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{{Short description|
{{Infobox medical intervention |
Name = Transcranial magnetic stimulation |
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<!-- Medical uses -->
TMS has shown diagnostic and therapeutic potential in the [[central nervous system]] with a wide variety of disease states in [[neurology]] and [[mental health]], with research still evolving.<ref name=diagnostic1>{{cite journal | vauthors = Groppa S, Oliviero A, Eisen A, Quartarone A, Cohen LG, Mall V, Kaelin-Lang A, Mima T, Rossi S, Thickbroom GW, Rossini PM, Ziemann U, Valls-Solé J, Siebner HR | display-authors = 6 | title = A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee | journal = Clinical Neurophysiology | volume = 123 | issue = 5 | pages = 858–882 | date = May 2012 | pmid = 22349304 | pmc = 4890546 | doi = 10.1016/j.clinph.2012.01.010 }}</ref><ref name=Lefaucher1>{{cite journal | vauthors = Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L | display-authors = 6 | title = Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) | journal = Clinical Neurophysiology | volume = 125 | issue = 11 | pages = 2150–2206 | date = November 2014 | pmid = 25034472 | doi = 10.1016/j.clinph.2014.05.021 | s2cid = 206798663 | url = https://hal.archives-ouvertes.fr/hal-03183867/file/S1388245719312799.pdf }}</ref><ref name=pmid21474597>{{cite journal |last1=George |first1=Mark S. |last2=Post |first2=Robert M. |title=Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation for Acute Treatment of Medication-Resistant Depression |journal=American Journal of Psychiatry |date=April 2011 |volume=168 |issue=4 |pages=356–364 |doi=10.1176/appi.ajp.2010.10060864 |pmid=21474597 }}</ref><ref name=pmid22091472>{{cite book |last1=Gaynes |first1=Bradley N. |last2=Lux |first2=Linda J. |last3=Lloyd |first3=Stacey W. |last4=Hansen |first4=Richard A. |last5=Gartlehner |first5=Gerald |last6=Keener |first6=Patricia |last7=Brode |first7=Shannon |last8=Evans |first8=Tammeka Swinson |last9=Jonas |first9=Dan |last10=Crotty |first10=Karen |last11=Viswanathan |first11=Meera |last12=Lohr |first12=Kathleen N. |title=Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults |date=2011 |pmid=22091472 |url=https://www.ncbi.nlm.nih.gov/books/NBK65315/ |publisher=Agency for Healthcare Research and Quality |series=AHRQ Comparative Effectiveness Reviews }}</ref><ref name=pmid23249815>{{cite journal |last1=Berlim |first1=Marcelo T |last2=Van den Eynde |first2=Frederique |last3=Jeff Daskalakis |first3=Z |title=Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials |journal=Neuropsychopharmacology |date=19 November 2012 |volume=38 |issue=4 |pages=543–551 |doi=10.1038/npp.2012.237 |pmid=23249815 |pmc=3572468 }}</ref><ref name="Perera et al 2015">{{cite report |first1=Tarique |last1=Perera |first2=Mark |last2=George |first3=Geoffrey |last3=Grammer |first4=Philip |last4=Janicak |first5=Alvaro |last5=Pascual-Leone |first6=Theodore |last6=Wirecki |date=April 27, 2015 |title=TMS Therapy For Major Depressive Disorder: Evidence Review and Treatment Recommendations for Clinical Practice |url=http://tmscenterofcolorado.com/wp-content/uploads/2015/09/Clinical-TMS-Society-WhitePaper_2015.pdf }}</ref><ref name=pmid22559998>{{cite journal |last1=Bersani |first1=F.S. |last2=Minichino |first2=A. |last3=Enticott |first3=P.G. |last4=Mazzarini |first4=L. |last5=Khan |first5=N. |last6=Antonacci |first6=G. |last7=Raccah |first7=R.N. |last8=Salviati |first8=M. |last9=Delle Chiaie |first9=R. |last10=Bersani |first10=G. |last11=Fitzgerald |first11=P.B. |last12=Biondi |first12=M. |title=Deep transcranial magnetic stimulation as a treatment for psychiatric disorders: A comprehensive review |journal=European Psychiatry |date=January 2013 |volume=28 |issue=1 |pages=30–39 |doi=10.1016/j.eurpsy.2012.02.006 |pmid=22559998 |s2cid=29053871 }}</ref><ref name=Doug2015>{{cite journal | vauthors = Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A | title = Transcranial magnetic stimulation (TMS) for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 8 | pages = CD006081 | date = August 2015 | pmid = 26289586 | doi = 10.1002/14651858.CD006081.pub2 | pmc = 9395125 | url = http://dspace.stir.ac.uk/bitstream/1893/22520/1/Dougall_et_al-2015-The_Cochrane_Library.pdf | hdl = 1893/22520 | hdl-access = free }}</ref><ref>{{Cite web |title=Pupil response may shed light on who responds best to transcranial magnetic stimulation for depression |url=https://www.uclahealth.org/news/pupil-response-may-shed-light-who-responds-best-transcranial |access-date=2024-01-06 |website=www.uclahealth.org |language=en}}</ref>
<!-- Side effects -->
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== Medical uses ==
[[File:Neuro-ms.png|thumb|285x285px|A magnetic coil is positioned on the patient's head.<ref name=":0" />]]
TMS does not require surgery or electrode implantation.
TMS does not require surgery or electrode implantation. Its use can be divided into diagnostic and therapeutic applications. Effects vary based on frequency and intensity of the magnetic pulses as well as the length of treatment, which dictates the total number of pulses given.<ref>{{Cite journal|date=2015-09-01|title=Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS)|journal=Annals of Physical and Rehabilitation Medicine|language=en|volume=58|issue=4|pages=208–213|doi=10.1016/j.rehab.2015.05.005|issn=1877-0657|doi-access=free|last1=Klomjai|first1=Wanalee|last2=Katz|first2=Rose|last3=Lackmy-Vallée|first3=Alexandra|pmid=26319963}}</ref> TMS treatments are approved by the FDA in the US and by NICE in the UK for the treatment of depression and are predominantly provided by private clinics. TMS stimulates cortical tissue without the pain sensations produced in [[transcranial direct-current stimulation|transcranial electrical stimulation]].<ref>Moliadze, V., Zhao, Y., Eysel, U. and Funke, K., 2003. "Effect of transcranial magnetic stimulation on single‐unit activity in the cat primary visual cortex". ''The Journal of Physiology'', 553(2), pp. 665–679.</ref>▼
▲
=== Diagnosis ===
TMS can be used clinically to measure activity and function of specific brain circuits in humans, most commonly with single or paired magnetic pulses.<ref name=diagnostic1 /> The most widely accepted use is in measuring the connection between the [[primary motor cortex]] of the [[central nervous system]] and the [[peripheral nervous system]] to evaluate damage related to past or progressive neurologic insult.<ref name=diagnostic1 /><ref>{{cite journal | vauthors = Rossini PM, Rossi S | title = Transcranial magnetic stimulation: diagnostic, therapeutic, and research potential | journal = Neurology | volume = 68 | issue = 7 | pages = 484–488 | date = February 2007 | pmid = 17296913 | doi = 10.1212/01.wnl.0000250268.13789.b2 | s2cid = 19629888 }}</ref><ref name="Dimyan">{{cite journal | vauthors = Dimyan MA, Cohen LG | title = Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke | journal = Neurorehabilitation and Neural Repair | volume = 24 | issue = 2 | pages = 125–135 | date = February 2010 | pmid = 19767591 | pmc = 2945387 | doi = 10.1177/1545968309345270 }}</ref><ref name="Nowak">{{cite journal | vauthors = Nowak DA, Bösl K, Podubeckà J, Carey JR | title = Noninvasive brain stimulation and motor recovery after stroke | journal = Restorative Neurology and Neuroscience | volume = 28 | issue = 4 | pages = 531–544 | year = 2010 | pmid = 20714076 | doi = 10.3233/RNN-2010-0552 }}</ref> TMS has utility as a diagnostic instrument for [[myelopathy]], [[amyotrophic lateral sclerosis]], and [[multiple sclerosis]].<ref name="Chen2008">{{cite journal |last1=Chen |first1=Robert |last2=Cros |first2=Didier |last3=Curra |first3=Antonio |last4=Di Lazzaro |first4=Vincenzo |last5=Lefaucheur |first5=Jean-Pascal |last6=Magistris |first6=Michel R. |last7=Mills |first7=Kerry |last8=Rösler |first8=Kai M. |last9=Triggs |first9=William J. |last10=Ugawa |first10=Yoshikazu |last11=Ziemann |first11=Ulf |title=The clinical diagnostic utility of transcranial magnetic stimulation: Report of an IFCN committee |journal=Clinical Neurophysiology |date=March 2008 |volume=119 |issue=3 |pages=504–532 |doi=10.1016/j.clinph.2007.10.014}}</ref>
=== Treatment ===
{{expand section|date=January 2024}}
Repetitive high frequency TMS (rTMS) has been investigated as a possible treatment option with various degrees of success in conditions including<ref name=Chen2008/><ref>{{Cite journal |last=Lefaucheur |first=Jean-Pascal |last2=André-Obadia |first2=Nathalie |last3=Antal |first3=Andrea |last4=Ayache |first4=Samar S. |last5=Baeken |first5=Chris |last6=Benninger |first6=David H. |last7=Cantello |first7=Roberto M. |last8=Cincotta |first8=Massimo |last9=de Carvalho |first9=Mamede |last10=De Ridder |first10=Dirk |last11=Devanne |first11=Hervé |last12=Di Lazzaro |first12=Vincenzo |last13=Filipović |first13=Saša R. |last14=Hummel |first14=Friedhelm C. |last15=Jääskeläinen |first15=Satu K. |date=November 2014 |title=Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) |url=https://doi.org/10.1016/j.clinph.2014.05.021 |journal=Clinical Neurophysiology |volume=125 |issue=11 |pages=2150–2206 |doi=10.1016/j.clinph.2014.05.021 |issn=1388-2457}}</ref>
*Chronic [[neuropathic pain]]
*Motor diseases (e.g., [[Parkinson's disease]], [[essential tremor]])
*[[Amyotrophic lateral sclerosis]]
*[[Multiple sclerosis]]
*[[Epilepsy]]
*Disorders of consciousness (e.g., [[vegetative state]] or [[minimally conscious state]])
*[[Alzheimer's disease|Alzheimer’s disease]]
*Psychiatric diseases, such as [[Depression (mood)|depression]],<ref>{{Cite journal |last=Hernández-Sauret |first=Ana |last2=Martin de la Torre |first2=Ona |last3=Redolar-Ripoll |first3=Diego |date=2024-05-21 |title=Use of transcranial magnetic stimulation (TMS) for studying cognitive control in depressed patients: A systematic review |url=https://doi.org/10.3758/s13415-024-01193-w |journal=Cognitive, Affective, & Behavioral Neuroscience |language=en |doi=10.3758/s13415-024-01193-w |issn=1531-135X|doi-access=free }}</ref> [[Obsessive–compulsive disorder|obsessive compulsive disorder]], [[schizophrenia]], [[Anxiety disorder|anxiety]] and [[Tourette syndrome]]
== Adverse effects ==
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{{Main article|Electromagnetic induction}}
[[File:TMS focal field.png|right|150px]]
[[File:TMS Butterfly Coil HEAD.png|right|thumb|240px|TMS –
TMS uses [[electromagnetic induction]] to generate an electric current across the [[scalp]] and [[Human skull|skull]].<ref>{{cite journal | vauthors = Cavaleri R, Schabrun SM, Chipchase LS | title = The number of stimuli required to reliably assess corticomotor excitability and primary motor cortical representations using transcranial magnetic stimulation (TMS): a systematic review and meta-analysis | journal = Systematic Reviews | volume = 6 | issue = 1 | pages = 48 | date = March 2017 | pmid = 28264713 | pmc = 5340029 | doi = 10.1186/s13643-017-0440-8 | doi-access = free }}</ref><ref name="NIMH">{{cite web |title=Brain Stimulation Therapies |url=https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml |website=NIMH }}</ref> A plastic-enclosed coil of wire is held next to the skull and when activated, produces a varying [[magnetic field]] oriented [[Orthogonality|orthogonally]] to the plane of the coil. The changing magnetic field then induces an electric current in the brain that activates nearby nerve cells in a manner similar to a current applied superficially at the cortical surface.<ref>{{cite book |title=Handbook of psychophysiology |year=2007 |publisher=Cambridge Univ. Press |location=New York |isbn=978-0-521-84471-0 |edition=3rd | veditors = Cacioppo JT, Tassinary LG, Berntson GG |page=121}}</ref>
The magnetic field is about the same strength as [[
Transcranial magnetic stimulation is achieved by quickly discharging current from a large [[capacitor]] into a coil to produce pulsed [[magnetic fields]] between 2 and 3 [[Tesla (unit)|
The induced electric field inside the brain tissue causes a change in transmembrane potentials resulting in depolarization or hyperpolarization of neurons, causing them to be more or less excitable, respectively.<ref name=Walsh />
TMS usually stimulates to a depth from 2 to 4 cm below the surface, depending on the coil and intensity used. Consequently, only superficial brain areas can be affected.<ref>{{Cite journal |last=Lefaucheur |first=Jean-Pascal |last2=André-Obadia |first2=Nathalie |last3=Antal |first3=Andrea |last4=Ayache |first4=Samar S. |last5=Baeken |first5=Chris |last6=Benninger |first6=David H. |last7=Cantello |first7=Roberto M. |last8=Cincotta |first8=Massimo |last9=de Carvalho |first9=Mamede |last10=De Ridder |first10=Dirk |last11=Devanne |first11=Hervé |last12=Di Lazzaro |first12=Vincenzo |last13=Filipović |first13=Saša R. |last14=Hummel |first14=Friedhelm C. |last15=Jääskeläinen |first15=Satu K. |date=November 2014 |title=Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) |url=https://linkinghub.elsevier.com/retrieve/pii/S138824571400296X |journal=Clinical Neurophysiology |language=en |volume=125 |issue=11 |pages=2150–2206 |doi=10.1016/j.clinph.2014.05.021}}</ref> Deep TMS can reach up to 6 cm into the brain to stimulate deeper layers of the [[motor cortex]], such as that which controls leg motion. The path of this current can be difficult to model because the brain is irregularly shaped with variable internal density and water content, leading to a nonuniform magnetic field strength and [[Electrical conduction|conduction]] throughout its tissues.<ref>See:
# {{cite journal | vauthors = Zangen A, Roth Y, Voller B, Hallett M | title = Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil | journal = Clinical Neurophysiology | volume = 116 | issue = 4 | pages = 775–779 | date = April 2005 | pmid = 15792886 | doi = 10.1016/j.clinph.2004.11.008 | s2cid = 25101101 }}
# {{cite journal | vauthors = Huang YZ, Sommer M, Thickbroom G, Hamada M, Pascual-Leonne A, Paulus W, Classen J, Peterchev AV, Zangen A, Ugawa Y | display-authors = 6 | title = Consensus: New methodologies for brain stimulation | journal = Brain Stimulation | volume = 2 | issue = 1 | pages = 2–13 | date = January 2009 | pmid = 20633398 | pmc = 5507351 | doi = 10.1016/j.brs.2008.09.007 }}</ref>
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The effects of TMS can be divided based on frequency, duration and intensity (amplitude) of stimulation:<ref>{{cite journal | vauthors = Rubens MT, Zanto TP | title = Parameterization of transcranial magnetic stimulation | journal = Journal of Neurophysiology | volume = 107 | issue = 5 | pages = 1257–1259 | date = March 2012 | pmid = 22072509 | pmc = 3311692 | doi = 10.1152/jn.00716.2011 }}</ref>
* Single or paired pulse TMS causes neurons in the neocortex under the site of stimulation to [[Depolarization|depolarize]] and discharge an [[action potential]]. If used in the [[primary motor cortex]], it produces muscle activity referred to as a [[Evoked potential#Motor evoked potentials|motor evoked potential]] (MEP) which can be recorded on [[electromyography]]. If used on the [[occipital cortex]], '[[phosphene]]s' (flashes of light) might be perceived by the subject. In most other areas of the cortex, there is no conscious effect, but behaviour may be altered (e.g., slower reaction time on a cognitive task), or changes in brain activity may be detected using diagnostic equipment.<ref name="Handbook of Transcranial Magnetic Stimulation">{{cite book | author-link1 = Alvaro Pascual-Leone | vauthors = Pascual-Leone A, Davey N, Rothwell J, Wassermann EM, Puri BK | year = 2002 | title = Handbook of Transcranial Magnetic Stimulation | publisher = Edward Arnold|location=London | isbn = 978-0-340-72009-7 }}</ref>
* Repetitive TMS produces longer-lasting effects which persist past the period of stimulation. rTMS can increase or decrease the excitability of the [[corticospinal tract]] depending on the intensity of stimulation, coil orientation, and frequency. Low frequency rTMS with a stimulus frequency less than 1 Hz is believed to inhibit cortical firing while a stimulus frequency greater than 1 Hz, or high frequency, is believed to provoke it.<ref name="ReferenceA">{{cite journal | vauthors = Cusin C, Dougherty DD | title = Somatic therapies for treatment-resistant depression: ECT, TMS, VNS, DBS | journal = Biology of Mood & Anxiety Disorders | volume = 2 | issue = 1 | pages = 14 | date = August 2012 | pmid = 22901565 | pmc = 3514332 | doi = 10.1186/2045-5380-2-14 | doi-access = free }}</ref> Though its mechanism is not clear, it has been suggested as being due to a change in synaptic efficacy related to [[long-term potentiation]] (LTP) and long-term depression like plasticity (LTD-like plasticity).<ref name=Fitzgerald>{{cite journal | vauthors = Fitzgerald PB, Fountain S, Daskalakis ZJ | title = A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition | journal = Clinical Neurophysiology | volume = 117 | issue = 12 | pages = 2584–2596 | date = December 2006 | pmid = 16890483 | doi = 10.1016/j.clinph.2006.06.712 | s2cid = 31458874 }}
=== Coil types ===
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Work to directly stimulate the human brain with electricity started in the late 1800s, and by the 1930s the Italian physicians [[Ugo Cerletti|Cerletti]] and [[Lucio Bini|Bini]] had developed [[electroconvulsive therapy]] (ECT).<ref name=Horvath/> ECT became widely used to treat [[mental illness]], and ultimately overused, as it began to be seen as a [[panacea (medicine)|panacea]]. This led to a backlash in the 1970s.<ref name=Horvath/>
In 1980 Merton and Morton successfully used transcranial electrical stimulation (TES) to stimulate the motor cortex. However, this process was very uncomfortable, and subsequently Anthony T. Barker began to search for an alternative to TES.<ref>{{cite journal | vauthors = Klomjai W, Katz R, Lackmy-Vallée A | title = Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS) | journal = Annals of Physical and Rehabilitation Medicine | volume = 58 | issue = 4 | pages = 208–213 | date = September 2015 | pmid = 26319963 | doi = 10.1016/j.rehab.2015.05.005 | doi-access = free }}</ref> He began exploring the use of magnetic fields to alter electrical signaling within the brain, and the first stable TMS devices were developed in 1985.<ref name=Horvath/><ref name=Nooh/> They were originally intended
== Research ==
{{expand section|date=January 2024}}
TMS has shown potential therapeutic effect on [[neurology|neurologic]] conditions such as mild to moderate [[Alzheimer's disease]],<ref name=Lefaucher1 /> [[amyotrophic lateral sclerosis]],<ref name=Lefaucher1 /><ref>{{cite journal | vauthors = Fang J, Zhou M, Yang M, Zhu C, He L | title = Repetitive transcranial magnetic stimulation for the treatment of amyotrophic lateral sclerosis or motor neuron disease | journal = The Cochrane Database of Systematic Reviews | issue = 5 | page = CD008554 | date = May 2013 | volume = 2013 | pmid = 23728676 | doi = 10.1002/14651858.CD008554.pub3 | pmc = 7173713 }}</ref> [[persistent vegetative state]]s,<ref name=Lefaucher1 /> [[epilepsy]],<ref name=Lefaucher1 /><ref name="PereiraMüller2016">{{cite journal | vauthors = Pereira LS, Müller VT, da Mota Gomes M, Rotenberg A, Fregni F | title = Safety of repetitive transcranial magnetic stimulation in patients with epilepsy: A systematic review | journal = Epilepsy & Behavior | volume = 57 | issue = Pt A | pages = 167–176 | date = April 2016 | pmid = 26970993 | doi = 10.1016/j.yebeh.2016.01.015 | s2cid = 3880211 }}</ref> [[stroke]] related disability,<ref name=Lefaucher1 /><ref name=Rossi /><ref name="Dimyan" /><ref name="Nowak" /><ref>{{cite journal | vauthors = Martin PI, Naeser MA, Ho M, Treglia E, Kaplan E, Baker EH, Pascual-Leone A | title = Research with transcranial magnetic stimulation in the treatment of aphasia | journal = Current Neurology and Neuroscience Reports | volume = 9 | issue = 6 | pages = 451–458 | date = November 2009 | pmid = 19818232 | pmc = 2887285 | doi = 10.1007/s11910-009-0067-9 }}</ref><ref>{{cite journal | vauthors = Corti M, Patten C, Triggs W | title = Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review | journal = American Journal of Physical Medicine & Rehabilitation | volume = 91 | issue = 3 | pages = 254–270 | date = March 2012 | pmid = 22042336 | doi = 10.1097/PHM.0b013e318228bf0c | s2cid = 16233265 }}</ref> [[tinnitus]],<ref name=Lefaucher1 /><ref>{{cite journal | vauthors = Kleinjung T, Vielsmeier V, Landgrebe M, Hajak G, Langguth B | title = Transcranial magnetic stimulation: a new diagnostic and therapeutic tool for tinnitus patients | journal = The International Tinnitus Journal | volume = 14 | issue = 2 | pages = 112–118 | year = 2008 | pmid = 19205161 }}</ref> [[multiple sclerosis]],<ref name=Lefaucher1 /> [[schizophrenia]],<ref name=Lefaucher1 /><ref name="Doug2015"/> and [[traumatic brain injury]].<ref name=TBI>{{cite journal | vauthors = Shin SS, Dixon CE, Okonkwo DO, Richardson RM | title = Neurostimulation for traumatic brain injury | journal = Journal of Neurosurgery | volume = 121 | issue = 5 | pages = 1219–1231 | date = November 2014 | pmid = 25170668 | doi = 10.3171/2014.7.JNS131826 | doi-access = free }}</ref>
With [[Parkinson's disease]], early results suggest that low frequency stimulation may have an effect on medication associated [[dyskinesia]], and that high frequency stimulation improves motor function.<ref>{{cite journal | vauthors = Machado S, Bittencourt J, Minc D, Portella CE, Velasques B, Cunha M, Budde H, Basile LF, Chadi G, Cagy M, Piedade R, Riberio P | display-authors = 6 | title = Therapeutic applications of repetitive transcranial magnetic stimulation in clinical neurorehabilitation | journal = Functional Neurology | volume = 23 | issue = 3 | pages = 113–122 | date = 2008 | pmid = 19152730 }}</ref><ref>{{Cite journal |last1=Liu |first1=Xuan |last2=Li |first2=Lei |last3=Liu |first3=Ye |date=2023-09-29 |title=Comparative motor effectiveness of non-invasive brain stimulation techniques in patients with Parkinson's disease: A network meta-analysis |journal=Medicine |volume=102 |issue=39 |pages=e34960 |doi=10.1097/MD.0000000000034960 |issn=1536-5964 |pmid=37773851|pmc=10545289 }}</ref> The most effective treatment protocols appear to involve high frequency stimulation of the [[motor cortex]], particularly on the dominant side,<ref name="Chou YH 2014">{{cite journal | vauthors = Chou YH, Hickey PT, Sundman M, Song AW, Chen NK | title = Effects of repetitive transcranial magnetic stimulation on motor symptoms in Parkinson disease: a systematic review and meta-analysis | journal = JAMA Neurology | volume = 72 | issue = 4 | pages = 432–440 | date = April 2015 | pmid = 25686212 | pmc = 4425190 | doi = 10.1001/jamaneurol.2014.4380 }}</ref> but with more variable results for treatment of the [[dorsolateral prefrontal cortex]].<ref>{{cite journal | vauthors = Yang C, Guo Z, Peng H, Xing G, Chen H, McClure MA, He B, He L, Du F, Xiong L, Mu Q | display-authors = 6 | title = Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta-analysis | journal = Brain and Behavior | volume = 8 | issue = 11 | page = e01132 | date = November 2018 | pmid = 30264518 | pmc = 6236247 | doi = 10.1002/brb3.1132 }}</ref> It is less effective than [[electroconvulsive therapy]] for motor symptoms, though both appear to have utility.<ref>{{cite journal | vauthors = Fregni F, Simon DK, Wu A, Pascual-Leone A | title = Non-invasive brain stimulation for Parkinson's disease: a systematic review and meta-analysis of the literature | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 76 | issue = 12 | pages = 1614–1623 | date = December 2005 | pmid = 16291882 | pmc = 1739437 | doi = 10.1136/jnnp.2005.069849 }}</ref><ref>{{cite journal | vauthors = Lefaucheur JP | title = Treatment of Parkinson's disease by cortical stimulation | journal = Expert Review of Neurotherapeutics | volume = 9 | issue = 12 | pages = 1755–1771 | date = December 2009 | pmid = 19951135 | doi = 10.1586/ern.09.132 | s2cid = 6404434 }}</ref><ref>{{cite journal | vauthors = Arias-Carrión O | title = Basic mechanisms of rTMS: Implications in Parkinson's disease | journal = International Archives of Medicine | volume = 1 | issue = 1 | page = 2 | date = April 2008 | pmid = 18471317 | pmc = 2375865 | doi = 10.1186/1755-7682-1-2 | doi-access = free }}</ref> Cerebellar stimulation has also shown potential for the treatment of levodopa associated dyskinesia.<ref>{{cite journal | vauthors = França C, de Andrade DC, Teixeira MJ, Galhardoni R, Silva V, Barbosa ER, Cury RG | title = Effects of cerebellar neuromodulation in movement disorders: A systematic review | journal = Brain Stimulation | volume = 11 | issue = 2 | pages = 249–260 | pmid = 29191439 | doi = 10.1016/j.brs.2017.11.015 | year = 2018 | s2cid = 46810543 }}</ref>
In [[psychiatry]], it has shown potential with [[anxiety disorders]], including [[panic disorder]]<ref>{{cite journal | vauthors = Li H, Wang J, Li C, Xiao Z | title = Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | page= CD009083 | date = September 2014 | pmid = 25230088 | doi = 10.1002/14651858.CD009083.pub2 | pmc = 6885044 }}</ref> and [[obsessive–compulsive disorder]] (OCD).<ref name=Lefaucher1 /> The most promising areas to target for OCD appear to be the [[orbitofrontal cortex]] and the [[supplementary motor area]].<ref name=Berlim2013>{{cite journal | vauthors = Berlim MT, Neufeld NH, Van den Eynde F | title = Repetitive transcranial magnetic stimulation (rTMS) for obsessive-compulsive disorder (OCD): an exploratory meta-analysis of randomized and sham-controlled trials | journal = Journal of Psychiatric Research | volume = 47 | issue = 8 | pages = 999–1006 | date = August 2013 | pmid = 23615189 | doi = 10.1016/j.jpsychires.2013.03.022 }}</ref> Older protocols that targeted the prefrontal dorsal cortex were less successful.<ref name=Saba2015>{{cite journal | vauthors = Saba G, Moukheiber A, Pelissolo A | title = Transcranial cortical stimulation in the treatment of obsessive-compulsive disorders: efficacy studies | journal = Current Psychiatry Reports | volume = 17 | issue = 5 | page= 36 | date = May 2015 | pmid = 25825002 | doi = 10.1007/s11920-015-0571-3 | s2cid = 22071333 }}</ref> It has also been studied with [[autism]],<ref name=Oberman2016>{{cite journal | vauthors = Oberman LM, Enticott PG, Casanova MF, Rotenberg A, Pascual-Leone A, McCracken JT | title = Transcranial magnetic stimulation in autism spectrum disorder: Challenges, promise, and roadmap for future research | journal = Autism Research | volume = 9 | issue = 2 | pages = 184–203 | date = February 2016 | pmid = 26536383 | pmc = 4956084 | doi = 10.1002/aur.1567 }}</ref> [[substance abuse]],<ref name=Lefaucher1 /> [[addiction]],<ref name=Lefaucher1 /><ref>{{cite journal | vauthors = Nizard J, Lefaucheur JP, Helbert M, de Chauvigny E, Nguyen JP | title = Non-invasive stimulation therapies for the treatment of refractory pain | journal = Discovery Medicine | volume = 14 | issue = 74 | pages = 21–31 | date = July 2012 | pmid = 22846200 | url = http://www.discoverymedicine.com/Julien-Nizard/2012/07/24/non-invasive-stimulation-therapies-for-the-treatment-of-refractory-pain/ | archive-url = https://web.archive.org/web/20140226110824/http://www.discoverymedicine.com/Julien-Nizard/2012/07/24/non-invasive-stimulation-therapies-for-the-treatment-of-refractory-pain/ | url-status = dead | archive-date = 2014-02-26 }}</ref><ref>{{Cite journal |last1=Ponciano-Rodríguez |first1=Guadalupe |last2=Chávez-Castillo |first2=Carlos A. |last3=Ríos-Ponce |first3=Alma E. |last4=Villafuerte |first4=Gabriel |date=2021 |title=High Frequency and Low Intensity Transcranial Magnetic Stimulation for Smoking Cessation |journal=Journal of Addiction |volume=2021 |pages=9988618 |doi=10.1155/2021/9988618 |issn=2090-7834 |pmc=8476253 |pmid=34589245|doi-access=free }}</ref> and [[post-traumatic stress disorder]] (PTSD).<ref name=Lefaucher1 /> For treatment-resistant [[major depressive disorder]], high-frequency (HF) rTMS of the left [[dorsolateral prefrontal cortex]] (DLPFC) appears effective and low-frequency (LF) rTMS of the right DLPFC has probable efficacy.<ref name=Lefaucher1 /><ref name=pmid21474597/><ref name=pmid23249815/><ref name="Perera et al 2015"/><ref name=pmid22559998/> Research on the efficacy of rTMS in non-treatment-resistant depression is limited.<ref>{{Cite journal|last1=Kiebs|first1=Maximilian|last2=Hurlemann|first2=René|last3=Mutz|first3=Julian|date=August 2019|title=Repetitive transcranial magnetic stimulation in non-treatment-resistant depression|journal=British Journal of Psychiatry|language=en|volume=215|issue=2|pages=445–446|doi=10.1192/bjp.2019.75|pmid=31014413|issn=0007-1250|doi-access=free}}</ref>
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TMS can also be used to map functional connectivity between the cerebellum and other areas of the brain.<ref>{{cite journal | vauthors = van Dun K, Bodranghien F, Manto M, Mariën P | title = Targeting the Cerebellum by Noninvasive Neurostimulation: a Review | journal = Cerebellum | volume = 16 | issue = 3 | pages = 695–741 | date = June 2017 | pmid = 28032321 | doi = 10.1007/s12311-016-0840-7 | s2cid = 3999098 }}</ref>
A study on alternative Alzheimer's treatments at the Wahrendorff Clinic in Germany in 2021<ref>{{Cite web |date=11 April
Under the supervision of Professor Marc Ziegenbein, a psychiatry and psychotherapy specialist, the study of 77 subjects with mild to moderate
Improvements were mainly found in the areas of orientation in the environment, concentration, general well-being and satisfaction.
=== Study blinding ===
Mimicking the physical discomfort of TMS with [[placebo]] to discern its true effect is a challenging issue in research.<ref name=Lefaucher1 /><ref name=Rossi /><ref name=Duecker>{{cite journal | vauthors = Duecker F, Sack AT | title = Rethinking the role of sham TMS | journal = Frontiers in Psychology | volume = 6 | page= 210 | year = 2015 | pmid = 25767458 | pmc = 4341423 | doi = 10.3389/fpsyg.2015.00210 | doi-access = free }}</ref><ref name = Davis>{{cite journal | vauthors = Davis NJ, Gold E, Pascual-Leone A, Bracewell RM | title = Challenges of proper placebo control for non-invasive brain stimulation in clinical and experimental applications | journal = The European Journal of Neuroscience | volume = 38 | issue = 7 | pages = 2973–2977 | date = October 2013 | pmid = 23869660 | doi = 10.1111/ejn.12307 | s2cid = 2152097 | url = https://zenodo.org/record/3436292 }}</ref> It is difficult to establish a convincing [[placebo]] for TMS during [[Scientific control|controlled]] [[Clinical trial|trials]] in [[conscious]] individuals due to the neck pain, headache and twitching in the scalp or upper face associated with the intervention.<ref name=Lefaucher1 /><ref name = Rossi /> In addition, placebo manipulations can affect
A 2011 review found that most studies did not report [[unblinding]]. In the minority that did, participants in real and sham rTMS groups were not significantly different in their ability to correctly guess their therapy, though there was a trend for participants in the real group to more often guess correctly.<ref>{{cite journal | vauthors = Broadbent HJ, van den Eynde F, Guillaume S, Hanif EL, Stahl D, David AS, Campbell IC, Schmidt U | display-authors = 6 | title = Blinding success of rTMS applied to the dorsolateral prefrontal cortex in randomised sham-controlled trials: a systematic review | journal = The World Journal of Biological Psychiatry | volume = 12 | issue = 4 | pages = 240–248 | date = June 2011 | pmid = 21426265 | doi = 10.3109/15622975.2010.541281 | s2cid = 21439740 }}</ref>
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====Neurosurgery planning====
===Depression===
The National Institutes of Health estimates depression medications work for 60 percent to 70 percent of people who take them.<ref>{{cite book | url=https://www.ncbi.nlm.nih.gov/books/NBK20369/|title= Information about Mental Illness and the Brain|year= 2007|publisher= National Institutes of Health (US)}}</ref><ref>
===
In August 2018, the US Food and Drug Administration (US FDA) authorized the use of TMS developed by the [[Israel]]i company [[Brainsway]] in the treatment of [[obsessive–compulsive disorder]] (OCD).<ref>{{cite web |date=2020-02-20 |title=FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm617244.htm |website=[[Food and Drug Administration]]}}</ref>
In 2020, US FDA authorized the use of TMS developed by the U.S. company MagVenture Inc. in the treatment of OCD.<ref>{{Cite web |title=MagVenture receives FDA clearance for OCD {{!}} Clinical TMS Society |url=https://www.clinicaltmssociety.org/news/2020-08/magventure-receives-fda-clearance-ocd-0 |access-date=2023-10-11 |website=www.clinicaltmssociety.org}}</ref>
In 2023, US FDA authorized the use of TMS developed by the U.S. company Neuronetics Inc. in the treatment of OCD.
====Other neurological areas====
In the [[European Economic Area]], various versions of deep TMS H-coils have [[CE marking]] for
[[Alzheimer's disease]],<ref name=OCD/>
[[autism]],<ref name=OCD/>
[[bipolar disorder]],<ref name=Chronicpain/>
[[epilepsy]],<ref>{{cite journal | vauthors = Gersner R, Oberman L, Sanchez MJ, Chiriboga N, Kaye HL, Pascual-Leone A, Libenson M, Roth Y, Zangen A, Rotenberg A | display-authors = 6 | title = H-coil repetitive transcranial magnetic stimulation for treatment of temporal lobe epilepsy: A case report | journal = Epilepsy & Behavior Case Reports | volume = 5 | issue = Supplement C | pages = 52–56 | date = 2016-01-01 | pmid = 27114902 | pmc = 4832041 | doi = 10.1016/j.ebcr.2016.03.001 }}</ref>
chronic pain,<ref name=Chronicpain/>
[[major depressive disorder]],<ref name=Chronicpain/>
[[Parkinson's disease]],<ref name="Chou YH 2014"/><ref>{{cite journal | vauthors = Torres F, Villalon E, Poblete P, Moraga-Amaro R, Linsambarth S, Riquelme R, Zangen A, Stehberg J | display-authors = 6 | title = Retrospective Evaluation of Deep Transcranial Magnetic Stimulation as Add-On Treatment for Parkinson's Disease | journal = Frontiers in Neurology | volume = 6 | pages = 210 | date = 2015-10-26 | pmid = 26579065 | pmc = 4620693 | doi = 10.3389/fneur.2015.00210 | doi-access = free }}</ref>
[[post-traumatic stress disorder]] (PTSD),<ref name=Chronicpain/><ref name=TMSPTSD>{{cite journal |title= Transcranial magnetic stimulation for post-traumatic stress disorder |pmid= 34733479 |doi= 10.1177/20451253211049921 | doi-access = free |first1= Nicholas J. |last1= Petrosino |first2= Camila |last2= Cosmo |first3= Yosef A. |last3= Berlow |first4= Amin |last4= Zandvakili |first5= Mascha |last5= van ’t Wout-Frank |first6= Noah S. |last6= Philip |journal= [[Therapeutic Advances in Psychopharmacology]] |date= 2021 |volume= 11 |pmc= 8558793 }}</ref>
[[schizophrenia]] (negative symptoms)<ref name=Chronicpain>{{cite web |url=http://www.medgadget.com/2012/07/brainsways-deep-tms-eu-cleared-for-neuropathic-chronic-pain.html|title= Brainsway's Deep TMS EU Cleared for Neuropathic Chronic Pain|date= July 3, 2012 |publisher= medGadget |access-date=December 16, 2013}}</ref>
and to aid smoking cessation.<ref name=OCD>{{cite news |url=http://www.medicaldevice-network.com/news/newsbrainsway-reports-positive-deep-tms-system-trial-data-ocd|title= Brainsway reports positive Deep TMS system trial data for OCD|newspaper= Medical Device Network|date= September 6, 2013 |publisher= Medicaldevice-network |access-date= December 16, 2013}}</ref>
One review found tentative benefit for cognitive enhancement in healthy people.<ref>{{cite journal | vauthors = Luber B, Lisanby SH | title = Enhancement of human cognitive performance using transcranial magnetic stimulation (TMS) | journal = NeuroImage | volume = 85 Pt 3 | issue = 3 | pages = 961–970 | date = January 2014 | pmid = 23770409 | pmc = 4083569 | doi = 10.1016/j.neuroimage.2013.06.007 }}</ref>
===Coverage by health services and insurers===
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==== United States: Medicare ====
Policies for Medicare coverage vary among local jurisdictions within the Medicare system,<ref>{{cite web|url=https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html|archive-url=https://web.archive.org/web/20140214094931/http://cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html|archive-date=2014-02-14|title=Medicare Administrative Contractors|publisher=[[Centers for Medicare and Medicaid Services]]|date=2013-07-10|access-date=2014-02-14|url-status=dead}}</ref> and Medicare coverage for TMS has varied among jurisdictions and with time. For example:
* In early 2012 in [[New England]], Medicare covered TMS for the first time in the United States.<ref>{{cite web|author=NHIC, Corp.|url=http://coverage.cms.fu.com/mcd_archive/viewlcd.asp?lcd_id=32228&lcd_version=5&basket=lcd%3A32228%3A5%3ARepetitive+Transcranial+Magnetic+Stimulation+%28rTMS%29%3AMAC+%2D+Part+B%3ANHIC%7C%7C+Corp%2E+%2814202%29%3A|archive-url=https://archive.today/
* In August 2012, the jurisdiction covering Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma, and New Mexico determined that there was insufficient evidence to cover the treatment,<ref>{{cite web |
* Subsequently,{{when|date=April 2021}} some other Medicare jurisdictions added Medicare coverage for depression.{{citation needed|date=April 2021}}<!-- By mid-2020, it was available in Illinois, to this editor. Acwilson9 -->
== Limitations ==
There are serious concerns about stimulating brain tissue using non-invasive magnetic field methods:
First, the uncertainty in the dose (time and technical field parameters) for correct and healthy stimulation is a complex and challenging issue.<ref>Benussi A, Pascual-Leone A, Borroni B (2020). "Non-Invasive Cerebellar Stimulation in Neurodegenerative Ataxia: A Literature Review". ''International Journal of Molecular Sciences.'' 21 (6): 1948. doi:10.3390/ijms21061948</ref> While neurophysiology lacks knowledge about the nature of such a treatment of nervous diseases at the cellular level,<ref>Rosa, MA; Lisanby, SH (2012). "Somatic treatments for mood disorders". ''Neuropsychopharmacology.'' 37 (1): 102–116. doi:10.1038/npp.2011.225</ref> this method involves excessive exposure of the brain to an intense field, which is several times and even orders of magnitude higher than natural electromagnetic fields in the brain.<ref>Grimaldi G, Argyropoulos GP, Boehringer A, Celnik P, Edwards MJ, Ferrucci R, et al. (2014). "Non-invasive cerebellar stimulation--a consensus paper" (PDF). ''Cerebellum.'' 13 (1): 121–138. doi:10.1007/s12311-013-0514-7</ref><ref>Siebner HR, Hartwigsen G, Kassuba T, Rothwell JC (2009). "How does transcranial magnetic stimulation modify neuronal activity in the brain? Implications for studies of cognition". ''Cortex; A Journal Devoted to the Study of the Nervous System and Behavior.'' 45 (9): 1035–1042. doi:10.1016/j.cortex.2009.02.007</ref>
Second, it is impossible to localize the effect of stimulation on specific neural networks that need to be treated.<ref name="Sparing and Mottaghy_2008">Sparing R, Mottaghy FM (2008). "Noninvasive brain stimulation with transcranial magnetic or direct current stimulation (TMS/tDCS)-From insights into human memory to therapy of its dysfunction". ''Methods.'' 44 (4): 329–337. doi:10.1016/j.ymeth.2007.02.001</ref>
Neuronal activity related to mental processes, neuronal correlates of cognitive functions are still intriguing questions for contemporary research. Non-invasive brain tissue stimulation targets a large area of poorly characterized tissue. An undefined dose and target of radiation can destroy healthy cells during a treatment procedure. Because it is unclear whether magnetic fields reach only those neural structures of the brain that need treatment, this uncertainty challenges the selection of treatment for neurological disorders by magnetic fields. Thus, magnetic field exposure may destroy healthy neuronal structures. The inability to localize the effect of stimulation makes it challenging to target stimulation only to the desired neural networks. <ref name="Sparing and Mottaghy_2008" />
== See also ==
|