{"id":4660,"date":"2007-10-15T12:14:28","date_gmt":"2007-10-15T20:14:28","guid":{"rendered":"http:\/\/gql.fus.mybluehost.me\/en\/?p=160"},"modified":"2007-10-15T12:14:28","modified_gmt":"2007-10-15T20:14:28","slug":"transcranial-magnetic-stimulation","status":"publish","type":"post","link":"https:\/\/neuroft.com\/en\/transcranial-magnetic-stimulation\/","title":{"rendered":"Transcranial magnetic stimulation"},"content":{"rendered":"<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\"><span lang=\"EN\" style=\"mso-ansi-language: EN\">Transcranial magnetic stimulation<\/span><\/span><\/span><span lang=\"EN\" style=\"font-size: 12pt; font-family: Calibri; mso-ansi-language: EN\"><o:p><\/o:p><\/span><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\"><b><span lang=\"EN\" style=\"mso-ansi-language: EN\">Transcranial magnetic stimulation<\/span><\/b><span lang=\"EN\" style=\"mso-ansi-language: EN\"> (<b>TMS<\/b>) is a noninvasive method to excite neurons in the brain: weak electric currents are induced in the tissue by rapidly changing magnetic fields (electromagnetic induction). This way, brain activity can be triggered with minimal discomfort, and the functionality of the circuitry and connectivity of the brain can be studied.<\/span><\/span><\/span><font size=\"3\"><span lang=\"EN\" style=\"font-family: Calibri; mso-ansi-language: EN\"><o:p><\/o:p><\/span><\/font><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\"><b><span lang=\"EN\" style=\"mso-ansi-language: EN\">Repetitive transcranial magnetic stimulation<\/span><\/b><span lang=\"EN\" style=\"mso-ansi-language: EN\"> is known as <b>rTMS<\/b> and can produce longer lasting changes. Numerous small-scale pilot studies have shown it could be a treatment tool for various neurological conditions (e.g. migraine, stroke, Parkinson&rsquo;s disease, dystonia, tinnitus) and psychiatric conditions (e.g. major depression, auditory hallucinations).<\/span><\/span><\/span><font size=\"3\"><span lang=\"EN\" style=\"font-family: Calibri; mso-ansi-language: EN\"><o:p><\/o:p><\/span><\/font><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\"><b><span style=\"font-style: normal\">How TMS affects the brain<\/span><\/b><\/span><\/span><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">The exact details of how TMS functions are still being explored. The effects of TMS can be divided into two types depending on the mode of stimulation:<\/span><\/span><\/p>\n<ul type=\"disc\">\n<li>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">Single or paired pulse TMS. The pulse(s) causes a population of neurons in the neocortex to depolarise and discharge an action potential. If used in the primary motor cortex, it produces a motor-evoked potential (MEP) which can be recorded on electromyography (EMG). If used on the occipital cortex, &#8216;phosphenes&#8217; (flashes of light) might be detected by the subject. In most other areas of the cortex, the participant does not consciously experience any effect, but his or her behavior may be slightly altered (e.g. slower reaction time on a cognitive task), or changes in brain activity may be detected using Positron Emission Tomography or fMRI. These effects do not outlast the period of stimulation. A review of TMS can be found in the Handbook of Transcranial Magnetic Stimulation.<\/span><\/span><\/p>\n<\/li>\n<\/ul>\n<ul type=\"disc\">\n<li>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">Repetitive TMS (rTMS) produces effects which last longer than the period of stimulation. rTMS can increase or decrease the excitability of corticospinal or corticocortical pathways depending on the intensity of stimulation, coil orientation and frequency of stimulation. The mechanism of these effects is not clear although it is widely believed to reflect changes in synaptic efficacy akin to long-term potentiation (LTP) and long-term depression (LTD). A recent review of rTMS can be found in Fitzgerald et al, 2006.<\/span><\/span><\/p>\n<\/li>\n<\/ul>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">As such, it is important to distinguish TMS from repetitive TMS (rTMS) as they are used in different ways for different purposes.<\/span><\/span><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\"><b>TMS for the investigation of attention<\/b><\/span><\/span><\/p>\n<p><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">A number of investigators have studied the modulation of attention using TMS and rTMS particularly combined with cognitive testing and functional brain imaging. Some leading researchers on this include Prof Vincent Walsh, Prof Masud Husain, Prof Jon Driver and Dr Chris Chambers, at the Institute of Cognitive Neuroscience and Institute of <\/span><\/span><\/p>\n<p><span style=\"font-size: smaller\"><\/p>\n<p><span style=\"\"><span style=\"\">Neurology, Queen Square in London. TMS has been used to study the phenomenon of spatial neglect, the control of spatial attention by the parietal cortex and the prefrontal cortex.<\/span><\/span><\/p>\n<p><b>TMS for the investigation of speech and language<\/b>The study of language and aphasia is also possible with TMS. There are numerous investigators including Prof Alvaro Pascual-Leone, Prof Elizabeth Warrington and Prof Joseph Devlin involved in this research, and has studied speech production, syntax and grammar. It has also validated the broad principles about language from the 19th century (i.e. Broca&#8217;s area, Wernicke&#8217;s area and left cerebral hemisphere language specialisation)<b>TMS for the investigation of neuroplasticity<\/b>A rich area of current interest is that current study of neuroplasticity which is believed to be the underlying basis of learning and memory in the central nervous system. TMS and rTMS has allowed the study of this phenomenon in humans where before it was only possible to be studied in animals, where the classical form is known as long term potentiation or LTP.<b><span style=\"font-style: normal\">Risks of TMS and rTMS<\/span><\/b>As it induces an electrical current in the human brain, TMS and rTMS can produce a seizure. The risk is very low with TMS except in patients with epilepsy and patients on medications. The risk is significantly higher, but still very low, in rTMS especially when given at rates &gt;5Hz at high intensity.<br \/>\nThe only other effects of TMS which are reported in most subjects are:<\/span><\/p>\n<ul type=\"disc\">\n<li><span style=\"font-size: smaller\">Discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin<\/span><\/li>\n<li><span style=\"font-size: smaller\">Hearing from the loud click made by the TMS pulse<\/span><\/li>\n<\/ul>\n<p><span style=\"font-size: smaller\"><b><span style=\"font-style: normal\">Clinical uses of TMS and rTMS<\/span><\/b>The uses of TMS and rTMS can be divided into diagnostic and therapeutic uses.&nbsp;<\/span><\/p>\n<div style=\"margin: auto 0cm\"><span style=\"font-size: smaller\"><b>TMS for diagnostic purposes<\/b><\/span><\/div>\n<div><span style=\"font-size: smaller\">TMS is used currently clinically to measure activity and function of specific brain circuits in humans. The most robust and widely-accepted use is in measuring the connection between the <\/span><span style=\"font-size: smaller\">primary motor cortex<\/span><span style=\"font-size: smaller\"> and a muscle (i.e. MEP amplitude, MEP latency, central motor conduction time). This is most useful in <\/span><span style=\"font-size: smaller\">stroke<\/span><span style=\"font-size: smaller\">, <\/span><span style=\"font-size: smaller\">spinal cord<\/span><span style=\"font-size: smaller\"> injury, <\/span><span style=\"font-size: smaller\">multiple sclerosis<\/span><span style=\"font-size: smaller\"> and <\/span><span style=\"font-size: smaller\">motor neuron disease<\/span><span style=\"font-size: smaller\">. There are numerous other measures which have been shown to be abnormal in various diseases but few are validated or reproduced and more importantly, no one knows the significance of these measures. The most famous is short-interval intracortical inhibition (SICI) which measures the internal circuitry (intracortical circuits) of the <\/span><span style=\"font-size: smaller\">motor cortex<\/span><span style=\"font-size: smaller\"> described by Kujirai et al. in 1993. <\/span><\/div>\n<div><span style=\"font-size: smaller\">Plasticity<\/span><span style=\"font-size: smaller\"> of the <\/span><span style=\"font-size: smaller\">human brain<\/span><span style=\"font-size: smaller\"> can also be measured now with repetitive TMS (and variants of the technique, e.g. theta-burst stimulation, paired associative stimulation) and it has been suggested that this abnormality of plasticity is the primary abnormality in a number of conditions.<\/span><\/div>\n<div style=\"margin: auto 0cm\"><span style=\"font-size: smaller\"><b>TMS for therapeutic purposes<\/b><\/span><\/div>\n<div><span style=\"font-size: smaller\">A large number of studies with TMS and rTMS have been conducted for a variety of neurological and psychiatric conditions but few have been confirmed and most show very modest effects, if any. Some conditions which have been reported to be responsive to TMS-based therapy are:<\/span><\/div>\n<ul type=\"disc\">\n<li><span style=\"font-size: smaller\">Stroke<\/span><\/li>\n<li><span style=\"font-size: smaller\">Nonfluent aphasia <\/span><\/li>\n<li><span style=\"font-size: smaller\">Tinnitus<\/span><\/li>\n<li><span style=\"font-size: smaller\">Parkinson&rsquo;s Disease<\/span><\/li>\n<li><span style=\"font-size: smaller\">Dystonia<\/span><\/li>\n<li><span style=\"font-size: smaller\">Amyotrophic lateral sclerosis<\/span><\/li>\n<li><span style=\"font-size: smaller\">Epilepsy<\/span><\/li>\n<li><span style=\"font-size: smaller\">Migraine<\/span><span style=\"font-size: smaller\"><sup id=\"cite_ref-6\">[7]<\/sup><\/span><\/li>\n<li><span style=\"font-size: smaller\">Dysphasia<\/span><\/li>\n<li><span style=\"font-size: smaller\">Hemispatial neglect<\/span><\/li>\n<li><span style=\"font-size: smaller\">Major depression<\/span><span style=\"font-size: smaller\"> (rTMS therapy for drug-resistant depression has been approved by Health Canada for clinical delivery since 2002). <\/span><\/li>\n<li><span style=\"font-size: smaller\">Phantom limb<\/span><\/li>\n<li><span style=\"font-size: smaller\">Chronic pain <\/span><\/li>\n<li><span style=\"font-size: smaller\">Obsessive-compulsive disorder<\/span><span style=\"font-size: smaller\"> (ongoing study) <\/span><\/li>\n<li><span style=\"font-size: smaller\">Auditory Hallucinations associated with Schizoaffective Disorders <\/span><\/li>\n<\/ul>\n<div><span style=\"font-size: smaller\">It is important to stress that in a vast majority of these studies, no adequate control of <\/span><span style=\"font-size: smaller\">placebo effect<\/span><span style=\"font-size: smaller\"> was possible and thus it is tempting to wonder if this effect is <\/span><span style=\"font-size: smaller\">placebo<\/span><span style=\"font-size: smaller\">.<\/span><\/div>\n<div>&nbsp;<\/div>\n<div><span style=\"font-size: smaller\">If you want to obtain full text:<\/span><\/div>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation\"><span style=\"font-size: smaller\"><span style=\"font-family: Verdana\">http:\/\/en.wikipedia.org\/wiki\/Transcranial_magnetic_stimulation<\/span><\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a noninvasive method to excite neurons in the brain: weak electric currents are  [&#8230;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[551,534,538,564,565],"tags":[866,902,935,992,464,1026],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Transcranial magnetic stimulation - Terapia F\u00edsica Costa Rica y Rehabilitaci\u00f3n Neurol\u00f3gica - Dra. 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