BALI TMS 30 APRIL 2016.ppt 1.ppt

7/26/2019 BALI TMS 30 APRIL 2016.ppt 1.ppt

1/53

Aplication In Neurology

(Diagnostic, Treatment, and Research)

Jumraini Tammasse,Jumraini Tammasse,MDMD,,

Department of Neurology

Neurorestoration andNeurorestoration and

NeurorehabilitationNeurorehabilitation Faculty of Medicine


2/53

2


3/53


4/53


5/53

dArsonval (1896/1911)Phospone

Magnusson &

Stevens, 1911Thompson, 1910

Merton &Morton (1980). Successful

Transcranial Electrical Stimulation


6/53

Sheffield group 1985 : Reza Jalinous,

Ian Freeston, Tony Barer

History of TMS


7/53

Barker, 1984Barker, 1984

ad!ell

DantecMagstim

Common Modern rTMS Machines

Transcranial MagneticTranscranial Magnetic

Stimulation allows theStimulation allows theSafe, Non-invasive andSafe, Non-invasive and

Neurosoft


8/53

ROBOTIC TMS

8


9/53


10/53


11/53

What is TMS?


12/53Figure: illustration of TMS ( retrieved fro Roger!2"#$%


13/53

!

"ischargeswitch

#nerg$-storageca%acito

r

Ca%acitorcharger

Stimulatingcoil

#lectricoutlet

Controller

Magnetic &eld

'nduced

currents

(Neuronetics)


14/53

T&'es of Coils and Their ffe)ts

Single )oil:u)h larger s'atial effe)t
http://www.neurosoft.ru/eng/product/neuro-ms/index.aspxhttp://www.neurosoft.ru/eng/product/neuro-ms/index.aspxhttp://www.neurosoft.ru/eng/product/neuro-ms/index.aspxhttp://www.neurosoft.ru/eng/product/neuro-ms/index.aspx


15/53


16/53

The geoetr& of the

)oil deterines the

fo)alit& of the

agneti) field and ofthe indu)ed )urrent *

hen)e also of the

targeted +rain area,

TPractical

considerationsCoil shape


17/53

25mm

15mm20mm

70x60

55x4540x30

0

5mm

Practical Considerations- stimulation depth

Cannot stimulate medial or sub-cortical areas


18/53

-o. does a signal transit do.n fro the otor

)orte/ to the us)le to ena+le us)ular oveent

or )ontra)tion ?

(Retrieved fro 0i)hols et al,! 2"#2%


19/53

(Rossi! et a!l,"##9%,

"asic #rinciples

$f Magnetic Stimulation


20/53


21/53


22/53


23/53

DIA%N$STISR$%N$STIS


24/53

The redu)ed

a'litude of M1s

is asso)iated .itha )entral otor

)ondu)tion failure

MOTOR EVOKED

POTENTIALS


25/53


26/53

Silent period

TranscallosalInhibition


27/53

T-R314TIC


28/53


29/53


30/53


31/53

TMS for neurosurer!

'reo'erative assessent :

s'e)ifi) +rain areas

iniise the ris5 of 'ost*surgi)al

defi)its

to identif& the

language doinant heis'here!

lo)alise the language areas

intrao'erative:onitoring of

)orti)os'inal

otor tra)t fun)tion to o'tiise

surgi)al 'ro)edures,


32/53

Therapeutic "se

The lasting odulation of

)orti)al a)tivit& +& rTMS

is not

liited to otor )orti)al

areas,

rTMS )an +e indu)ed in

areas outside the otor

)orte/ and +e asso)iated

.ith easura+le

+ehavioural effe)ts!

This finding raises the

'ossi+ilit& of

thera'euti)

a''li)ations of rTMSto

6noralise7

'athologi)all&

de)reased orin)reased levels of

)orti)al a)tivit&,


33/53

Therapeutic rTMS in Neurology

entral Ner'ous System #eripheral Ner'ous System


34/53

3fter 'h&siologi)al

studies of tas5*

s'e)ifi) d&stonia

suggestedh&'ere/)ita+ilit& of

the otor )orte/ or a

failure of intra)orti)al

inhi+ition!


35/53

Main 1oint of TMS


36/53

Indication and ontraindication

of TMS


37/53

3)ute 1hase Stro5e -eorrhagi)


38/53

Side ffe)ts fro TMS

The ost )oon side effe)ts

are:

-eada)hes usuall& of ild

intensit&

is)ofort or 'ain at thestiulation site

&e us)le t.it)hing (during

treatent%

T.it)hing in other us)les

near stiulation site 9ou .ill +e as5ed to .ear ear

'lugs during &our treatent to

'rote)t &our hearing

Transcranial Magnetic Stimulation


39/53

le)troagneti) indu)tion of)urrent in )orte/

ire)tl& a)tivates )ir)uits Freuen)&*de'endent ;T1*

and ;T*li5e effe)ts 3)ute effe)ts * Ma''ing

< li)its o+serva+le res'onses

(otor t.it)h%< isru'ts (e,g, s'ee)h arrest%

or fa)ilitates 'ro)essing

;asting effe)ts*0euro'lasti)it&< S&na'ti) effi)a)&! ;T1=;T

< 0eurotro'i) fa)tors< Modulates )orti)al e/)ita+ilit&< Modulates fun)tional

)onne)tivit&

Transcranial Magnetic Stimulation


40/53

he TMS Coittee of the International Federation of Clini)al

0euro'h&siolog& suggests that TMS should not+e used under

these )ir)ustan)es:

The 'resen)e of etal an&.here in the head! e/)luding the outh,

This in)ludes shra'nel! and s)re.s and )li's fro surgi)al

'ro)edures,

TMS also should not +e 'erfored in 'atients .ith ele)trodes

inside the heart .hi)h ight 'rovide a lo.*resistan)e )urrent 'athto ele)tri)all& sensitive tissue,

1ersons .ith in)reased intra)ranial 'ressure! as in a)ute large

intra)ranial infar)tions or traua! are also at in)reased ris5 in the

event of a sei>ure! and should not re)eive TMS,

Safet& of TMS during 'regnan)& has not +een esta+lished!

therefore 'regnant .oen are not 'otential )andidates for TMS atthis tie,

Finall&! great )aution is needed .hen a''l&ing TMS to su+e)ts

.ith a histor& of sei>ures! a fail& histor& of e'ile's&! and 'atients

ta5ing edi)ation that ight in)rease the ris5 of sei>ures,


41/53

Neurophysiology Related to rTMS in

#ost&stroe Dysphagia

@in*Woo 1ar5 2"#A


42/53


43/53

Sei>ure 2" )ases of sei>ure re'orted .orld.ide

Single 'ulse TMS thought to +ee/treel& safe! sei>ure ris5

in)reases .ith freuen)& of stiulation 0eed safet& eui'ent on hand

in)luding 3tivan! )rash )art S&n)o'e Tension heada)he @a. 'ain = fa)ial 'ain -earing loss (ear 'rote)tion reuired%

$


44/53

Masahito o*ayashi and Al'aro

#ascual&+eone -.

TMS )an +e used )lini)all& to easure a)tivit& and fun)tion ofs'e)ifi) +rain )ir)uits in huans


45/53

ffi)a)& of re'etitive trans)ranial agneti) stiulation

for the treatent of refra)tor& )hroni) tinnitus: a

randoi>ed! 'la)e+o )ontrolled stud&,

S l t d R f Ti it


46/53

Selected References Tinnitus


47/53

TMS AND MI%RAIN/S


48/53

hronic #ain


49/53


50/53


51/53


52/53


53/53

BALI TMS 30 APRIL 2016.ppt 1.ppt

Documents

Transcript of BALI TMS 30 APRIL 2016.ppt 1.ppt