The New Inovation
-
Upload
rajaalfatih -
Category
Documents
-
view
243 -
download
0
Transcript of The New Inovation
-
7/29/2019 The New Inovation
1/51
Dr.AGUS SOLICHIEN,SpS,MARS
-
7/29/2019 The New Inovation
2/51
Treatment Diagnostic
-
7/29/2019 The New Inovation
3/51
Trans cranial Magnetic Stimulation/PeripheralMagnetic Stimulation
Found by Anthony Barker 1985
Diagnostic tool
Therapeutic tool (rTMS)
-
7/29/2019 The New Inovation
4/51
Magnetic field product by Neuro MS
Intensities up to 2.5 tesla
Magnetic field was given to the head (cranial)
and body (peripheral)
-
7/29/2019 The New Inovation
5/51
-
7/29/2019 The New Inovation
6/51
6
Capacitor is charged to high voltage (0-3,000 V)
Capacitor is discharged into stimulating coil (current 0-8,000 A)
Magnetic field is induced around stimulating coil (0-2.5 T)
Dischargeswitch
Energy-storage
capacitor
Capacitorcharger
Stimulatingcoil
Electricoutlet
Controller
Magneticfield
Inducedcurrents
[Neuronetics]
-
7/29/2019 The New Inovation
7/517
Current pulse in Neuro MS coil inducesmagnetic field
Magnetic field pulse induces electricalcurrents in brain
Principle of electromagnetic induction,also used in electrical transformers
Magnetic field has to change rapidly;Putting fridge magnets on your headwont do
+- --
-
--
--
-
- ---
--
-
++++
+
+ ++ +
+++++
+
- --
---
+ +
--
Magneticfield
Electric field
Axon
Induced currents depolarizeaxons and make them fire
[Ruohonen & Ilmoniemi, 2005]
-
7/29/2019 The New Inovation
8/518
[Walsh & Pascual-Leone, 2003]
Neuronal Membrane Potential
Coil current (a) induces magnetic
field (b)
Changing magnetic field (c)
induces electric field (d) in brain
Electric field (d) induces electric
current (e) in brain tissue Induced currents (e) depolarize
neuronal membranes (f)
Neuronal depolarization (f)
modulates neuronal firing,
resulting in behavioral effects (g)
f
g
-
7/29/2019 The New Inovation
9/51
Continues stimulation may change nervespolarity.
Clinical improvement
Effect magnetic to ferum made oxygenationcirculation improve.
-
7/29/2019 The New Inovation
10/51
Sherrington dan Cajal : Proses belajarperubahandisynap LTP
Hebbian Synap: synap yang meningkat efektifnyadi pre dan post synap oleh kerena aktivitas yangterus menerus.
LTP : jika satu atau lebih akson yang terhubungdengan beberapa dendrit dilakukan stimulasisecara serial dan singkat menggunakan frekuensi
yang tinggi maka akan terjadi ledakan stimulasiyang menimbulkan synap menjadi lebih responterhadap rangsang baru yang sejenis untukbeberapa menit, hari, bahkan minggu.
-
7/29/2019 The New Inovation
11/51
LTP : menunjukan tiga basis seluler dalambelajar dan memori:
1. Spesifisity Jika beberapa synap yang masuk
kedalam sel sangat aktif sedangkan yang laintidak, maka yang aktif yang akan menjadi kuat.
2. Cooperativity Jika stimulasi dilakukan padalebih dari satu akson maka akan menghasilkanefek LTP yang lebih kuat dibandingkan bilasatu akson saja.
-
7/29/2019 The New Inovation
12/51
Ex: akson A dan B :aktif,B dan C :tidak, A dan B
akan lebih kuat sebaliknya B dan C akan tetap samaatau melemah ( Sejnowski, Chattarji, n Stanton)
3. Asosiativityjika input berpasangan antara yg
lemah dgn yang kuat akan memperkuat input yglemah. Synap yg ke LTP akan seperti Hebiansynap, kecuali LTP membutuhkan depolarisasi didenrit yg tidak perlu potensial aksi.
LTD berkebalikan dgn LTP stimulasi dengan lowfrekuensi.
-
7/29/2019 The New Inovation
13/51
-
7/29/2019 The New Inovation
14/51
-
7/29/2019 The New Inovation
15/51
15
Monophasic Biphasic
Magnetic
Field
NeuronalMembrane
Potential
Electric
Field
More selective stimulation
Single-pulse devices
Less selective stimulation
Rapid-rate devices
-
7/29/2019 The New Inovation
16/51
16
double cone
Circular (round) coil
Non-focal
Medium efficiency
Fast field falloff
Figure-of-8 (double) coil
Focal
Low efficiency
Fast field falloff
magnetic flux
-
7/29/2019 The New Inovation
17/51
17
Figure-of-eight coil stimulates focally under intersection of two loops
Circular equally stimulates all structures under the loop If tilted, circular coil becomes more focal
[Ruohonen & Ilmoniemi, 2005]
-
7/29/2019 The New Inovation
18/51
18
Small coil: focal, small depth
Large coil: diffuse, larger depth
Fundamental physics constraints:
Larger coils can stimulate deeperbrain structures, but are less focal
Smaller coils stimulate the cortexmore focally, but cannot stimulate
deeper structures
-
7/29/2019 The New Inovation
19/51
-
7/29/2019 The New Inovation
20/51
Brain: ( Neurology) Stroke therapy Parkinson Epilepsy Tinnitus Suppression Vertigo Cognitive Studies Sleep research ADHD Smoking cessation Inducing Dyscalculia
-
7/29/2019 The New Inovation
21/51
Brain: (Psychiatry)
Schizophrenia
Depression
OCD
Manic Depression
-
7/29/2019 The New Inovation
22/51
Peripheral :
Pain Management
Arthritis
Bone healing
Muscle soreness
Chronic Low Back Pain
Aid Diaphragm Contraction Fibromyalgia
-
7/29/2019 The New Inovation
23/51
Systemic
Neurological
Psychiatric
-
7/29/2019 The New Inovation
24/51
Gastrointestinal: nausea
Cardiovascular: theoretical, but none reported
Musculoskeletal: back pain, muscle pain,
muscle twitch, arthralgias Hormonal: incr TSH (George 1996); incr
prolactin (1 patient, George, unpubl); negresults for ACTH, PRL, TSH, LH, FSH
Immunologic: CD8+ T-cell (+/-) Skin: erythema, burn (e-shield)
-
7/29/2019 The New Inovation
25/51
Pain: Treatment site: scalp muscle
Treatment site: superficial nerves/branches
Headache
Paresthesias
General:
Fatigue
Malaise
Dizziness
-
7/29/2019 The New Inovation
26/51
Mostly generalized TC; at least one partial
Single pulse vs repetitive
Frequency
Intertrain interval
Structural brain lesions--cortical
Concomitant medications Epilepsy or seizure history, family history
-
7/29/2019 The New Inovation
27/51
As of 2000, 6 seizures in normal controls, 2 inpatients with depression
Site of stimulation: primary motor cortex
No long-term sequelae (except 1 patient withstructural lesion-->epilepsy)
Short-term mild recall deficits (24h)
Normal EEG (Loo 1999)
-
7/29/2019 The New Inovation
28/51
Inefficacy
Anxiety
Acute dysphoria/crying
Laughing (speech arrest study)
Suicidal ideation
Switch to mania
-
7/29/2019 The New Inovation
29/51
Metal implants
Pacemakers, implanted medication pumps
Unstable CV disease
Increased intracranial pressure
Pregnancy
Children
-
7/29/2019 The New Inovation
30/51
Stroke Patients ( 12 orang)
Stimulasi Frekuensi 1HZ, Train 50 X, Pause5,Sesion 10 Serial 5hari ,Power 80%-100%
Perbaikan motorik Perbaikan cognitive
Perbaikan pola tidur
-
7/29/2019 The New Inovation
31/51
-
7/29/2019 The New Inovation
32/51
Parkinson syndrome: (4 orang)
Frekuensi 1HZ ,Train 50X, Pause 5,Sesion 10
Power 80%
Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5Power 100%
Perbaikan gerakan
Tremor berkurang Perbaikan pola tidur
-
7/29/2019 The New Inovation
33/51
FromJournal WatchPhysician-authored summaries and commentaryfrom the publishers of the New Engl and Journalof MedicineJournal Watch NeurologyAugust 21, 2003Repetitive Transcranial Magnetic Stimulation to Treat Parkinson DiseasePosted 10/06/2003SummaryRepetitive transcranial magnetic stimulation (rTMS) of the brain is a noninvasive, well-tolerated technique that can modify cerebral cortex excitability both locally and at remote,but functionally connected, areas (Lancet Neurology 2003; 2:145). Initial research on rTMSfor motor function in Parkinson disease (PD) showed promising results (Neurology 1994;44:892), but later research failed to confirm initial find ings (e.g., Neurology 1999; 52:768)and has yielded mostly conflicting results. Now, two groups of researchers report results
with further variations on rTMS in PD.
http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664http://www.medscape.com/viewpublication/664 -
7/29/2019 The New Inovation
34/51
Pasien post CKS dengan gangguan memory,disfasia
Frekuensi 1HZ,Train 50X,Pause 5 Sesion 10
Power 80% Frekuensi 2,5HZ,Train50X,Pause 5,Sesion 5
Power 80%
Perbaikan dramatis memory dan disfasia Perbaikan pola tidur
-
7/29/2019 The New Inovation
35/51
Pasien Ischialgia dan Cronic LBP (30 orang)
Frekuensi 2,5 HZ, Train 50X,Pause 5Sesion 5
Power 40%
Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5Power 50%
Hasil : Perbaikan Nyeri
Perbaikan ADL
-
7/29/2019 The New Inovation
36/51
Pasien Bells Palsy (3 orang)
Celah mata 3mm,sudut nasolabialis -
Frekuensi 2,5 HZ, Train 50X,Pause 5Sesion 5
Power 40% Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5
Power 50%
Hasil : Perbaikan muka simetris setelah 4Xstimulasi
-
7/29/2019 The New Inovation
37/51
Pasien gangguan memory (2 orang)
Frekuensi 2,5 HZ, Train 50X,Pause 5Sesion 5
Power 40%
Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5Power 50%
Hasil : Perbaikan fungsi memory
-
7/29/2019 The New Inovation
38/51
Pasien Hiperventilation Syndrome (10 orang)
Frekuensi 2,5 HZ, Train 50X,Pause 5Sesion 5
Power 40%
Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5Power 50%
Hasil : Perbaikan symptomatik
-
7/29/2019 The New Inovation
39/51
Pasien Vertigo, Dizziness, Tinitus (7 orang)
Frekuensi 2,5 HZ, Train 50X,Pause 5Sesion 5
Power 40%
Frekuensi 5HZ,Train 50X,Pause 5,Sesion 5Power 50%
Hasil : Perbaikan fungsi memory
-
7/29/2019 The New Inovation
40/51
Pasien ADHD, Autis, DownSyndrome,Dyscalculi (4 orang)
Perbaikan klinis.
-
7/29/2019 The New Inovation
41/51
-
7/29/2019 The New Inovation
42/51
-
7/29/2019 The New Inovation
43/51
66
-
7/29/2019 The New Inovation
44/51
Hari Ke 3
-
7/29/2019 The New Inovation
45/51
-
7/29/2019 The New Inovation
46/51
-
7/29/2019 The New Inovation
47/51
-
7/29/2019 The New Inovation
48/51
-
7/29/2019 The New Inovation
49/51
-
7/29/2019 The New Inovation
50/51
-
7/29/2019 The New Inovation
51/51