rTMS is a technology based on creating a magnetic pulse when you pass electricity through a metal coil.
It is not the electricity that stimulates the body, it is the magnetic pulse
that stimulates the cells. In this case, we use it to stimulate nerves or nerve cells
that have been deactivated either by a depressed function or a damaged structure.
For example, in stroke rehabilitation, you have the damage to the structure and in conditions
like depression, you have a depression of the function and what rTMS does is not only
stimulates the nerves to work again, but it recreates the nerve pathways again.
We call that a neuroplastic effect.
RTMS is used to treat many conditions.
RTMS works where drugs fail and work as well as a replacement of drugs whereby if people don’t
want to have drugs or cannot have drugs for whatever reason, whether they’re pregnant,
breastfeeding, allergies to drugs, can’t tolerate side effects, rTMS comes in very useful.
Another condition where it’s recommended
by NICE is migraine. rTMS cuts the attack short and not only that but can be very useful
in prevention of migraine attacks. Other conditions where rTMS is very useful are things like
stroke rehabilitation, Parkinson’s disease, you’ll also get improvement in gait, movement,
fluidity of movement. In things like Alzheimer’s disease, you’ll get improvement in memory. In chronic
schizophrenia, you’ll get improvement in memory. In pain syndromes, it reduces pain
perception. In fibromyalgia and chronic fatigue syndrome, they find that it improves quality
of life and pain parameters regardless of the improvement of mood. All of this is very
encouraging. Certainly, we’re looking for more applications to use this conditions particularly
there has no harm and no side effects.
RTMS works by delivering a physical pulse
that people feel like a tap. People feel that physically in the head but interestingly,
that tap penetrates the skull, goes through the other side and physically stimulates the
brain as if you touch the brain with a magnetic field. That tap stimulates the blood flow
and the neuron electivity in the nerve cells whereby the cells start to communicate more,
more blood flow, more activity, more glucose utilisation, and that restores the function
of the cell. What you have from thereon is the neuroplastic
effect whereby the repeated stimulation and the activation of nerve cells helps to create
new pathways in the brain to allow the cells to work for longer time and for that to be
sustainable. For example, when they looked at the recovery
rates of depression with rTMS versus medication or electrocompulsive treatment whilst with
medication, this figure was 13% and with ECT it was 30%. It is clear that rTMS effects
are long lasting as opposed to those with medication or ECT.
rTMS is effectively suitable for everybody except with those with a history of seizures
which is uncontrollable. If you have a seizure disorder, epilepsy, which has failed to respond
to treatment or you’ve had active seizures before, or resistance seizures before, then rTMS may
not be the best treatment for you because it could aggravate the seizures. Although
the seizure risk with rTMS is far below the seizure risk you get with medication for depression,
other patients would be suitable for others who don’t want to take drugs, those in whom
drug treatments fail, those who cannot tolerate drugs have side effects from drugs whether
metabolic or physical or sexual side effects, weight gain, all these side effects will cause
people to want to come off their drugs. Also, it would be suitable for women who are pregnant
or for women who are breastfeeding because you don’t get any interference with the
development of the foetus. It is too distant from the magnetic field and you don’t get
any interference with breast milk production.