The armoury of the neurologist is traditionally a cocktail of tablets and injections. The neurosurgeons and neuroradiologists seem to have all the fancy gadgets. This may however be changing with techniques that are gradually creeping into neurological practice. One such technique is transcranial magnetic stimulation (TMS). This is a non-invasive method of stimulating specific parts of the brain using a magnetic field generator or coil.
The classical neurological application of TMS is in the treatment and prevention of migraine. The role of TMS in migraine has been fairly well-studied although the impact on symptoms is modest. There is however enough evidence to convince the National Institute of Health and Care Excellence to issue NICE guidelines on TMS. These, as expected, prescribed hope and caution in equal measure.
A potential application of TMS is in Parkinson’s disease. A recent systematic review and meta-analysis in JAMA Neurology is fairly convincing that TMS improves the motor symptoms of Parkinson’s disease.
What of TMS as a cognitive enhancer? I came across the report that TMS may boost memory in Gizmag. OK it’s not a neurology journal but it made a more exciting headline than the original study published in Science under the elusive title targeted enhancement of cortical-hippocampal brain networks and associative memory. In simple language, TMS may enhance the neural networks in the hippocampus, the brains memory hub. Whilst the study was carried out in people with normal memory, there are implications for cognitive disorders such as Alzheimer’s disease if the potential and promise of TMS are realised.
A further surprising application of TMS, potential of course, is in dyslexia. This is an emerging field, still under investigation, but imagine the potential this will unleash! There is a helpful review article in Neuroimmunology and Neuroinflammation which discusses the role of rapid rate TMS in the treatment of dyslexia.
We’re not quite there yet but there is hope for the neurological arsenal; who knows, we may soon dispense with all these difficult to swallow pills and cumbersome to deliver injections!
Interested in delving deeper into TMS?
- I haven’t found any article more practical than this fairly old review in Lancet Neurology on applications of TMS in Neurology.
- If you are keen in the basic principles, then look at this article in Neurology which reviews the more complex physiological applications of TMS.
- Thinking of research into TMS? Then have a look at this article in Clinical Neurophysiology which reviews the safety and ethical considerations of TMS