Transcranial Magnetic Stimulation, TMS in Advanced Parkinson’s disease

Transcranial magnetic stimulation (TMS) is a non-invasive method of stimulating the brain. A coil of wire, insulated in plastic, is put on the head like a big spoon. Each TMS pulse then produces a magnetic field that stimulates the surface of the brain beneath the coil. Since magnetic fields do not hurt, this process is not painful. This is a growing and exciting concept, the therapeutic effect of TMS upon psychiatric practice is exemplified by the fact that hundreds of clinics in the United States now use an FDA-approved TMS system to treat depression. Though not yet FDA approved, double blind studies have shown the efficacy of TMS in treating Tourette’s syndrome, improved and complete rehabilitation of Stroke patients, Seizure control, Parkinson’s disease is a slowly progressive neurodegenerative disorder characterized by typical motor deficits, which result from the depletion of the neurotransmitter dopamine. The characteristic motor deficits of Parkinson’s disease include a slowing of physical movement, muscle rigidity, involuntary resting tremor, postural instability and gait disturbances. Although the motor symptoms of Parkinson’s are mainly treated with drugs, the clinical utility of these medications tends to become limited over the years, often due to adverse effects such as dyskinesias. Invasive brain stimulation for PD, such the DBS technique and minimally invasive cortical stimulation have reduced the surgical risks but are still costly and invasive. Therefore, non-invasive forms of brain stimulation are desirable. Repetitive Transcranial Magnetic Stimulation (rTMS) has been used in PD patients and has been suggested as possible therapeutic tool. Dr. Robert D. McMullen, MD. Psychiatrist, is specialized in neuropharmacology to treat neurodegenerative disorders via drugs. Though hesitant to diversify into procedural treatments for neurological disorders, the amazing results observed with TMS in treating various conditions led him to try this in patients with advanced PD. One particular patient’s treatment consisted of excitatory stimulation of the brain in 15-20 sessions. The improvement was visibly dramatic. Her parkinsonian score went form a 70 to under 35. Another patient showed a drop in the score from 32 to under 16, with improved speech and motor function and could even drive a car. Through repetitive magnetic impulses, TMS appears to improve the neuroplasticity of the brain.TMS can enhance or decrease cortical excitability and thus potentiate or modulate neuroplastic processes. This application of TMS might be capable of speeding up recovery from stroke\ reducing the consequences of immobilization\ or enhancing acquisition of new skills. Long-term rTMS significantly stimulates the expression of BDNF in distinct areas of brain, as has been reported to occur after antidepressant drug treatment. With TMS, you can intervene in the brain in exactly the parts that are not functioning well. We now have a non-invasive way in which we can actually target the part of the brain that has to do with movement, and will hopefully be able to improve people’s lives.