Transcranial Magnetic Stimulation (TMS): an innovative approach to neurological, psychiatric and addiction treatment.
Transcranial magnetic stimulation (TMS) is an innovative and very promising treatment for various neurological and psychiatric pathologies, the use of which has been approved by the American Food and Drug Administration (FDA) and by the European Community.
It is used in the treatment of the following pathologies:
- Depressive disorders
- Bipolar Disorders
- Obsessive Compulsive Disorder
- Anxiety disorders Personality disorders
- Psychotic disorders
- Disorders related to substances of abuse and addictive disorders
- Disorders related to traumatic and stressful events
- Gilles de la Tourette syndrome
- Alzheimer's disease
- Parkinson's disease
It is usually carried out in synergy with other therapies, such as e.g. pharmacology, psychological interviews and rehabilitation. This technology has recently been used at the Santa Caterina da Siena Clinic in Turin for the treatment of these pathologies.
What is Transcranial Magnetic Stimulation (TMS)?
The functioning of TMS is based on a known phenomenon, namely the neuroplasticity of the brain: neurons modify their structure and function as a result of stimuli, traumas or pathologies.
Transcranial magnetic stimulation can restore neuronal cells to the status quo, contributing to the regression of some psychiatric and neurological pathologies. The technique has low side effects compared to pharmacological therapies, such as a slight sense of dizziness or headaches, which subside over time. However, the procedure is not indicated on patients who have clips or stents for aneurysms, prostheses or metal splinters in the neck-head area, or face tattoos made with an ink containing metals.
TMS is a particularly advantageous therapy because it does not require anesthesia or recovery time after the session, so the patient can immediately return to his daily life.
How does the Transcranial Magnetic Stimulation procedure work?
The treatment is painless, the patient is asked to remove earrings, jewelry, glasses, credit cards and other objects that could interact with the magnetic waves. TMS is performed sitting down, wearing headphones to block out noise and placing the head under a device that generates a magnetic field. The emitted waves interact with the neuronal cells located in the areas responsible for controlling mood or motor skills, depending on the objective of the treatment and the pathology to be treated. Thus a process of neuromodulation occurs.
What science says about TMS?
Scientific studies carried out so far on TMS show that it is a promising technology. In particular, a study published in 2018 in The Lancet, a prestigious international scientific journal, reports that 47% of patients treated with TMS for major depression responded to therapy and 27% achieved remission of symptoms.
Further studies show that TMS is a promising technology to treat neurological pathologies such as Alzheimer's and Parkinson's disease on which it seems to have efficacy in the remission of motor and cognitive symptoms. In general, the data confirm the efficacy of transcranial magnetic stimulation in neurophysiological pathologies and its safety as a minimally invasive technique with low risk for the patient.
TMS and the treatment of depression
In the treatment of depression, today it is customary to use multiple therapeutic approaches in an integrated manner. Generally, we talk about drug therapy and psychotherapy. TMS aims to modulate neuronal activity through the magnetic impulses emitted by a device and can be used both as an integration to traditional therapies, drugs and psychotherapy, to improve the effects of traditional treatments, and as an alternative to medical therapy.
In particular, it can be indicated, together with psychotherapy, for those patients who have contraindications to taking drugs due to other pathologies (heart disease, liver disease, nephropathy) or in patients who refuse drug therapy due to experienced side effects or simple personal aversion. A very recent study from 2021, published by PubMed confirms the effectiveness of TMS in regressing the symptoms of drug-resistant depression.
TMS and the treatment of Parkinson's and Alzheimer's
Transcranial Magnetic Stimulation (TMS) is utilized in treating both Alzheimer's and Parkinson's diseases. For Alzheimer's patients, TMS targets the precuneus, a brain region associated with memory functions, which is affected early in the disease. By stimulating the precuneus, TMS helps counteract the disconnection between brain regions, slowing cognitive decline and aiming to preserve memory function.
Early intervention is crucial for effectiveness, requiring accurate diagnosis and timely treatment. TMS for Parkinson's patients focuses on the motor cortex, aiding traditional medication and physiotherapy to improve motor symptoms. This combined approach shows promise in enhancing movement control and managing the disease's progression.
TMS and cognitive behavioral therapy for addiction
Transcranial magnetic stimulation, TMS, together with cognitive behavioral therapy, CBT (Cognitive Behavioral Therapy), helps reduce the desire to smoke or to consume other psychostimulant substances, if used frequently.
The limbic system, comprising various nuclei and nerve fibers, regulates emotions in the brain. It interacts with the orbito-frontal cortex, pivotal for emotional responses and decision-making. Neurotransmitters, natural chemicals in the nervous system, control this system's activation and inhibition, influencing the development of emotions and other nervous system functions by exciting or inhibiting brain circuits. Nicotine and psychostimulants disrupt neurotransmitter activity, particularly in the limbic system, altering brain messaging. They primarily affect dopamine, crucial for memory consolidation and pleasure sensations, and glutamate, which facilitates neuron communication and activates nervous system circuits.
Psychostimulant substances or an excess of psychoactive drugs introduced into the body from the outside, through the activation of the circuits of the limbic system, intensify the sensation of pleasure and sense of gratification. Hence a sensation of false well-being which, in the event of problematic and prolonged use, leads to addiction and a desire that is difficult to control, defined as craving, to take the psychostimulant substance to which the whole organism, and in particular the brain, is by now used to it.
TMS and cognitive-behavioral therapy, used in synergy, are effective for treating patients who make problematic use of nicotine or other psychostimulant substances. The aim of treatment is for the person to have the opportunity to choose to stop using nicotine or other psychoactive substances, without being dominated by craving. This is possible only by restoring decision control, which occurs above all in the orbito-frontal area of the brain, freeing this function from the conditioning of false emotions. The process, from the initial clinical assessment of the patient to the completion of the series of TMS treatment sessions, takes approximately one month. In some cases, it is useful to continue with boosters with TMS sessions in the following months.