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Prof. Dr. Cengiz BAHADIR

Paralyzed Patients

Transcranial Magnetic Stimulation Treatment (TMS) in Paralyzed Patients

What is TMS?

Transcranial magnetic stimulation (TMS) is based on stimulation of brain from outside with magnetic field. The first studies on this method dates back to 1800s. At the end of 20. century, in 80s it was first tried in sick people. This method is performed with a device called magnetic coil through connecting a magnetic stimulation device. Magnetic coils can be round or in shape of 8. Coil is put near to head and in this coil, a magnetic field is formed with the help of a high-intensity electric current of which direction changes suddenly. This magnetic field stimulates cells in the upper cortex of brain.

How is TMS effective in paralyzed patients?

Due to most of the researches of TMS treatment are focused on unilateral cerebral palsy (hemiplegia, paralysis, stroke) TMS is commonly used in this disease. Generally, these patients, whose part of the body has lost its mobility, have a partial recovery over time. Recovery in leg and foot is more successful compared to arm and hand. For paralyzed patients, excessive muscle tension called spasticity occurs especially in hands and arms and due to suppression of healthy hemisphere against affected hemisphere it is not possible to see intentional movements. The most important problem in paralyzed patients is suppression of healthy hemisphere against affected hemisphere and hence prevention of movement capability. TMS treatment is effective at this point. TMS treatment creates effect of activation (stimulator) or inhibition (inhibitor) in related part of brain. For paralyzed patients, it is possible to inhibit by giving low-frequency current to healthy hemisphere or stimulate by giving high-frequency current to affected hemisphere. As a result, both methods facilitates developing of movement by affected hemisphere. Low-frequency stimulation to healthy hemisphere is more commonly preferred. In this way, exitability of the neurons in the affected hemisphere increases and patient starts to make the movements that he/she can not make before. With numerous studies on this subject, TMS has been found to be effective in the development of the arm and hand movements especially in paralyzed patients.

How TMS treatment is applied?

Before paralyzed patient starts TMS treatment, a test called motor threshold is performed. This test takes approximately ten minutes and the lowest current intensity which creates movement in hand muscles with stimulation given to brain and related brain region (motor point) are determined. This current intensity is different in every person. According to this threshold value, treatment is applied to the relevant brain area in accordance with the purpose of treatment. Stimulation is performed by bringing the magnetic coil closer to head. Generally 1000-1200 stimulation is given and treatment takes nearly 15 minutes. Patient feels no pain during the treatment.

How many sessions of TMS treatment are required?

There is no definite treatment protocols as TMS treatment is still a quite new treatment method. However, generally a 10-day treatment protocol is used in cases which focus on developing intentional movements in paralyzed patients. The patient continues treatment scheduled as once a week for while.. Physician can make changes in treatment protocol based of patient’s response to the treatment. TMS treatment has become a new hope for paralyzed patients for whom we cannot find a way out. It is certain that TMS treatment will be increasingly used in paralyzed patients in the near future. For paralyzed patients, TMS treatment has been successfully used in some patients with aphasia, treatmant- resitant depression and chronic central pain