Transcranial Magnetic Stimulating and Usage in Neurorehabilitation

Abstract

Transcranial magnetic stimulation (TMS) is a non-invasive, painless and safe method used to identify changes in cortical excitability as a marker of neurological changes. TMS, which creates a magnetic field in a coil placed on the scalp with the electric current given by the high-voltage capacitor, causes some changes at the cellular level in the cortical region tissue. Obtained changes can also be viewed macroscopically with various imaging tools. With the coil types used in the TMS device, stimulation is given to cortical tissues of different depths and widths. In TMS, there are various measurement parameters used to evaluate the integrity of the corticospinal pathways, the conduction velocity of the peripheral nerve pathways, the function of the motor pathways, the mechanisms of spinal inhibition, and the motor cortex excitability. With these measurement parameters, some diseases can be diagnosed and prognosis can be followed. Stimulation parameters used for treatment in TMS application also differ. While single-pulse TMS is generally used for diagnostic purposes, repetitive TMS (rTMS) is mostly used for therapeutic purposes because it can modulate the level of cortical activity. TMS is a popular application that is mostly used in the diagnosis and treatment of neurological and psychological diseases. It has been reported to be beneficial, especially in addition to neurorehabilitation. It has been stated that low-frequency rTMS application may be beneficial for the treatment of post-stroke spasticity and motor problems in individuals with multiple sclerosis, and high-frequency rTMS application for the treatment of motor freezing in individuals with Parkinson's. In this review, general information about the application of TMS, its working principle, various measurement and stimulation parameters and its use in neurorehabilitation will be given.

Keywords

• Transcranial magnetic stimulation
• Neurorehabilitation
• Magnetic field

Transkraniyal Manyetik Stimülasyon ve Nörorehabilitasyonda Kullanımı

Abstract

Transkraniyal manyetik stimülasyon (TMS), nörolojik değişikliklerin belirteci olarak kortikal eksitabilite değişikliklerini belirlemek için kullanılan non-invazif, ağrısız ve güvenilir bir yöntemdir. Yüksek voltajlı kapasitör tarafından verilen elektrik akımı ile kafa derisi üzerine yerleştirilmiş bir koilde manyetik alan oluşturan TMS, kortikal bölge dokusunda birtakım hücresel düzeyde değişiklikler meydana getirmektedir. Elde edilen değişiklikler çeşitli görüntüleme araçlarıyla makroskopik olarak da görüntülenebilmektedir. TMS cihazında kullanılan koil çeşitleri ile farklı derinlik ve genişlikteki kortikal dokulara stimülasyon verilmektedir. TMS’de, kortikospinal yolların bütünlüğünü, periferik sinir yollarının iletim hızını, motor yolların fonksiyonunu, spinal inhibisyon mekanizmalarını, motor korteks eksitabilitesinin durumlarını değerlendirmek için kullanılan çeşitli ölçüm parametreleri bulunmaktadır. Bu ölçüm parametreleri ile bazı hastalıkların tanısı konulabilmekte ve prognoz takibi yapılabilmektedir. TMS uygulamasında tedavi amaçlı kullanılan stimülasyon parametreleri de farklılık göstermektedir. Tek atım TMS genellikle tanı amaçlı kullanılmaktayken, tekrarlayıcı TMS (rTMS) ise kortikal aktivite düzeyini modüle edebildiğinden dolayı daha çok tedavi amacıyla kullanılmaktadır. TMS günümüzde daha çok nörolojik ve psikolojik hastalıkların tanısında ve tedavisinde kullanılmakta olan popüler bir uygulamadır. Özellikle nörorehabilitasyona ek olarak kullanımının faydalı olduğu bildirilmiştir. İnme sonrası spastisite tedavisi ve multipl sklerozlu bireylerde motor problemlerin tedavisi için düşük frekanslı rTMS uygulaması, parkinsonlu bireylerde ise motor donmaların tedavisi için yüksek frekanslı rTMS uygulamasının yararlı olabileceği belirtilmiştir. Bu derlemede TMS uygulamasına ilişkin genel bilgiler, çalışma prensibi, çeşitli ölçüm ve stimülasyon parametreleri ve nörorehabilitasyonda kullanımı hakkında bilgi verilecektir.

Keywords

• Transkraniyal manyetik stimülasyon
• Nörorehabilitasyon
• Manyetik alan

References

1. 1.Kobayashi, M, Pascual-Leone, A, Transcranial magnetic stimulation in neurology, Lancet Neurology, 2003, 2(3), 145-156.
2. 2.Chervyakov, A.V, Chernyavsky, A.Y, Sinitsyn, D.O, Piradov, M.A, Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation, Frontiers in human neuroscience, 2015, 9.
3. 3.Nollet, H, Van Ham, L, Deprez, P, Vanderstraeten, G, Transcranial magnetic stimulation: review of the technique, basic principles and applications, The Veterinary Journal, 2003, 166(1), 28-42.
4. 4.Butler, A.J, Wolf, S.L, Putting the brain on the map: use of transcranial magnetic stimulation to assess and induce cortical plasticity of upper-extremity movement, Physical therapy, 2007, 87(6), 719-736.
5. 5.Barker, A.T, Jalinous, R, Freeston, I.L, Non-invasive magnetic stimulation of human motor cortex, Lancet, 1985, 1(8437), 1106–1107.
6. 6.Pascual-Leone, A, Davey, N.J, Rothwell, J, Wasserman, E.M, Puri, B.K, Handbook of Transcranial Magnetic Stimulation. Press:London, United Kingdom, 2002, pp 406.
7. 7.Rotenberg, A, Prospects for clinical applications of transcranial magnetic stimulation and real-time EEG in epilepsy, Brain topography, 2010, 22(4), 257-266.
8. 8.Horvath, J.C, Perez, J.M, Forrow, L, Fregni, F, Pascual-Leone, A, Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns, Journal of Medical Ethics, 2011, 37(3), 137–143.

9. 9.Faraday, M, I. Experimental researches in electricity. fifteenth series, Philosophical Transactions of the Royal Society of London, 1839, (129), 1-12.
10. 10.Hallett, M, Chokroverty, S, Magnetic Stimulation in Clinical Neurophysiology. Elsevier Health Sciences, 2005.
11. 11.Cracco, R.Q, Evaluation of Conduction in Central Motor Pathways Techniques, Pathophysiology and Clinical Interpratation, Neurosurgery, 1987, 20, 199-203.
12. 12.Barker, A.T, Jalinous, R, Freeston, I.L, Jarratt, J.A, Clinical evaluation of conduction time measurements in central motor pathways using magnetic stimulation of the human brain, Lancet, 1985b, 1, 1325-1326.
13. 13.Barker, A.T, The history and basic principles of magnetic nerve stimulation. In: Pascual-Leone, A, Davey, N.J, Rothwell, J, Wassermann, E.M, Puri, B.K, (eds) Handbook of Transcranial Magnetic Stimulation, Oxford University Press Inc, New York, 2002, pp 3-17.
14. 14.Ruohonen, J, Ilmoniemi, R.J, Physical principles for transcranial magnetic stimulation. In: Pascual-Leone, A, Davey, N.J, Rothwell, J, Wassermann, E.M, Puri, B.K, (eds) Handbook of Transcranial Magnetic Stimulation. Oxford University Press Inc, New York, 2002, pp 18-29.
15. 15.Rossi, S, Hallett, M, Rossini, P.M, Pascual-Leone, A, Safety of TMS Consensus Group, Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research, Clinical Neurophysiology, 2009, 120(12), 2008-2039.
16. 16.Takeuchi, N, Izumi, S.I, Rehabilitation with poststroke motor recovery: a review with a focus on neural plasticity, Stroke Research and Treatment, 2013.
17. 17.Meyer, B.U, Introduction to diagnostic strategies of magnetic stimulation. In: Pascual-Leone, A, Davey, N, Rothwell, J, Wasserman, E, Puri, B.K, (eds) Handbook of transcranial magnetic stimulation, Arnold, London, 2002, 177–84.
18. 18.Rossini, P.M, Rossi, S, Clinical applications of motor evoked potentials, Electroencephalography and Clinical Neurophysiology, 1998, 106(3), 180-94.
19. 19.Deng, Z.D, Lisanby, S.H, Peterchev, A.V, Coil design considerations for deep transcranial magnetic stimulation, Clinical Neurophysiology, 2014, 125(6), 1202-1212.
20. 20.Roth, Y, Amir, A, Levkovitz, Y, Zangen, A, Three-dimensional distribution of the electric field induced in the brain by transcranial magnetic stimulation using figure-8 and deep H-coils, Journal of Clinical Neurophysiology, 2007, 24(1), 31–38.
21. 21.Hovey, C, Jalinous, R, Part 1: Fundamental and Technical Aspects. Hovey C, Jalinous, R, (ed) The Guide to Magnetic Stimulation The Magstim Company Limited, 2006, 3- 9.
22. 22.Machado, S, Bittencourt, J, Minch, D, Therapeutic applications of repetitive transcranial magnetic stimulation in clinical neurorehabilitation, Functional Neurology, 2008, 23(3), 113-122.
23. 23.Stinear, C.M, Barber, P.A, Smale, P.R, Coxon, J.P, Fleming, M.K, Byblow, W.D, Functional potential in chronic stroke patients depends on corticospinal tract integrity, Brain, 2007, 130(1), 170-180.
24. 24.Cortes M, Black-Schaffer, R.M, Edwards, D.J, Transcranial magnetic stimulation as an investigative tool for motor dysfunction and recovery in stroke: an overview for neurorehabilitation clinicians, Neuromodulation, 2012, 15, 316-325.
25. 25.Escudero, J.V, Sancho, J, Bautista, D, Escudero, M, Lopez-Trigo, J, Prognostic value of motor evoked potential obtained by transcranial magnetic brain stimulation in motor function recovery in patients with acute ischemic stroke, Stroke, 1998, 29(9), 1854-1859.
26. 26.Davey, N.J, Smith, H.C, Wells, E, et al. Responses of thenar muscles to transcranial magnetic stimulation of the motor cortex in patients with incomplete spinal cord injury, Journal of Neurology, Neurosurgery and Psychiatry 1998, 65, 80–87.
27. 27.Hess, C.W, Mills, K.R, Murray, N.M, Schriefer, T.N, Magnetic brain stimulation: central motor conduction studies in multiple sclerosis, Annals of Neurology, 1987, 22, 744–752.
28. 28.Boniface, S.J, Mills, K.R, Schubert, M, Responses of single spinal motoneurons to magnetic brain stimulation in healthy subjects and patients with multiple sclerosis, Brain, 1991, 114, 643–662.
29. 29.de Noordhout, A.M, Myressiotis, S, Delvaux, V, Born, J.D, Delwaide, P.J, Motor and somatosensory evoked potentials in cervical spondylotic myelopathy, Electroencephalography and Clinical Neurophysiology, 1998, 108, 24–31.
30. 30.Soysal, A, Sobe, I, Atay, T, Sen, A, Arpaci, B, Effect of therapy on motor cortical excitability in Parkinson’s disease, Canadian Journal of Neurological Sciences, 2008, 35(2), 166-72.
31. 31.Restivo, D, Giuffrida, S, Rapisarda, G, et al. Central motor conduction to lower limb after transcranial magnetic stimulation in spinocerebellar ataxia type 2 (SCA2), Clinical neurophysiology, 2000, 111(4), 630-635.
32. 32.Weber, M, Eisen, A.A, Magnetic stimulation of the central and peripheral nervous systems, Muscle Nerve, 2002, 25, 160–175.
33. 33.Triggs, W.J, Macdonell, R.A, Cros, D, Chiappa, K.H, Shahani, B.T, Day, B.J, Motor inhibition and excitation are independent effects of magnetic cortical stimulation, Annals of Neurology, 1992, 32, 345–351.
34. 34.Brasil-Neto, J.P, Cammarota, A, Valls-Sole, J, Pascual-Leone, A, Hallett, M, Cohen, L.G, Role of intracortical mechanisms in the late part of the silent period to transcranial stimulation of the human motor cortex, Acta Neurologica Scandinavica, 1995, 92, 383–386.
35. 35.Aurora, S.K, al-Sayeed, F, Welch, K.M, The cortical silent period is shortened in migraine with aura, Cephalalgia, 1999, 19(8), 708-712.
36. 36.Anand, S, Hotson, J, Transcranial magnetic stimulation: Neurophysiological application and safety, Brain Cognition, 2002, 50, 366-386.
37. 37.Currà, A, Modugno, N, Inghilleri, M, Manfredi, M, Hallett, M, Berardelli, A, Transcranial magnetic stimulation techniques in clinical investigation, Neurology, 2002, 59(12), 1851–1859.
38. 38.Centonze, D, Koch, G, Versace, V, Mori, F, et al. Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis, Neurology, 2007, 68, 1045–1050.
39. 39.Koch, G, Brusa, L, Caltagirone, C, et al. rTMS of supplementary motor area modulates therapy-induced dyskinesias in Parkinson disease, Neurology, 2005, 65(4), 623-625.
40. 40.Khedr, E.M, Ahmed, M.A, Fathy, N, Rothwell, J.C, Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke, Neurology, 2005, 65(3), 466-468.
41. 41.Khedr, E.M, Kotb, H, Kamel, N.F, Ahmed, M.A, Sadek, R, Rothwell, J.C, Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain, Journal of Neurology, Neurosurgery and Psychiatry, 2005, 76(6), 833-838.
42. 42.Hoogendam, J.M, Ramakers, G.M, Di Lazzaro, V, Physiology of repetitive transcranial magnetic stimulation of the human brain, Brain Stimuation, 2010, 3(2), 95-118.
43. 43.Huang, Y.Z, Edwards, M.J, Rounis, E, Bhatia K.P, Rothwell, J.C, Theta burst stimulation of the human motor cortex, Neuron, 2005, 45(2), 201-206.
44. 44.Cardenas-Morales, L, Nowak, D.A, Kammer, T, Wolf, R.C, Schonfeldt-Lecuona, C, Mechanisms and applications of theta-burst rTMS on the human motor cortex, Brain Topography, 2010, 22(4), 294-306.
45. 45.Ruohonen, J, Karhu, J, Navigated transcranial magnetic stimulation. Clinical Neurophysiology, 2010, 40, 7-17.
46. 46.Herwig, U, Schönfeldt-Lecuona, C, Wunderlich, A.P, et al. The navigation of transcranial magnetic stimulation, Psychiatry Research: Neuroimaging, 2001, 108(2), 123-131.
47. 47.Bashir, S, Edwards, D, Pascual-Leone, A, Neuronavigation increases the physiologic and behavioral effects of low-frequency rTMS of primary motor cortex in healthy subjects, Brain Topography, 2011, 24, 54–64.
48. 48.Hsu, W.Y, Cheng, C.H, Lin, M.W, Shih, Y.H, Liao, K.K, Lin, Y.Y, Antiepileptic effects of low frequency repetitive transcranial magnetic stimulation: a meta-analysis, Epilepsy Research, 2011, 96(3), 231–240.
49. 49.Frye, R.E, Rotenberg, A, Ousley, M, Pascual-Leone, A, Transcranial magnetic stimulation in child neurology: current and future directions, Journal of Children Neurology, 2008, 23, 79–96.
50. 50.Fitzgerald, P.B, Brown, T.L, Marston, N.A, et al. Reduced plastic brain responses in schizophrenia: a transcranial magnetic stimulation study, Schizophrenia Research, 2004, 71(1), 17–26.
51. 51.Oberman, L.M, Horvath, J.C, Pascual-Leone, A, TMS: using the theta-burst protocol to explore mechanism of plasticity in individuals with Fragile X syndrome and autism, Journal of Visualized Experiments, 2010, 28(46), 2272.
52. 52.Galvão, S.C.B, Dos Santos, R.B.C, Dos Santos, P.B, Cabral, M.E, Monte-Silva, K, Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: a randomized controlled trial, Archives of Physical Medicine and Rehabilitation, 2014, 95(2), 222-229.
53. 53.Rastgoo, M, Naghdi, S, Nakhostin Ansari, N, Olyaei, G, Jalaei, S, Forogh, B, Najari, H, Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients, Disability and rehabilitation, 2016, 38(19), 1918-1926.
54. 54.Gupta, M, Lal Rajak, B, Bhatia, D, Mukherjee, A, Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients, Journal of Medical Engineering and Technology, 2016, 40(4), 210-216.
55. 55.Elzamarany, E, Afifi, L, El-Fayoumy, N.M, Salah, H, Nada, M, Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis, Acta Neurologica Belgica, 2016, 116 (2), 145-150.
56. 56.Darwish, M.H, El-Tamawy, M.S, Basheer, M.A, Khalifa, H.A, Elsherif, A.A, Effect of Repetitive Transcranial Magnetic Stimulation on Motor Functions in Multiple Sclerosis Patients: A Randomized Controlled Trial, Indian Journal of Public Health Research and Development, 2019, 10(11), 3367-3373.
57. 57.Kim, M.S, Chang, W.H, Cho, J.W, Youn, J, et al. Efficacy of cumulative high-frequency rTMS on freezing of gait in Parkinson’s disease, Restorative Neurology and Neuroscience, 2015, 33(4), 521-530.
58. 58.Maruo, T, Hosomi, K, Shimokawa, T, et al. High-frequency repetitive transcranial magnetic stimulation over the primary foot motor area in Parkinson’s disease, Brain Stimulation, 2013, 6(6), 884-891.