Transcranial magnetic brain stimulation: therapeutic promises and scientific gaps

Eric M Wassermann, Trelawny Zimmermann, Eric M Wassermann, Trelawny Zimmermann

Abstract

Since its commercial advent in 1985, transcranial magnetic stimulation (TMS), a technique for stimulating neurons in the cerebral cortex through the scalp, safely and with minimal discomfort, has captured the imaginations of scientists, clinicians and lay observers. Initially a laboratory tool for neurophysiologists studying the human motor system, TMS now has a growing list of applications in clinical and basic neuroscience. Although we understand many of its effects at the system level, detailed knowledge of its actions, particularly as a modulator of neural activity, has lagged, due mainly to the lack of suitable non-human models. Nevertheless, these gaps have not blocked the therapeutic application of TMS in brain disorders. Moderate success has been achieved in treating disorders such as depression, where the U.S. Food and Drug Administration has cleared a TMS system for therapeutic use. In addition, there are small, but promising, bodies of data on the treatment of schizophrenic auditory hallucinations, tinnitus, anxiety disorders, neurodegenerative diseases, hemiparesis, and pain syndromes. Some other nascent areas of study also exist. While the fate of TMS as a therapeutic modality depends on continued innovation and experimentation, economic and other factors may be decisive.

Published by Elsevier Inc.

Figures

Fig. 1
Fig. 1
The effect of a short train of high frequency rTMS on MEP amplitude. Baseline MEP amplitude is measured by giving test stimuli, once every 10 s; then a 2 s train of 20 Hz rTMS is delivered (arrow). After a brief pause, test stimulation is resumed every 10 s. MEP amplitude is shown on the y-axis.
Fig. 2
Fig. 2
The effect of low frequency rTMS on MEP amplitude. In the first panel, test stimuli are delivered every 10 s (0.1 Hz). Then rTMS is delivered at 1 Hz (second panel); MEP amplitude decreases gradually during the stimulus train. 0.1 Hz stimuli are then resumed (third panel) and MEPs remain suppressed. The sequence of traces is from top to bottom in each panel.

Source: PubMed

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