planned maximum sample size.MethodsThe specific requirements of the analytic protocol are to (1) ensure the double-blind nature of the data while doing the analysis, (2) estimate the predictive probabilities of success (PPoSs), (3) estimate the numbers needed to treat, (4) re-estimate the initial required sample size. The initial estimate of sample size was 208. The interim analysis will be based on 150 patients who will be enrolled in the study and finish at least 8 weeks of the study. Our protocol for interim analysis, at the very first stage, is to determine the response rate for each participant to the treatment (either sham or active), while ensuring the double-blind nature of the data. The blinded data will be analyzed by a statistician to investigate the treatment efficacy. We will use Bayesian PPoS to predict the success rate and determine whether the study should continue.ResultsThe enrollment has been slowed significantly due to the COVID-19 pandemic and lockdown. Nevertheless, so far 133 participants have been enrolled, while 22 of these have been withdrawn or dropped out for various reasons. In general, rTMS has been found tolerable with no serious AE. Only 2 patients dropped out of the study due to their intolerability to rTMS pulses.ConclusionsOverall, the study with the same protocol is going as expected with no serious AE or any major protocol deviation.Trial RegistrationClinicalTrials.gov NCT02908815; https://clinicaltrials.gov/ct2/show/NCT02908815International Registered Report Identifier (IRRID)DERR1-10.2196/31183

A pilot study exploring the effect of repetitive transcranial magnetic stimulation (rTMS) treatment on cerebral blood flow and its relation to clinical outcomes in severe enduring anorexia nervosa

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a novel treatment option for people with severe enduring anorexia nervosa (SE-AN), but associated neurobiological changes are poorly understood. This study investigated the effect of rTMS treatment on regional cerebral blood flow (CBF) and whether any observed changes in CBF are associated with changes in clinical outcomes in people with SE-AN.MethodsAs part of a randomised sham-controlled feasibility trial of 20 sessions of high-frequency rTMS to the left dorsolateral prefrontal cortex, 26 of 34 trial participants completed arterial spin labelling (ASL) functional magnetic resonance imaging (fMRI) to quantify regional and global resting state CBF before (pre-randomisation baseline) and after real or sham treatment (1-month post-randomisation). A group of healthy females (n = 30) were recruited for baseline comparison. Clinical outcomes, including BMI, and depression and anxiety symptoms, were assessed at baseline, 1-, 4-, and 18-months post-randomisation.ResultsNo group differences in regional CBF were identified between the SE-AN and healthy comparison participants. A significant treatment-by-time interaction in a medial temporal lobe cluster with the maximal peak in the right amygdala was identified, reflecting a greater reduction in amygdala CBF following real rTMS compared to sham. Participants with the greatest rTMS-related reduction in amygdala CBF (i.e., between baseline and 1-month post-randomisation) showed the greatest sustained weight gain at 18-months post-randomisation. Higher baseline CBF in the insula predicted greater weight gain between baseline and 1-month post-randomisation and between baseline and 4-months post-randomisation.ConclusionsThis exploratory pilot study identified rTMS treatment related changes in CBF in adults with SE-AN and these were associated with changes in weight. Our preliminary findings also suggest that CBF (as measured by ASL fMRI) may be a marker of rTMS treatment response in this patient group. Future rTMS studies in AN should employ longitudinal neuroimaging to further explore the neurobiological changes related to rTMS treatment.Trial registrationISRCTN14329415, registered 23rd July 2015.

On chip detection of glial cell-derived neurotrophic factor secreted from dopaminergic cells under magnetic stimulation

Glial cell-derived neurotrophic factor (GDNF) is a small protein potently promoting the survival of dopaminergic and motor neurons. GDNF can be secreted from different types of cells including the dopaminergic neural cell line, N27. N27 cells, a rat dopaminergic neural cell line, is regarded as a suitable in vitro model for Parkinson's disease (PD) research. For PD treatment, transcranial magnetic stimulation (TMS), a noninvasive therapeutic method, showed beneficial clinical effects, but the mechanism for its benefit is not understood. Because GDNF is a potent neurotrophic factor, it is of great value to evaluate if GDNF secretion from N27 cells can be affected by magnetic stimulation (MS). However, the current methods for detecting GDNF are time-consuming and expensive. In this paper we outline the detection of GDNF secretion from N27 cells by ultrasensitive nanopore thin film sensors (nanosensor) for the first time. As low as 2 pg/mL GDNF can be readily detected by the nanosensor. Furthermore, we show that MS can promote GDNF secretion from N27 cells. Specifically, the GDNF concentration in N27 cell-conditioned media under MS treatment shows statistically significant increase up to 2-fold after 5 days in vitro in comparison with the control. This nanosensor along with the in vitro PD model N27 cells provides a low-cost, easy-to-use, sensitive approach for studying potential cell biological mechanisms of the clinical benefits of MS on PD.

Efficacy of magnetic stimulation for female stress urinary incontinence: a meta-analysis.

Aim:This meta-analysis aimed to evaluate the efficacy of magnetic stimulation (MS) in treating female stress urinary incontinence (SUI) and providing an alternative treatment for patients who are unwilling to undergo surgery.Methods:Randomized controlled trials (RCTs) that evaluated MS as a remedy for female SUI were retrieved from various electronic databases, including MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry system. Moreover, reference lists for related papers were carefully screened for relevant studies.Results:A total of six RCTs evaluating the effect of MS in treating female SUI were included in this study. Compared with the placebo group, the MS group exhibited higher quality-of-life scores [mean difference (MD) 0.59, 95% credibility interval (CI) 0.23–0.95; p = 0.001] and lower International Consultation on Incontinence Questionnaire scores (MD −3.93, 95% CI −5.85 to −2.01; p < 0.0001). Moreover, they exhibited a higher objective cure rate (odds ratio 8.49, 95% CI 3.08–23.37). In addition, MS treatment reduced the number of episodes of urinary incontinence (MD −1.42, 95% CI −2.24 to −0.59; p = 0.0007) and urine loss on pad test (MD −4.67, 95% CI −8.05 to −1.28; p = 0.007). There were no significant treatment-related adverse reactions.Conclusion:This study evaluated the efficacy and safety of MS in the treatment of female SUI. The results have important implications for patients who do not wish to undergo surgical therapy. We found that MS treatment for SUI has positive outcomes, however, future studies should aim at establishing the best protocol for optimizing the therapeutic effect.

Transcranial magnetic stimulation in treatment of motor and nonmotor symptoms of Parkinson’s disease

This review highlights topical issues of the use of transcranial magnetic stimulation as a non‑drug method for treating motor and non‑motor symptoms of Parkinson’s disease. The method of transcranial magnetic stimulation has a wide therapeutic potential since it has the ability to induce neuronal plasticity by modulating neuronal connections in the human brain, and in particular in patients with Parkinson’s disease. Several areas of application of transcranial magnetic stimulation in patients with Parkinson’s disease are currently being considered. Its effect on the severity of motor symptoms, such as tremor, rigidity, bradykinesia and gait disturbances, the manifestation of non‑motor symptoms, such as cognitive impairment and depressive disorders, is described. It is proved that patients with Parkinson’s disease have a wide range of disorders of neurophysiological parameters in the primary motor cortex, which are positively correlated with the severity of clinical symptoms of Parkinson’s disease and can be used for objectification of transcranial magnetic stimulation treatment results. According to the analysis of literature data, transcranial magnetic stimulation significantly improves the function of the upper extremities, the ability to walk and score III of UPDRS not only in the short term but also in the long term in patients with Parkinson’s disease. Today, a topical issue is the discussion of possible mechanisms of therapeutic action of transcranial magnetic stimulation on the level of cytokines associated with neuroinflammation in patients with Parkinson’s disease. The results of studies on the treatment of Parkinson’s disease by the method of transcranial magnetic stimulation are promising and encouraging, but many questions and controversies remain, which require additional study.

Exploring the experiences of stroke patients treated with transcranial magnetic stimulation for upper limb recovery: a qualitative study

BackgroundTranscranial magnetic stimulation (TMS) treatments have shown promise in improving arm recovery in stroke patients. Currently, little is known about patients’ experiences with repetitive TMS treatment, and this lack of knowledge may affect optimal implementation in clinical practice. The aim of this explorative study was to gain insight in the perceived effects and experiences of the design and delivery of a rTMS treatment for upper limb recovery from the perspectives of stroke patients.MethodsThis qualitative study was conducted as part of a randomized controlled trial (RCT) in a specialized rehabilitation center. Data were collected through face-to-face semi-structured interviews with 13 stroke patients who completed a 10-day rTMS intervention for upper limb recovery. The interviews were recorded, transcribed verbatim and analyzed using thematic analysis.ResultsThe major themes that emerged from the patients’ feedback were the following: positive experiences of the treatment (experienced physical effects, comfort, therapeutic relationship, receiving information, learning about the brain, no burden of added rTMS treatment session, no unpleasant aspects), concerns (effects of stimulation of the brain, equipment, logistics), general experience of recovery, experienced psychological effects (grateful, sense of purpose, recovery as extra motivation to exercise, disappointment and hope of group allocation), and motivation to participate (personal benefit and cognitions, altruism). Important components related to the positive experience of the design and delivery of the treatment included comfort (i.e. moment of relaxation) and the sensation of a painless treatment without side-effects. Key concerns included uncertainty and anxiety about possible negative consequences and group allocation.ConclusionsThis study demonstrates that rTMS is well accepted by stroke patients with an upper limb paresis. Besides the expectation of a therapeutic benefit, the patients reported various psychological effects. Positive experiences, such as the provision of a short moment of relaxation each day, could have practical implications for clinical stroke rehabilitation settings aimed at improving patient satisfaction. Explanation about and feedback from routine motor recovery progression monitoring at fixed times post-stroke is also valued by patients. Negative emotions may be limited or avoided by transparent and recurrent information delivery in future trials.

The role of Therapeutic Repetitive Transcranial Magnetic Stimulation in Treatment of Sleep Disorders in Parkinson’s disease Patients

Background: Parkinson’s disease (PD) is the most common movement disorder and represents the second most common degenerative disease of the central nervous system. Objective: To measure the effect of repetitive transcranial magnetic stimulation (rTMS) as therapeutic treatment on sleep disorders in patients with Parkinson’s disease (PD). Patients and methods: This double-blinded study included 20 PD patients (10 received real rTMs and 10 received sham rTMs) patients recruited from Inpatient and Outpatient Clinic of Neuropsychiatric Department of Aswan University Hospital. Our patients were divided into 2 groups (10 patients each). Results: As regards the effect of rTMs on PDSS and sleep latency, our study results found no significant change in Parkinson disease sleep scale between both groups but there was significant change in sleep latency that it decreased in the group received real rTMS in comparison with the SHAM group. In addition, there were significant changes in wake stage and rapid eye movement stage that both decreased in response to rTMS while there was no significant changes in non-rapid eye movement stage. Awakening after being asleep on both studied groups showing significant decrease in wake after sleep onset and wake after persistent sleep as both of them decrease wit rTMS. Conclusion: The main finding of this study was that 10 sessions of 20–Hz rTMS applied over both parietal area improved the subjective as well as the objective sleep quality as reflected by a decrease of frequency in arousal from sleep and in Non-REM–1 stage sleep.

The role of Therapeutic Repetitive Transcranial Magnetic Stimulation in Treatment of Sleep Disorders in Parkinson’s disease Patients

(PD) is the most common movement disorder and represents the second most common degenerative disease of the central nervous system.

Evaluating the Effect of Repetitive Transcranial Magnetic Stimulation (rTMS) and Humanistic Care Treatment on Cognitive Impairment Patients

Objective: To evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) and Humanistic care treatment on Cognitive impairment patients. Methods: We invested 60 patients to join our study who were diagnosed as cerebrovascular disease or alzheimer disease, the diseases are cognitive impairment. Their diagnose time is from January 2019 to December 2019. We randomly assign the participants to two groups, that include control group (n=30) and intervention group (n=30). In control group, participants receive conventional responsibility mode of nursing. Intervention group participants receive humanistic care model in treatment process. Result: In Unplanned extubation rate of rTMS, the control group has more case of Unplanned extubation, it also has higher Unplanned extubation rate than that of intervention group [3 (10.0%) vs 7 (23.3%)]. In incidence of agitation, it shows the cases of intervention group are less than that of control group, and it is statistical significance (8 vs 13, p=0.014). In accurate response research, the intervention group has better performance in accurate response test, its accurate response rate is 86.7% and the case of accurate response is 26, that is better than that of control group in our research result. Conclusion: The effect of repetitive transcranial magnetic stimulation (rTMS) and Humanistic care treatment is good for improve treatment outcome of cognitive impairment.

Repetitive Transcranial Magnetic Stimulation in Treatment of Binge Eating Disorder

Repetitive Transcranial Magnetic Stimulation in Treatment of Binge Eating Disorder

Repetitive Transcranial Magnetic Stimulation in Treatment of Levodopa-Induced Dyskinesia in Parkinson’s Disease

Background: Dyskinesia is one of the major complications of long-term dopaminergic treatment of Parkinson’s disease (PD), and deep brain stimulation may be the only satisfactory treatment for it. This study aims to search if there is any therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) for levodopa-induced dyskinesia (LID) in PD patients. Methods: This study was conducted in Mansoura International Specialized Hospital in 43 complicated idiopathic PD patients. The patients with LID were divided into two groups matched in age, sex, duration and stage of the disease. Dyskinesia was detected by the Unified PD Rating Scale section IV. The patients of the study group (20 patients) received active rTMS, 5 Hz was applied bilaterally over the motor hand and leg areas of the cortex, in 20 trains, and each train is formed of 100 pulses, with 20-s inter-train interval. Ten sessions were administered once per day for 10 successive days for each patient. The patients of the control group (20 patients) received sham rTMS. Results: After rTMS, there was significant improvement in LID in the study group (P < 0.001), while there was no improvement in the control one (P = 0.585). As regards to the LID clinical presentations, there was no significant difference between the two groups according to dyskinesia duration (P = 0.246), disability (P = 0.425) and early morning dystonia (P = 0.059), while there was significant improvement of painful dyskinesia in the study group (P = 0.046). Conclusions: The rTMS may have an additional therapeutic benefit for LID. Further studies may put the best rTMS parameters to establish more prominent and longer-lasting clinical effects. J Neurol Res. 2019;9(3):28-34 doi: https://doi.org/10.14740/jnr512

An Effective Meta-analysis of Magnetic Stimulation Therapy for Urinary Incontinence

Magnetic stimulation (MS) is a novel approach for treating urinary incontinence (UI), but its applicability remains unclear. This systematic review and meta-analysis were conducted to evaluate the effects of MS treatment on UI. A literature search was performed in EMBASE, PubMed and Cochrane Library (from May 2018 to August 2018), and all randomized control trials (RCTs) published in English were screened to determine whether they met the inclusion criteria. A manual search of the reference lists of the retrieved studies was also performed. Eleven studies involving 612 patients were included in this review. According to the results of the meta-analysis, MS therapy relieved UI symptoms evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score (mean difference [MD] −3.03, 95% CI −3.27 to −2.79). In addition, the frequency of UI in the MS treatment group was also alleviated compared with sham group (MD −1.42, 95% CI −2.15 to −0.69). Finally, MS treatment improved the quality of life of patients with UI (standardized mean difference [SMD] −1.00, 95% CI −1.24 to −0.76). Our meta-analysis preliminarily indicates that MS treatment is an effective therapeutic modality for patients with UI. Nevertheless, additional large, high quality RCTs with a longer follow-up period that use consistent stimulation methods and analyse comparable outcomes are required to validate the efficacy.

Effect of Sequential Bilateral (Theta Burst + 1 Hz) Transcranial Magnetic Stimulation (TMS) Treatment in Patients with Unipolar Major Refractory Depression and Comorbid Anxiety

Effect of Sequential Bilateral (Theta Burst + 1 Hz) Transcranial Magnetic Stimulation (TMS) Treatment in Patients with Unipolar Major Refractory Depression and Comorbid Anxiety