Repetitive Transcranial Magnetic Stimulation (rTMS/TMS)

One such potential treatment showing strong promise for the non-invasive treatment of Parkinson's disease is Repetitive Transcranial Magnetic Stimulation (rTMS) or Transcranial Magnetic Stimulation (TMS). A TMS coil generates an electromagnetic field that is delivered transcranially to the subject. It should be noted that the rTMS coil utilizes a magnetic field strength millions of times more powerful than the ones used by the Resonator™ device.

rTMS works by inducing electrical currents in tissue using a non-invasive stimulating coil at frequencies of up to 100Hz. The stimulating coil is placed near the intended site of stimulation and trigger pulses initiate brief magnetic pulses. rTMS is a way of stimulating the brain that may change the electrical activity of the nerve cells in the brain. It has been proposed as a treatment for brain disorders, including Parkinson's disease. The magnetic fields can pass through clothing, tissue and bone to reach otherwise inaccessible areas.

The all-encompassing potential of rTMS is exemplified in the abstracts below:

1. Mechanisms and state of the art of transcranial magnetic stimulation.
   J. ECT., 2002 Dec;18(4):170-81.
   George MS, Nahas Z, Kozel FA, Li X, Denslow S, Yamanaka K, Mishory A, Foust MJ, Bohning DE.
   Psychiatry Department, Center for Advanced Imaging Research, Medical University of South Carolina, Charleston, SC 29425, USA.

   In 1985, Barker et al. built a transcranial magnetic stimulation (TMS) device with enough power to stimulate dorsal roots in the spine. They quickly realized that this machine could likely also noninvasively stimulate the superficial cortex in humans. They waited a while before using their device over a human head, fearing that the TMS pulse might magnetically "erase the hard-drive" of the human brain. Almost 10 years later, in 1994, an editorial in this journal concerned whether TMS might evolve into a potential antidepressant treatment. In the intervening years, there has been an explosion of basic and clinical research with and about TMS. Studies are now uncovering the mechanisms by which TMS affects the brain. It does not "erase the hard-drive" of the brain, and it has many demonstrated research and clinical uses including modulating cortical-limbic loops.

2. "Mechanisms and the current state of transcranial magnetic stimulation.
   CNS Spectr. 2003 Jul;8(7):496-514.
   George MS, Nahas Z, Kozol FA, Li X, Yamanaka K, Mishory A, Bohning DE.
   Psychiatry Department, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

   Transcranial magnetic stimulation (TMS) is unique among the current brain stimulation techniques because it is relatively non-invasive. TMS markedly differs from vagus nerve stimulation, deep brain stimulation and magnetic seizure therapy, all of which require either an implanted prosthesis or general anesthesia, or both. Since its rebirth in its modern form in 1985, TMS has already shown potential usefulness in at least three important domains-as a basic neuroscience research instrument, as a potential clinical diagnostic tool, and as a therapy for several different neuropsychiatric conditions. The TMS scientific literature has now expanded beyond what a single summary article can adequately cover. TMS' ability to non-invasively and focally stimulate the brain of an awake human is proving to be a most important development for neuroscience in general, and neuropsychiatry in particular.”

3. "Transcranial magnetic stimulation in clinical practice.
   Medicina (Kaunas). 2005;41(10):813-24.
   Alisauskiene M, Truffert A, Vaiciene N, Magistris MR.
   Clinic of Neurology, Kaunas University of Medicine, Kaunas, Lithuania.

   Transcranial magnetic stimulation allows a non-invasive and painless stimulation of the human brain and cranial nerves. The method is in use since 1985. Transcranial magnetic stimulation can use single stimuli, pairs of stimuli separated by different intervals (to the same or to several brain areas), or trains of repetitive stimuli at various frequencies. Single stimuli give rise to motor evoked potentials that have clinical use and serve diagnostic and prognostic purposes. Repetitive transcranial magnetic stimulation can modify excitability of cerebral cortex. Repetitive transcranial magnetic stimulation has opened a new field of investigation of the neural circuitry, and is developing into a therapeutic tool.”

One prominent rTMS device is the Magstim range of magnetic nerve stimulators (www.magstim.com). The first commercial magnetic stimulators were produced in Sheffield in 1985 and the Magstim Model 200, based on the original Sheffield design, was launched in 1986. Since then, subsequent models have been launched, including Magstim 200² and Bistim² systems. Magstim Rapid² magnetic stimulators combine stimulation frequencies from 1Hz to 100Hz.

The 510(k) History for the Magstim magnetic stimulator products is as follows:

1. K871338: 8/4/87: Novametrix Model 200 Magstim.
2. K992911: 1/7/00: Magstim Rapid
3. K051864: 12/21/05. Magstim Rapid2, Magstim Super Rapid2.

For all of the above 510(k)s, the following information is applicable:

• Classification Product Code: GWF
• Device Classification Name: Stimulator, Electrical, Evoked Response.
• Classification/Review Advisory Committee: Neurology

The devices are indicated for: “Stimulation of peripheral nerves.”

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Other Forms of Deep Brain Stimulation

Doctor’s looking to refer patients suffering from Parkinson’s disease can contact Pico-Tesla for information on their clinical trials, now being conducted in Colorado, Michigan and Florida. During the trial, patients will be exposed to a low strength magnetic field around their body to test how this new pulsed magnetic therapy treats symptoms of Parkinson’s disease. Patients must qualify for the clinical trial, and also complete the procedure, before they can be compensated.

All Pico-Tesla office locations where these clinical trials are being held are in close proximity to major cities in each state. Any interested party can contact Pico-Tesla for more information.