View source for Repetitive Transcranial Magnetic Stimulation Treatment For Parkinson's

=== Types of TMS ===
# '''Single-pulse TMS''' can be used to simply stimulate a given area while recording the output and is commonly used in research where an area such as the motor cortex is stimulated and a motor response can be recorded from muscles of the body via electromyography.<ref name=":4" /><ref name=":5" />
# '''Paired-pulse TMS''' can be used to assess the effect of a preceding stimulus on a secondary stimulus.<ref>Chen R. [https://link.springer.com/article/10.1007/s00221-003-1684-1 Interactions between inhibitory and excitatory circuits in the human motor corte]x. ''Experimental Brain Research''. 2004;154:1-10.</ref> While this technique is also primarily used in research, it allows for the assessment of one brain region on another. For example, a TMS pulse delivered to the motor cortex of one hemisphere of the brain 10ms prior to a TMS pulse delivered over the opposite motor cortex results in an inhibitory effect in motor output to the arms, showing firing patterns that allow for unimanual control of the upper limbs.<ref>Ni Z, Gunraj C, Nelson AJ, et al. [https://academic.oup.com/cercor/article/19/7/1654/318228?login=true Two Phases of Interhemispheric Inhibition between Motor Related Cortical Areas and the Primary Motor Cortex in Huma]n. ''Cerebral Cortex''. 2009;19:1654-1665.</ref><ref>Ferbert A, Priori A, Rothwell JC, Day BL, Colebatch JG, Marsden CD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175572/ Interhemispheric inhibition of the human motor cortex]. ''The Journal of Physiology''. 1992;453:525-546</ref>
# '''Repetitive TMS (rTMS)''' techniques involve stringing a large number of consecutive TMS pulses together in rapid succession. This method is used both in research and clinically as it can produce changes in cortical activity that last beyond the duration of the TMS protocol.<ref name=":1" /><ref name=":7" /><ref>Chung SW, Rogasch NC, Hoy KE, Fitzgerald PB. [https://www.sciencedirect.com/science/article/abs/pii/S1935861X15010542?via%3Dihub Measuring Brain Stimulation Induced Changes in Cortical Properties Using TMS-EEG]. ''Brain Stimulation''. 2015;8:1010-1020.</ref> With some reports demonstrating excitability changes persisting for a number of hours<ref>Huang Y-Z, Edwards MJ, Rounis E, Bhatia KP, and Rothwell JC. [https://www.sciencedirect.com/science/article/pii/S0896627304008463?via%3Dihub Theta Burst Stimulation of the Human Motor Cortex]. ''Neuron'' 45: 201-206, 2005.</ref>. The rate of pulse delivery appears to dictate the effect of the rTMS protocol, whereas those that deliver pulses at rates of >5Hz (high frequency rTMS) tend to produce excitatory effects and those delivered at rates of < 1Hz (low frequency rTMS) tend to produce inhibitory effects in the brain.<ref name=":6" /><ref name=":7" />. These rTMS techniques have been approved as a treatment modality for those with non-responsive major depression disorder (MDD) in Canada.<ref name=":9">Downar J, Blumberger D, Daskalakis Z. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088079/ Repetitive transcranial magnetic stimulation: an emerging treatment for medication-resistant depression]. ''CANADIAN MEDICAL ASSOCIATION JOURNAL''. 2016;188:1175-1177.</ref> While the use of rTMS has not yet been approved for clinical use in the treatment of movement disorders such as [[stroke]], [[Overview of spinal cord injuries|spinal cord injury]],, and PD, the scientific literature suggests that it may provide some benefit to both motor and cognitive symptoms in these populations.<ref name=":10" /><ref>Le Q, Qu Y, Tao Y, Zhu S. Effects of repetitive transcranial magnetic stimulation on hand function recovery and excitability of the motor cortex after stroke: a meta-analysis. American journal of physical medicine & rehabilitation. 2014 May 1;93(5):422-30.</ref><ref>Tazoe T, Perez MA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526137/ Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury]. Archives of physical medicine and rehabilitation. 2015 Apr 1;96(4):S145-55.</ref><ref name=":8">Goodwill A, Lum J, Hendy A, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665996/ Using non-invasive transcranial stimulation to improve motor and cognitive function in Parkinson's: a systematic review and meta-analysis]. ''SCIENTIFIC REPORTS''. 2017;7.</ref>
{{#ev:youtube|NmciYGTXOBo}}<ref>TMS Center - Southeastern Psychiatric AssociatesRepetitive Trancranial Magnetic Stimulation (rTMS) Physiology by Magstim Available from https://www.youtube.com/watch?v=NmciYGTXOBo&feature=emb_logo</ref>