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Aplication In Neurology
(Diagnostic, Treatment, and Research)
Jumraini Tammasse,Jumraini Tammasse,MDMD,,
Department of Neurology
Neurorestoration andNeurorestoration and
NeurorehabilitationNeurorehabilitation Faculty of Medicine
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2
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dArsonval (1896/1911)Phospone
Magnusson &
Stevens, 1911Thompson, 1910
Merton &Morton (1980). Successful
Transcranial Electrical Stimulation
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Sheffield group 1985 : Reza Jalinous,
Ian Freeston, Tony Barer
History of TMS
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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
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ROBOTIC TMS
8
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What is TMS?
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12/53Figure: illustration of TMS ( retrieved fro Roger!2"#$%
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!
"ischargeswitch
#nerg$-storageca%acito
r
Ca%acitorcharger
Stimulatingcoil
#lectricoutlet
Controller
Magnetic &eld
'nduced
currents
(Neuronetics)
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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.aspx7/26/2019 BALI TMS 30 APRIL 2016.ppt 1.ppt
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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
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25mm
15mm20mm
70x60
55x4540x30
0
5mm
Practical Considerations- stimulation depth
Cannot stimulate medial or sub-cortical areas
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-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%
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(Rossi! et a!l,"##9%,
"asic #rinciples
$f Magnetic Stimulation
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DIA%N$STISR$%N$STIS
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The redu)ed
a'litude of M1s
is asso)iated .itha )entral otor
)ondu)tion failure
MOTOR EVOKED
POTENTIALS
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Silent period
TranscallosalInhibition
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T-R314TIC
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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,
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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&,
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Therapeutic rTMS in Neurology
entral Ner'ous System #eripheral Ner'ous System
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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!
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Main 1oint of TMS
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Indication and ontraindication
of TMS
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3)ute 1hase Stro5e -eorrhagi)
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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
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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
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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,
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Neurophysiology Related to rTMS in
#ost&stroe Dysphagia
@in*Woo 1ar5 2"#A
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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%
$
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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
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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
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Selected References Tinnitus
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TMS AND MI%RAIN/S
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hronic #ain
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