Transcript FOr Video: “Advanced Parkinson’s Treatment with TMS”
Advanced Parkinson’s Treatment with TMS
Robert McMullen: I’m Robert McMullen M.D. I’m a psychiatrist in New York City. I trained in medical school at Georgetown in Washington D.C. and I did my residency at Columbia Presbyterian in New York. I have been in practice 36 years, mainly concentrating on psychopharmacology, the use of medication to treat various psychiatric illnesses.
Five and a half years ago, we added TMS, trans-cranial magnetic stimulation. This had been quite a radical shift and advance in psychiatry. We have brought 50% or more of patients with treatment resistant depression all the way to normal. But today I want to talk about Parkinson’s disease. There’s a number of different neurological disorders that have been successfully treated with TMS, although these treatments are not FDA approved yet, but there are double blind studies showing they work. These include Tourette’s Syndrome and strokes, where the TMS helps the rehabilitation to be faster and more complete and even seizures.
Let me give the example of the first one. This 55-year-old lady came to see me with her husband and she wanted to be treated for anxiety and depression. But she had severe Parkinson’s. She was shaking like this and her speech was slurred. You couldn’t really let her walk by herself. You had to hold onto her when she walked. And I told her your big problem is Parkinson’s disease not anxiety and depression, let’s go next door and treat it. I had been hesitant to treat this because I’m not a neurologist and I had trouble getting patients to try this out on even though there’s research to show that it works. I was a little nervous but this was my opportunity. We went next door and I gave her a treatment, it’s an excitatory treatment on the motor strip that covers most of the body. We did this five times before Passover, and then we did it another 15 times later. But after Passover, I happened to see her son-in-law and he said, “You know Dr. McMullen, I don’t know if it’s ethical for me to talk about my mother-in-law.” And I said yeah you could talk about her and tell me. I just can’t tell you things about her. He said, “Well everyone was shocked at the Passover dinner because the last few Passovers, she’s so disabled with this Parkinson’s that she would just come and sit there for 10 minutes to make an appearance and then she would leave and go upstairs for the rest of the night. This time she stayed there the whole dinner, she cut her own food, she walked, she talked, she joked with people,” and it was just hard for them to believe. She really made a dramatic improvement. By the way, she was already on medicine. She was on a lot of medicine that was giving her side effects. She couldn’t even go higher on her medication. I did another 15 or 20 treatments just because she insisted on it, because she was doing so well. But we really reached the maximum benefit around this. I think her Parkinsonian score was about 90 and it went to 50% less than this. No that was a mistake, it was about 70 and it went down to under 35. And then she did very well and about 6 months later she was beginning to relapse and she came back in for 5 or 6 treatments and those were doing better and went back home. We had another gentleman who was 84 and his scores went from about 32 down to 16. He was much more able to walk around the house, or outside of the house, and to talk more clearly. He even drove a car, but he wasn’t supposed to do but his wife was happy he was able to do it because it was improvement with his motor function. We’re not sure why this works, and there are a few theories. One thing that does happen with TMS is that it increases plasticity in the brain. By this we mean that the brain’s ability to change, for the neurons to change and take on new functions. So if a person has a stroke and they can’t move their arms very much, if they keep exercising and do rehabilitation they can gradually do more and that’s because the area that controls the arm, which is on the opposite side of the brain has recruited neurons that are still living to take over these functions.
The way that the TMS seems to work is that it increases the BDNF, brain-derived neurotropic factor; it’s a growth hormone in the brain that induces plasticity. This is why the treatment helps with strokes. It may be a similar reason for helping with Parkinson’s, we’re not sure, but it doesn’t matter. The main thing is that it works. There’s many things in medicine that we for decades we didn’t know how they were. We didn’t know why aspirin lowered a fever, we now know it has to do with prostaglandin. We didn’t know why morphine reduced pain. We know all the basic science reasons for many of these things, but not yet for TMS. I think for any neurological disorder, and depression, and obsessive-compulsive disorder, even bi-polar depression people should seriously consider using TMS as a treatment. When it works, it often has a long-term benefit, both in depression. With the 55-year-old lady and 83-year-old man both of them did not begin to relapse for 6 months and then they only needed a few treatments, five or six. They didn’t need another 20 or so to recover.
The benefit is long lasting and when you do relapse you don’t need the same number of total treatments.