What is rTMS?
rTMS involves a device delivering magnetic stimuli to the outside of the head that pass through the skull and creates either inhibitory (calming) or excitatory (excite) effects on underlying brain neurons, depending on the stimulation frequency. Inhibitory (low frequency) stimulation can be applied to the non-stroke side of the brain to suppress signals coming from that side that inhibit surviving neurons in the other side of the brain that had the stroke. Thus, in this case, the rTMS would have the strange but true effect of “inhibiting the inhibition." By quieting the signals sent from the non-stroke side of the brain, the neurons in the stroke-side of the brain can become excited and contribute again to hand function. Alternatively, high-frequency stimulation can be applied to the stroke hemisphere to yield a more direct excitatory effect.
In either approach, the patient sits in a chair and EMG electrodes are applied to the skin over certain hand muscles. While monitoring responses on an EMG screen, we use the TMS device to search for the best location and lowest intensity of stimulation that delivers a reasonable response. During this a clicking noise is heard and a painless tapping sensation is felt on the scalp. Once the best location and intensity are confirmed, treatment then occurs for 10-20 minutes followed by hand exercises for 30-45 minutes.
The Brain Following Stroke
Neurons (brain cells) that lose their blood supply for very long because of a stroke become destroyed, creating an infarct, or an obstruction. If the infarcted region is in the area of the brain that controls hand movement, or its pathways, hand function suffers. As if the stroke itself were not bad enough, the brain -- while reorganizing in response to the stroke -- can have an effect on surviving neurons that are close to the infarct. These surviving neurons can then become suppressed, worsening the paralysis. Rehabilitation cannot bring destroyed neurons back to life, but it can raise the excitability of suppressed neurons and thereby improve hand function. Repetitive transcranial magnetic stimulation (rTMS) is a procedure used in combination with rehabilitation that, in some people, can improve hand recovery.
- Benefits and Risks
- Cost of rTMS
Please review the criteria below to recieve rTMS for hand recovery following stroke:
- Finished with their initial rehabilitation
- Have at least some active finger motion
- No metal in the head with the exception of dental metal
- No indwelling medical devices
- No seizure within 2 years
- Certain medications may not allow a person to receive this treatment
- An MD referral is needed
Benefits and Risks
Click the buttons below to view the before and after rTMS treatment videos of an individual who received rTMS combined with physical therapy.
However, not every person will benefit from rTMS. There are no guarantees of improved recovery but certain characteristics increase the likelihood of a beneficial outcome, such as presence of active finger motion, stroke location, time since stroke, and absence of medical depression.
The primary risk of rTMS is a seizure. We have taken measures in our protocol to minimize this risk but the risk is still present. Other risks include headache, impaired hearing, impaired concentration, tiredness, lightheadedness, and mood change. All these are rare.
Cost of rTMS
At this early innovative stage in rehabilitation, Medicare does not yet cover the expense and so patients would have to pay privately for the service. The service (10 treatments) costs a total of $2395. (Some assistance may be available to patients that are not able to afford the care on their own.)