Role Of Transcranial Magnetic Stimulation Research Articles

Role of Transcranial Magnetic Stimulation in Cognitive Disorders and Late Life Depression

Depression and cognitive impairment in late life are significant public health problems. Treatment of depression in late life can be challenging due to potential adverse effects related to pharmacotherapy. Depression in late life is one of the most important risk factors for the development of cognitive impairment and subsequent dementia. There have been some recent developments in treatment of cognitive impairment due to Alzheimer's disease, however these treatments have several potential adverse effects and are not easily accessible. Thus, there is a need to develop novel treatments for both late life depression and cognitive disorders in late life. Brain Stimulation interventions such as Transcranial Magnetic Stimulation (TMS) have shown promise in treating late life depression. TMS has also shown efficacy in enhancing cognition, however the results have not been uniformly replicated. TMS in combination with electroencephalography can also help improve understanding of neurophysiological mechanisms underlying cognitive impairment. Thus, while TMS is approved for treatment of depression, its role in treatment of cognitive impairment, and impact of TMS on neurophysiological parameters is less clear. Further, effects of treating cognition using TMS on caregivers of those with cognitive disorders are even less well understood. In this session, we will review use of TMS for treatment of late life depression, and cognitive disorders. Original data will be presented on a novel TMS paradigm using deep transcranial magnetic stimulation (dTMS) for treatment of late life depression. Further, we will present data on use of TMS for understanding mechanisms underlying cognitive impairment, its role in improving cognition, and its impact on caregiver burden.

Transcranial Magnetic Stimulation to Treat Neuropathic Pain: A Bibliometric Analysis.

Neuropathic pain is caused by a lesion or disease of the somatosensory system and is one of the most incapacitating pain types, representing a significant non-met medical need. Due to the increase in research in the field and since innovative therapeutic strategies are required, namely in intractable neuropathic pain, neurostimulation has been used. Within this approach, transcranial magnetic stimulation (TMS) that uses a transient magnetic field to produce electrical currents over the cortex emerges as a popular method in the literature. Since this is an area in expansion and due to the putative role of TMS, we performed a bibliometric analysis in Scopus with the primary objective of identifying the scientific production related to the use of TMS to manage neuropathic pain. The research had no restrictions, and the analysis focused on the characteristics of the literature retrieved, scientific collaboration and main research topics from inception to 6 July 2023. A total of 474 articles were collected. A biggest co-occurrence between the terms "neuropathic pain" and "transcranial magnetic stimulation" was obtained. The journal "Clinical Neurophysiology" leads the Top 5 most productive sources. The United States is the most productive country, with 50% of US documents being "review articles", followed by France, with 56% of French documents being "original articles". Lefaucheur, JP and Saitoh, Y are the two most influential authors. The most frequent type of document was "original article". Most of the studies (34%) that identified the neuropathic pain type focused on traumatic neuropathic pain, although a large proportion (38%) did not report the neuropathic pain type. This study allows us to provide a general overview of the field of TMS application for neuropathic pain and is useful for establishing future directions of research in this field.

Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (TDCS) in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disease characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, as well as difficulties in emotional regulation. To date, pharmacological approaches are essentially limited to some drugs, such as aripiprazole and risperidone. Drug responses are often partial. Neuromodulation therapies, including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (TDCS) are sometimes used for cognitive, social, behavioral and affective symptoms of ASD. In fact, by targeting specific brain regions, such as the dorsolateral prefrontal cortex (DLPFC), temporoparietal junction (TPJ) and the motor cortex, these therapies can improve the main symptoms of the disease. This work examines the role of TMS and TDCS in ASD. Even though new studies need to be implemented, they have proven to be promising and precise therapeutic strategies for ASD.

Driving innovation in addiction treatment: role of transcranial magnetic stimulation.

Addictions comprises heterogenous psychiatric conditions caused by the complex interaction of genetic, neurobiological, psychological, and environmental factors with a chronic relapsing-remitting pattern. Despite the long-standing efforts of preclinical and clinical research studies, addiction field has seen relatively slow progress when it comes to the development of new therapeutic interventions, most of which failed to demonstrate a significant efficacy. This is likely due to the very complex interplay of many factors that contribute to both the development and expression of addictions. The imbalance between the salience and the reward brain network circuitry has been proposed as the neurobiological mechanisms explaining the pathognomonic symptoms of addictions.Non-invasive neuromodulation techniques have been proposed as a promising therapeutic intervention to restore these brain circuits dysfunctions. Here, we propose a multi-level strategy to innovate the diagnosis and the treatment of addictive disorders.

Opening new therapeutic horizons: the revolutionary role of transcranial magnetic stimulation in modern medicine

Opening new therapeutic horizons: the revolutionary role of transcranial magnetic stimulation in modern medicine

Motor Cortex Inhibition and Facilitation Correlates with Fibromyalgia Compensatory Mechanisms and Pain: A Cross-Sectional Study.

The role of transcranial magnetic stimulation (TMS) measures as biomarkers of fibromyalgia syndrome (FMS) phenotypes is still unclear. We aimed to determine the clinical correlates of TMS measures in FMS patients. We conducted a cross-sectional analysis that included 58 patients. We performed standardized TMS assessments, including resting motor threshold (MT), motor-evoked potential (MEP), short intracortical inhibition (SICI), and intracortical facilitation (ICF). Sociodemographic, clinical questionnaires, and quantitative sensory testing were collected from all of the patients. Univariate and multivariate linear regression models were built to explore TMS-associated factors. We found that SICI did not significantly correlate with pain levels but was associated with sleepiness, comorbidities, disease duration, and anxiety. On the other hand, ICF showed a positive correlation with pain levels and a negative correlation with body mass index (BMI). BMI was a negative effect modifier of the ICF and pain association. The clinical correlates of MT and MEP were scarce. Our results suggest that SICI and ICF metrics are potential phenotyping biomarkers in FMS related to disease compensation and levels of pain perception, respectively. The clinical translation of TMS paired-pulse protocols represents an opportunity for a mechanistic understanding of FMS and the future development of precision treatments.

Cortico-bulbar excitability in abductor laryngeal dystonia disease: the diagnostic role of transcranial magnetic stimulation.

Cortico-bulbar excitability in abductor laryngeal dystonia disease: the diagnostic role of transcranial magnetic stimulation.

The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Efforts to find therapeutic methods that support spinal cord functional regeneration continue to be desirable. Natural recovery is limited, so high hopes are being placed on neuromodulation methods which promote neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation used as treatment options for managing incomplete spinal cord injury (iSCI) apart from kinesiotherapy. However, there is still no agreement on the methodology and algorithms for treatment with these methods. The search for effective therapy is also hampered by the use of different, often subjective in nature, evaluation methods and difficulties in assessing the actual results of the therapy versus the phenomenon of spontaneous spinal cord regeneration. In this study, an analysis was performed on the database of five trials, and the cumulative data are presented. Participants (iSCI patients) were divided into five groups on the basis of the treatment they had received: rTMS and kinesiotherapy (N = 36), peripheral electrotherapy and kinesiotherapy (N = 65), kinesiotherapy alone (N = 55), rTMS only (N = 34), and peripheral electrotherapy mainly (N = 53). We present changes in amplitudes and frequencies of the motor units' action potentials recorded by surface electromyography (sEMG) from the tibialis anterior-the index muscle for the lower extremity and the percentage of improvement in sEMG results before and after the applied therapies. The increase in values in sEMG parameters represents the better ability of motor units to recruit and, thus, improvement of neural efferent transmission. Our results indicate that peripheral electrotherapy provides a higher percentage of neurophysiological improvement than rTMS; however, the use of any of these additional stimulation methods (rTMS or peripheral electrotherapy) provided better results than the use of kinesiotherapy alone. The best improvement of tibialis anterior motor units' activity in iSCI patients provided the application of electrotherapy conjoined with kinesiotherapy and rTMS conjoined with kinesiotherapy. We also undertook a review of the current literature to identify and summarise available works which address the use of rTMS or peripheral electrotherapy as neuromodulation treatment options in patients after iSCI. Our goal is to encourage other clinicians to implement both types of stimulation into the neurorehabilitation program for subjects after iSCI and evaluate their effectiveness with neurophysiological tests such as sEMG so further results and algorithms can be compared across studies. Facilitating the motor rehabilitation process by combining two rehabilitation procedures together was confirmed.

The role of transcranial magnetic stimulation in the therapy of patients with multiple sclerosis Clinical and neurophysiological features of multiple sclerosis

The role of transcranial magnetic stimulation in the therapy of patients with multiple sclerosis Clinical and neurophysiological features of multiple sclerosis

Role of TMS in Improving the Nerve Functions in Radial, Median, and Ulnar Neuritis Among Patients with Leprosy: Study Protocol for a Randomized Controlled Trial

Objectives: The overall aim of this RCT is to evaluate the role of Trans-cranial Magnetic Stimulation (TMS) as a new treatment approach in physiotherapy-based rehabilitation in leprosy patients. More specifically, the primary objective of this study is to study the effect of TMS in leprosy patients with median, radial, and/or ulnar neuritis from <6 months. The secondary objective is to establish TMS as a therapeutic tool to treat leprosy patients effectively. Methods: Study Population - 98 diagnosed leprosy patients with ulnar, median, and or radial nerve function impartment for <6 months duration attending the out-patient department in CSSH Subharti Hospital, Meerut. We will include clinically diagnosed leprosy patients with median, radial, and/or ulnar neuritis from <6 months. Intervention - For Group A, TMS mapping of four hand target muscles will be performed In this group, each participant will receive ten treatment sessions of 30 min with high frequency 5-Hz TMS for 2 weeks. Along with TMS, home exercise program including standard exercises will be given. For group B, only home exercise program including standard will be given. Outcome Measures - To measure the outcomes of the study, the tools used will be electromyography, nerve conduction velocity, brain derived neurotrophic factor, manual muscle testing, monofilament sensory testing, and hand dynamometry. Statistical Analysis - F test and repeated-measures ANOVA between the factors will be used for the testing of this randomized control trial study. Discussion: It was believed that the leprosy only affects the peripheral nerves without affecting the brain but recent studies showed that brain plasticity can also occur following amputation, nerve damage, or injury. It is proved in various studies stated that the damage caused by leprosy is not limited to peripheral nerve only and is the evidence for brain plasticity. It is stated in many studies that, TMS can also be used as a neuro-modulatory tool and the application of TMS leads to improved motor performance and it also induces evident changes in connectivity in the interconnected regions of the brain but no literature evidence is available on the role of TMS in leprosy. Conclusion: In our study, we will try to fill this knowledge gap on the role of TMS as a therapeutic tool in patients with leprosy.

Role of transcranial magnetic stimulation (TMS) combined with electroencephalography (EEG) in disorders of consciousness (DOC)

The gold standard for the differential diagnosis between unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is the coma recovery scale-revised (CRS-R). However, severely brain-injured patients can be unresponsive but still retain consciousness. To deal with this issue, we applied TMS-EEG as an objective brain-based tool to assess consciousness in DOC patients.

Transcranial Magnetic Stimulation in Tremor Syndromes: Pathophysiologic Insights and Therapeutic Role

Transcranial magnetic stimulation (TMS) is a painless, non-invasive, and established brain stimulation technique to investigate human brain function. Over the last three decades, TMS has shed insight into the pathophysiology of many neurological disorders. Tremor is an involuntary, rhythmic oscillatory movement disorder commonly related to pathological oscillations propagated via the cerebello-thalamo-cortical pathway. Although tremor is the most common movement disorder and recent imaging studies have enhanced our understanding of the critical pathogenic networks, the underlying pathophysiology of different tremor syndromes is complex and still not fully understood. TMS has been used as a tool to further our understanding of tremor pathophysiology. In addition, repetitive TMS (rTMS) that can modulate brain functions through plasticity effects has been targeted to the tremor network to gain potential therapeutic benefits. However, evidence is available for only a few studies that included small patient samples with limited clinical follow-up. This review aims to discuss the role of TMS in advancing the pathophysiological understanding as well as emerging applications of rTMS for treating individual tremor syndromes. The review will focus on essential tremor, Parkinson's disease tremor, dystonic tremor syndrome, orthostatic tremor, and functional tremor.

Transcranial magnetic stimulation in animal models of neurodegeneration.

Brain stimulation techniques offer powerful means of modulating the physiology of specific neural structures. In recent years, non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, have emerged as therapeutic tools for neurology and neuroscience. However, the possible repercussions of these techniques remain unclear, and there are few reports on the incisive recovery mechanisms through brain stimulation. Although several studies have recommended the use of non-invasive brain stimulation in clinical neuroscience, with a special emphasis on TMS, the suggested mechanisms of action have not been confirmed directly at the neural level. Insights into the neural mechanisms of non-invasive brain stimulation would unveil the strategies necessary to enhance the safety and efficacy of this progressive approach. Therefore, animal studies investigating the mechanisms of TMS-induced recovery at the neural level are crucial for the elaboration of non-invasive brain stimulation. Translational research done using animal models has several advantages and is able to investigate knowledge gaps by directly targeting neuronal levels. In this review, we have discussed the role of TMS in different animal models, the impact of animal studies on various disease states, and the findings regarding brain function of animal models after TMS in pharmacology research.

Study of the role of the transcranial magnetic stimulation on language progress in autism spectrum disorder

BackgroundChildren with autism spectrum disorder (ASD) are almost universally delayed in the acquisition of spoken language as primary means of communication so they tend to have restricted outcomes in terms of independence and integration. Transcranial magnetic stimulation (TMS) is a promising, emerging tool for the study (study and modulate excitability and plasticity, applied in single pulses to investigate corticospinal excitability, pairs of pulses to study intracortical inhibition and facilitation) and potential treatment of ASD. The purpose of this study is to evaluate the role of repetitive TMS in language progress in children with ASD.ResultsThere was a statistically significant clinical improvement in patients receiving active TMS (group I) comparing baseline Childhood Autism Rating Scale (CARS) assessment and after treatment (P ≤ 0.05). There was mild improvement with no significant difference between the patients receiving active TMS (group I) and those of sham TMS (group II), and both groups received language therapy as regard post-treatment CARS. There was significant difference in improvement between the two groups according to eye contact (P ≤ 0.05). There was significant improvement in response to examiner (P ≤ 0.05). There was mild improvement with no statistically significant difference in attention between the two groups. There was significant difference in improvement between the two groups according to active expressive language. There was no statistically significant difference in passive vocabulary between the two groups.ConclusionRepetitive transcranial magnetic stimulation (rTMS) over left inferior frontal gyrus may be a safe and effective way of improving language of ASD. The joint application of rTMS and standard language therapy may lead to more rapid improvement in the language progress of children with ASD.

Contribution of TMS and TMS-EEG to the Understanding of Mechanisms Underlying Physiological Brain Aging.

In the human brain, aging is characterized by progressive neuronal loss, leading to disruption of synapses and to a degree of failure in neurotransmission. However, there is increasing evidence to support the notion that the aged brain has a remarkable ability to reorganize itself, with the aim of preserving its physiological activity. It is important to develop objective markers able to characterize the biological processes underlying brain aging in the intact human, and to distinguish them from brain degeneration associated with many neurological diseases. Transcranial magnetic stimulation (TMS), coupled with electromyography or electroencephalography (EEG), is particularly suited to this aim, due to the functional nature of the information provided, and thanks to the ease with which it can be integrated with behavioral manipulation. In this review, we aimed to provide up to date information about the role of TMS and TMS-EEG in the investigation of brain aging. In particular, we focused on data about cortical excitability, connectivity and plasticity, obtained by using readouts such as motor evoked potentials and transcranial evoked potentials. Overall, findings in the literature support an important potential contribution of TMS to the understanding of the mechanisms underlying normal brain aging. Further studies are needed to expand the current body of information and to assess the applicability of TMS findings in the clinical setting.

Probing the Brain-Body Connection Using Transcranial Magnetic Stimulation (TMS): Validating a Promising Tool to Provide Biomarkers of Neuroplasticity and Central Nervous System Function.

Transcranial magnetic stimulation (TMS) is a non-invasive method used to investigate neurophysiological integrity of the human neuromotor system. We describe in detail, the methodology of a single pulse TMS protocol that was performed in a large cohort of people (n = 110) with multiple sclerosis (MS). The aim was to establish and validate a core-set of TMS variables that predicted typical MS clinical outcomes: walking speed, hand dexterity, fatigue, and cognitive processing speed. We provide a brief and simple methodological pipeline to examine excitatory and inhibitory corticospinal mechanisms in MS that map to clinical status. Delayed and longer ipsilateral silent period (a measure of transcallosal inhibition; the influence of one brain hemisphere’s activity over the other), longer cortical silent period (suggestive of greater corticospinal inhibition via GABA) and higher resting motor threshold (lower corticospinal excitability) most strongly related to clinical outcomes, especially when measured in the hemisphere corresponding to the weaker hand. Greater interhemispheric asymmetry (imbalance between hemispheres) correlated with poorer performance in the greatest number of clinical outcomes. We also show, not surprisingly, that TMS variables related more strongly to motor outcomes than non-motor outcomes. As it was validated in a large sample of patients with varying severities of central nervous system dysfunction, the protocol described herein can be used by investigators and clinicians alike to investigate the role of TMS as a biomarker in MS and other central nervous system disorders.

Examining and Modulating Neural Circuits in Psychiatric Disorders With Transcranial Magnetic Stimulation and Electroencephalography: Present Practices and Future Developments.

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique uniquely equipped to both examine and modulate neural systems and related cognitive and behavioral functions in humans. As an examination tool, TMS can be used in combination with EEG (TMS-EEG) to elucidate directly, objectively, and noninvasively the intrinsic properties of a specific cortical region, including excitation, inhibition, reactivity, and oscillatory activity, irrespective of the individual's conscious effort. Additionally, when applied in repetitive patterns, TMS has been shown to modulate brain networks in healthy individuals, as well as ameliorate symptoms in individuals with psychiatric disorders. The key role of TMS in assessing and modulating neural dysfunctions and associated clinical and cognitive deficits in psychiatric populations is therefore becoming increasingly evident. In this article, the authors review TMS-EEG studies in schizophrenia and mood disorders, as most TMS-EEG studies to date have focused on individuals with these disorders. The authors present the evidence on the efficacy of repetitive TMS (rTMS) and theta burst stimulation (TBS), when targeting specific cortical areas, in modulating neural circuits and ameliorating symptoms and abnormal behaviors in individuals with psychiatric disorders, especially when informed by resting-state and task-related neuroimaging measures. Examples of how the combination of TMS-EEG assessments and rTMS and TBS paradigms can be utilized to both characterize and modulate neural circuit alterations in individuals with psychiatric disorders are also provided. This approach, along with the evaluation of the behavioral effects of TMS-related neuromodulation, has the potential to lead to the development of more effective and personalized interventions for individuals with psychiatric disorders.

The role of transcranial magnetic stimulation in understanding attention-related networks in single subjects.

Attention is a cognitive mechanism that has been studied through several methodological viewpoints, including animal models, MRI in stroke patients, and fMRI in healthy subjects. Activation-based fMRI research has also pointed to specific networks that activate during attention tasks. Most recently, network neuroscience has been used to study the functional connectivity of large-scale networks for attention to reveal how strongly correlated networks are to each other when engaged in specific behaviors. While neuroimaging has revealed important information about the neural correlates of attention, it is crucial to better understand how these processes are organized and executed in the brain in single subjects to guide theories and treatments for attention. Noninvasive brain stimulation is an effective tool to causally manipulate neural activity to detect the causal roles of circuits in behavior. We describe how combining transcranial magnetic stimulation (TMS) with modern precision network analysis in single-subject neuroimaging could test the roles of regions, circuits, and networks in regulating attention as a pathway to improve treatment effect magnitudes and specificity.

Study the therapeutic role of transcranial magnetic stimulation in a sample of Egyptian patients with resistant obsessive-compulsive disorder

Background: Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects approximately 2-3% of the world population. The first-line treatments are selective serotonin reuptake inhibitors and cognitive behavioral therapy. Despite that, approximately 40- 60% of patients remain treatment refractive. Aim of work: Evaluating the efficacy of different frequencies of repetitive transcranial magnetic stimulation (rTMS) applied over the right dorsolateral prefrontal cortex (DLPFC) as an adjunctive treatment for resistant OCD. Patient and Methods: Thirty patients with treatment resistant OCD were randomly assigned to 2 weeks either active LF (1 Hz, n=10), HF (10 Hz, n=10) with parameters (25-minute trains, 1,500 pulses/day at 100% of the resting motor threshold RMT, 5 sessions/week) or sham (n=10) (same HF parameters with coil tilting). OCD, anxiety and depressive symptoms were assessed using: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAM-A), Beck Depression Inventory (BDI) and Clinical Global Impression-Severity scale (CGI-S) before and immediately after sessions and 3 months later. Results: A repeated-measures analysis of variance (ANOVA) revealed a non-significant reduction in Y-BOCS scores in the active groups compared with the sham group after 2 weeks and 3 months later. Similarly, there was non-significant effect of time and time×group interaction on scores of (HAM-A) (CGI-S). While there was a significant effect of time and time×group interaction on scores of (BDI) after 2 weeks with active stimulation especially LF-rTMS not after 3 months. There were no reports of serious adverse effects following the active or sham rTMS treatments. Conclusion: Neither LF nor HF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD and anxiety symptoms in patients with treatment-resistant OCD. However, rTMS has a role in improving depressive symptoms, especially with LF-rTMS. Further trials with larger sample sizes should be conducted to confirm the present findings.

Cortico-cortical connectivity: the road from basic neurophysiological interactions to therapeutic applications.

Transcranial magnetic stimulation (TMS) based methods are emerging as a unique approach to evaluate in real-time brain electrical activity in healthy and pathological conditions. By applying TMS pulses in two different bran areas within a short temporal frame of few milliseconds, it is possible to investigate their physiological interactions. These paradigms, collectively termed dual-site TMS, have been inspired by Professor John Rothwell's work, based on the idea that applying a conditioning stimulus over a cortical area may activate putative pathways projecting onto a second target area, thus providing a unique opportunity to test the causal effects between interconnected brain areas. This review highlights the most important features of dual-coil TMS protocols, mainly pioneered in Professor John Rothwell's lab. In the first part, I reviewed development of dual-site TMS protocols leading to the discovery of a distributed system of short-latency interactions within the human parieto-frontal network, likely mediated by direct anatomical pathways. In the second part, the physiological role of these dual-site TMS evoked pathways is considered, describing how these functional interactions are not fixed but vary depending on the brain activation, the condition and on the precise time window in which they are explored. Then, I reviewed recent advances showing that the repeated coupling of interconnected neuronal populations, by means of dual-coil TMS, is able to induce spike-time-dependent plasticity and to determine selective potentiation of physiological connectivity between two human brain regions. Finally, the therapeutic implications of these novel discoveries are discussed, pointing to multi-site TMS as a novel tool to identify early features of synaptic dysfunctions, to monitor disease progression and potentially to provide novel therapeutic approaches by reshaping plasticity in different neurological and psychiatric conditions.