Smaller Subjects: TMS in Children and Animals
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Update: Transcranial Magnetic Stimulation (TMS) in Epilepsy Alexander Rotenberg, M.D., Ph.D. Director, Neuromodulation Program Boston Children’s Hospital, Harvard Medical School
Transcript of Smaller Subjects: TMS in Children and Animals
Update: Transcranial Magnetic
Stimulation (TMS) in Epilepsy
Alexander Rotenberg, M.D., Ph.D.
Director, Neuromodulation Program
Boston Children’s Hospital, Harvard Medical School
Conflict of Interest Disclosure
Current:Neuromotion Inc. (technology for improving emotional control; co-founder)Brainsway Inc. (research support [equipment and personnel])Soterix Medical Inc. (research support [equipment])Neuroelectrics Inc. (research support [equipment])Journal of Central Nervous System Diseases (EIC)NIH NIMH, DoD, CIMIT, ERF, TRP (research grants)
Past:Neuropace Inc. (research grant and equipment)
Nexstim Inc. (consultant) Sage Therapeutics Inc. (consultant)Fisher Family Fund and Fisher-Wallace Inc. (research support [unrestricted gift and equipment])
Alexander Rotenberg
TMS Basics
Frye, Rotenberg, et al. Child Neurol 2007
Perilesional mapping (Najib et al., 2011)
TMS FDA Status: four devices approved
Neuronetics: major depression
Nexstim: motor / language mapping
Brainsway: major depression
eNeura: migraine
Better seizure control with improved targeting in TLE: 1 Hz rTMS in TLE; trial in progress
Deep TMS H-Coil SystemBrainsway Inc.
Epilepsy Therapy Project (PI: Rotenberg)
Boston Children’s HospitalNeuromodulation Program
Change in Wechsler Memory Scale
% B
ase
line
*
Sham
Verum
* Multifocal epilepsy
Change in Seizure Frequency
% B
ase
line
*
Sham
Verum
* Multifocal epilepsy
Seizure frequency around rTMS block
Se
izu
res
pe
r d
ay
*
rTMS
Change in Seizure Frequency (%)
Nontarget rTMS
Target rTMS
Placebo rTMS
2.0-71.6 --6.0
2 Weeks After rTMS
1
Conditioning TMS
2Test TMS
50 ms
Paired-pulse MEP inhibition
Measures of Cortical Inihibition by Paired-Pulse TMS (ppTMS) in Epilepsy
Rotenberg and Pascual-Leone, 2010
200ms ISI
Time
Pre 1WK 2WKS 3WKS 4WKS 5WKS 6WKS
Ra
tio
0.0
0.2
0.4
0.6
0.8
1.0
Sham control
TBI
*** *
*
**
Hsieh et al. ETP 2013; in progress
Loss of cortical inhibition after TBI
42
Sham control Post-TBI (peri-lesion)
42 6 6PV
42
Post-TBI (contra-lesion)
6I
II/III
V
VI
*
***
****n.s. n.s.
Peri-lesion Contra-lesion
Gradual loss of parvalbumin (PV)-cells after TBI
ppTMS as a biomarker in TBI treatment
Goodrich et al., J. Neurotrauma 2013
Hameed et al., in progress
Colleagues and mentors– Narong Auvichayapat – Khon Kaen U.,
Thailand– Paradee Auvichayapat - Khon Kaen U.,
Thailand– Marom Bikson - CUNY– Blaise Bourgeois - BCH– Dana Ekstein – Hadassah, Israel– Felipe Fregni – Spaulding Rehab / MGH– Joseph Gonzalez-Heydrich - BCH– Takao Hensch - BCH– Frances Jensen – U Penn– Anli Liu - NYU– Tobias Loddenkemper - BCH– Xavier Navarro – UAB, Barcelona– Alvaro Pascual-Leone - BIDMC– James Riviello - Columbia– Paul Rosenberg - BCH– Steve Schachter – CIMIT / BIDMC– Masanori Takeoka - BCH– Abraham Zangen – BGU, Israel
THANKS!Support:NIN NINDSDepartment of DefenseCIMITEpilepsy Research FoundationCitizens United for Research in EpilepsyChildren’s Hospital Translational Research ProgramChildren’s Hospital Department of NeurologyAl Rashed family; Siegel family; Fisher Family
Current and recent lab members–Andrew Vahabzadeh–Tsung-Hsun Hsieh–Sameer Dhame–Roman Gersner–Michaela Levin–Zhihong Zhou–Mustafa Hameed–Mutafa Sahin–Henry Lee–Carmen Parades–Masoud Majed–Richard Manfready
