Transcranial Magnetic

Stimulation
Rachel McAteer
BME 281
What is TMS?

Non-invasive method of
neurostimulation/neuromodulation
Causes:
Depolarization makes a cells membrane potential
more positive
Hyperpolarization makes a cells membrane
potential more negative
Induces controlled and controllable manipulations in
behavior
 How it works:
Uses a rapidly changing
magnetic field to induce weak
electric currents, through
pulses.
Induced by
electromagnetic induction
Generally reach no more
than 5cm into the brain

*Coil is held above the head;

pulses penetrate skin and
skull.
Plastic-enclosed wire coils deliver pulses

A. Figure-8 coil
B. Double-cone coil
C. Round coil

* Four-leaf coils are also used (not pictured)

B.
C.

A.
Kinds of TMS
Single-Pulse TMS Delivers one stimulus at a
time

Paired-Pulse TMS Pairs of stimuli separated by a

variable interval

Repetitive TMS (rTMS) Delivered in trains (can

be of low or high frequency)
Two Main Categories:

Diagnostic cases

Therapeutic cases
Diagnostic

Used clinically to:

Measure activity of certain brain circuits
Survey the damage done to particular muscles following
stroke, multiple sclerosis, motor neuron disease, and other
injuries or disorders
Locate tumors and other lesions to generate preoperative
motor maps
Therapeutic

rTMS
Used for both rehabilitation and symptom alleviating
purposes
Possible therapy for tic disorders, autism, migraines, tinnitus,
and in the treatment of certain psychiatric disorders including
PTSD, schizophrenia, and, popularly, Major Depressive
Disorder
Risks/side effects

Common side effects: local pain, headache, and mild

discomfort
Could potentially displace ferromagnetic objects (e.g titanium
skull plates)
Can induce voltages in nearby electronic devices/wires
Temporary increases in auditory thresholds
Induction of seizures
Syncope
Discussion
Diagnostic:

Diagnostically, the only FDA approval is the Navigated Brain

Stimulation System for pre-surgical planning in patients
undergoing brain surgery.

Proven equally successful as traditional imaging methods in

producing preoperative motor maps.
When compared to direct cortical stimulation (DCS), it was
found that TMS was able to recognize every motor site
mapped by DCS
Therapeutic:

FDA has currently only approved rTMS as a treatment for

Major Depressive Disorder (MDD) (under Class II restrictions
special controls).

Generally inconsistent results:

Ebmeier and colleagues - conducted a 5-day study with 15
patients that called for them to be treated twice per day. At the
end of the study, the participants saw a reduction of 44% on
Hamilton depression scales.
Another trial testing 100 patients, however, saw most to be
treatment-resistant.
Current trials include using TMS with: autism, MDD, improving
speech aphasia
 References
Hallet, Mark; Pascual-Leone, Alvaro ; Rossi, Simone; Rossini,
Paolo M. "Safety, ethical considerations, and application guidelines
for the use of transcranial magnetic stimulation in clinical practice
and research" Clinical Neurophysiology 120. 12 (2009): 2008-
2039. Web. US National Library of Medicine National Institutes of
Health. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260536/>
<http://www.medscape.org/viewarticle/420840>
< http://www.ncbi.nlm.nih.gov/pubmed/22579164>
<http://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation#Dia
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US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and
%20Resources/Policies%20and%20Protocols/Medical%20Policies/
Medical%20Policies/Transcranial_Magnetic_Stimulation.pdf>
<http://www.sciencedaily.com/releases/2012/07/120726180305.htm
>