Are magnets transforming neurological practice?

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.

"Transcranial magnetic stimulation" by Eric Wassermann, M.D. - Wassermann, Eric. Transcranial Brain Stimulation. Behavioral Neurology Unit. National Institute of Neurological Disorders and Stroke, National Institutes of Health, United States Department of Health and Human Services. Archived from the original on 2013-10-29. Retrieved on 2013-10-29.. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Transcranial_magnetic_stimulation.jpg#/media/File:Transcranial_magnetic_stimulation.jpg
“Transcranial magnetic stimulation” by Eric Wassermann, M.D. – Wassermann, Eric. Transcranial Brain Stimulation. Behavioral Neurology Unit. National Institute of Neurological Disorders and Stroke, National Institutes of Health, United States Department of Health and Human Services. Archived from the original on 2013-10-29. Retrieved on 2013-10-29.. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Transcranial_magnetic_stimulation.jpg#/media/File:Transcranial_magnetic_stimulation.jpg

 

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

"Basal ganglia in treatment of Parkinson's" by Mikael Häggström, based on image by Andrew Gillies/User:Anaru - Derivative of File:Basal ganglia circuits.png. Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Basal_ganglia_in_treatment_of_Parkinson%27s.png#/media/File:Basal_ganglia_in_treatment_of_Parkinson%27s.png
“Basal ganglia in treatment of Parkinson’s” by Mikael Häggström, based on image by Andrew Gillies/User:Anaru – Derivative of File:Basal ganglia circuits.png. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:Basal_ganglia_in_treatment_of_Parkinson%27s.png#/media/File:Basal_ganglia_in_treatment_of_Parkinson%27s.png

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.

"Magnet0873" by Newton Henry Black - Newton Henry Black, Harvey N. Davis (1913) Practical Physics, The MacMillan Co., USA, p. 242, fig. 200. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Magnet0873.png#/media/File:Magnet0873.png
“Magnet0873” by Newton Henry Black – Newton Henry Black, Harvey N. Davis (1913) Practical Physics, The MacMillan Co., USA, p. 242, fig. 200. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Magnet0873.png#/media/File:Magnet0873.png

 

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.

"Dislexia nens" by cuidado infantil - cuidadoinfantil.net. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Dislexia_nens.jpg#/media/File:Dislexia_nens.jpg
“Dislexia nens” by cuidado infantil – cuidadoinfantil.net. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Dislexia_nens.jpg#/media/File:Dislexia_nens.jpg

 

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!

 

Medicine 01 by Taki Steve on Flikr. https://www.flickr.com/photos/13519089@N03/4746653392
Medicine 01 by Taki Steve on Flikr. https://www.flickr.com/photos/13519089@N03/4746653392

Interested in delving deeper into TMS?

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