Use of transcranial magnetic stimulation in the treatment of selected movement disorders

Katlyn E Brown, Jason L Neva, Noah Mh Ledwell, Lara A Boyd, Katlyn E Brown, Jason L Neva, Noah Mh Ledwell, Lara A Boyd

Abstract

Transcranial magnetic stimulation (TMS) is a valuable technique for assessing the underlying neurophysiology associated with various neuropathologies, and is a unique tool for establishing potential neural mechanisms responsible for disease progression. Recently, repetitive TMS (rTMS) has been advanced as a potential therapeutic technique to treat selected neurologic disorders. In healthy individuals, rTMS can induce changes in cortical excitability. Therefore, targeting specific cortical areas affected by movement disorders theoretically may alter symptomology. This review discusses the evidence for the efficacy of rTMS in Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and multiple sclerosis. It is hoped that gaining a more thorough understanding of the timing and parameters of rTMS in individuals with neurodegenerative disorders may advance both clinical care and research into the most effective uses of this technology.

Keywords: repetitive transcranial magnetic stimulation; selected movement disorders; treatment.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2014 Brown et al.

Figures

Figure 1
Figure 1
Schematic of transcranial magnetic stimulation (TMS). Notes: (A) A TMS coil placed over the scalp produces an electric field in the TMS coil, as well as in the opposite direction in the cortex. (B) Electric field produced by the coil induces a magnetic field traversing the skull and dura, producing electrical activity in the cortex in the opposite direction, which activates intracortical interneurons synapsing on pyramidal neurons and thus activates the corticospinal tract. The descending corticospinal tract then synapses on to a motor neuron in the spinal gray matter, which then carries the signal to the muscle. (C) The electromyographical (EMG) response resulting from TMS-induced activation of the corticospinal tract is captured via electrodes recording from the target muscle. (D) Amplified EMG is projected onto a computer screen for quantification of motor evoked potential (MEP) amplitude and latency. The computer screen displays examples of TMS-induced MEP, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), long-interval intracortical inhibition (LICI), and cortical silent period (CSP).

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