Introduction to Parkinson’s Disease
Parkinson’s disease (PD) is a neurodegenerative disorder primarily impacting the brain region responsible for coordinating limb movements. While it commonly manifests in older individuals, there’s a variant known as young-onset PD, which initiates in one’s 40s. PD is characterized by symptoms such as tremors, slowed movements (bradykinesia), stiffness, reduced expressiveness, low voice, and a cautious, small-stepped gait. Gait disturbances can lead to an increased risk of falls, further compromising the patient’s quality of life. In addition to motor symptoms, PD is associated with psychiatric manifestations like hallucinations, emotional instability, and sleep disturbances. While medications are the primary treatment for PD, their efficacy diminishes over time, and adverse effects can limit their use.
Transcranial Magnetic Stimulation (TMS) is an FDA-approved, non-invasive, and painless method that has demonstrated promising results in recent studies, particularly in psychiatric conditions. TMS works by modulating cortical excitability and presents an innovative approach for managing symptoms associated with Parkinson’s disease.
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Candidacy for TMS in Parkinson’s
Patients exhibiting the following conditions are considered potential candidates for Transcranial Magnetic Stimulation (TMS):
Parkinson’s Disease (PD):
- PD patients with a short, stepped, hesitant gait and stooped posture.
- Functional decline and a tendency to fall.
- Stiffness and slowing of movement, which may progress to the point of dependency for daily needs.
- Increased impairment in daily functioning and a poor quality of life in advanced PD patients.
- Likelihood of experiencing depression, anxiety, and low mood.
Other Conditions:
- Patients with conditions such as pregnancy, hypertension, diabetes, thyroid disorders, kidney diseases, and heart diseases can also participate in TMS treatment.
- The presence of medical devices commonly used nowadays, such as stents, pacemakers, coils, orthopedic implants, etc., is usually MRI compatible and does not interfere with TMS.
- It’s important to note that TMS can be a viable option for a diverse range of patients, including those with neurological conditions like Parkinson’s Disease and individuals with various medical backgrounds. If you have specific questions or need more details, feel free to ask.
Present Literature
Transcranial Magnetic Stimulation (TMS) has been extensively researched since the 1980s, with numerous studies published in peer-reviewed journals showcasing positive outcomes and minimal adverse effects. Notable studies on TMS in Parkinson’s disease (PD) include:
A controlled, randomized study in Europe with 60 patients, revealed significant improvement in UPDRS III in patients receiving real TMS compared to the control group, particularly in motor scales.
A study with 27 PD patients undergoing 12 Deep TMS sessions in both motor and prefrontal cortical regions alongside medication. Improvement in gait, motor rigidity, tremors, and slowness of movement was observed.
Real-world data analysis from a German hospital, retrospectively showed a significant reduction in non-responsive Parkinson’s symptoms post-Deep TMS sessions. Improved depression and mood levels were also noted, with greater benefits seen in the older population.
A randomized controlled experiment was conducted in Hong Kong involving fifty participants explored the effects of TMS on gait. The study suggested that TMS can enhance the benefits of treadmill training, leading to long-term motor improvement up to three months post-intervention.
Method
Transcranial Magnetic Stimulation (TMS) is a non-invasive form of Neuromodulation that involves the low-energy magnetic stimulation of a specific brain site through the skull. This stimulation is delivered using a specially designed coil incorporated into a helmet. Here’s an overview of the TMS procedure:
- Patient Arrival and History: When the patient arrives, the nurse gathers a detailed medical history and updates the doctor.
- Protocol Discussion: The doctor discusses the most suitable protocol with the patient, determining the session duration, frequency per week, and the total number of sessions.
- Confirmation and Computer Input: Once confirmed, the protocol details are input into the computer system.
- Motor Threshold Evaluation: The patient undergoes necessary evaluations to determine the Motor Threshold (MT) by applying stimulation through the helmet.
- TMS Administration: Following pre-designed protocols, TMS is administered to the patient.
- Session Details for PD Patients: For Parkinson’s disease (PD), the patient typically undergoes about 12 sessions over four weeks, with each session lasting approximately 30-40 minutes.
- No Sedation or Fasting Required: The procedure does not require sedation or anesthesia, and the patient is not required to fast before the session.
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Why Should You Choose Jaslok Hospital for TMS?
The Jaslok Hospital & Research Centre stands as one of the oldest tertiary care, multi-specialty Trust hospitals in the country. The hospital is actively involved in ongoing research activities across various fields, collaborating with institutions in India and abroad. Within its framework, there exists a dedicated “Restorative and Regenerative Medicine” department comprising consultants with over 20 years of experience.
Equipped with cutting-edge technology and equipment from the internationally reputed “Brainsway” company, the department features the advanced H1-7 coils, a departure from conventional coils. This technology facilitates the delivery of noninvasive deep Transcranial Magnetic Stimulation (TMS) with precision, aiming to achieve optimal results. The equipment holds FDA and CE clearance for treating various neurological and psychiatric conditions. Notably, deep TMS expands the capabilities beyond the limitations of conventional TMS by reaching specific target sites like the insula and cingulate gyrus.