جستجوی مقالات مرتبط با کلیدواژه « transcranial magnetic stimulation » در نشریات گروه « پزشکی »

Chronic low back pain (CLBP) is a global burden with an unknown etiology. Reorganization of the cortical representation of paraspinal muscles in the primary motor cortex (M1) may be related to the pathology. Single-pulse transcranial magnetic stimulation (TMS), commonly used to map the functional organization of M1, is not potent enough to stimulate the cortical maps of paraspinal muscles in M1 in CLBP patients with reduced corticospinal excitability (CSE) with intensities even as high as maximum stimulator output (100% MSO). This makes TMS mapping impractical for these patients. The aim of this study was to increase the practicality of TMS mapping for people with CLBP.

This study included eight men and ten women who had CLBP for over three months. A biphasic paired-pulse TMS paradigm, conjunct anticipatory postural adjustment (APA), and maximal voluntary activation of paraspinal muscles (MVC) were used to facilitate TMS mapping. 

TMS mapping was possible in all CLBP participants, with TMS intensities <50% of the MSO. Reorganization in terms of an anterior and lateral shift of the center of gravity (COG) of the cortical maps of paraspinal muscles was observed in all participants with CLBP, and a reduced number of discrete peaks was found in 33%.

The facilitation of the CSE to paraspinal muscles makes TMS mapping more practical and tolerable in people with CLBP, lowering the risk of seizure and discomfort associated with high-intensity TMS pulses.

 An essential factor in the validity of motor evoked potential (MEP)s recorded by transcranial magnetic stimulation (TMS) over multiple times is their test-retest reliability which to a large extent depends on the accuracy and competence of the assessor (intra-rater reliability). However, intra-rater reliability is infrequently reported in TMS studies suggesting that this is rarely done.

 This study was conducted to determine the intra-rater within and between-session reliability of a newly trained TMS assessor prior to a main TMS study and report on the methodology used to encourage similar practice.

 Fourteen (10 males, 4 females; mean age: 32 ± 5.8 years) participants took part in the study. Motor evoked potentials were elicited from a relaxed, right first dorsal interosseous (FDI) muscle three times (T1, T2 and T3) across two testing sessions at least 48 hours apart. During the first session, MEPs were recorded twice (T1 and T2) within an interval of 20 minutes to determine the within (intra) session reliability of the assessor. During the second session, a single measurement was carried out (T3) which was compared to T1 to determine the inter-session reliability.

 Repeated measure analysis of variance (ANOVA) did not reveal significant difference in the amplitude of the MEPs obtained across the three time periods (P = 0.196) demonstrating agreement in the MEPs and hence the reliability of the assessor. Additionally, the intraclass correlation coefficient (ICC) between T1 and T2; and T1 and T3 were 0.952 (P < 0.001) and 0.833 (P = 0.001) respectively further indicating the within and between sessions reliability of the assessor.

 The agreement between the three measured MEPs amplitude and the significant ICC demonstrates the reliability of the assessor in this study to use TMS for research. We suggest that the intra-rater reliability of new TMS operators should be established using the methodology in this report prior to main TMS studies.

Phantom limb pain (PLP) presents complex challenges in treatment, lacking standardized clinical approaches, and understanding its mechanisms remains elusive. Noninvasive brain stimulation (NIBS), specifically transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), seems promising in treating chronic pain, including PLP. These modalities can modulate neural activity, offering potential benefits by acting on interconnected neural networks beyond the stimulation site. Studies from Jan 1, 2003, to 2021 were reviewed on PubMed, Google Scholar, and the Web of Science using the keywords PLP, neuromodulation, transcranial direct current stimulation, transcranial magnetic stimulation, pain management, and their combinations. The language was limited to English. A single-session treatment has the potential to change the intensity of PLP for several hours. On the other hand, a multi-session treatment approach can decrease both the intensity and frequency of PLP for an extended period of several months. Additional research with a greater sample size and extended follow-up periods is necessary to determine the precedence of utilizing tDCS, rTMS and the potential for integration with other treatments for individuals with amputation experiencing PLP.

Cognitive dysfunction is common in individuals with depression and these cognitive deficits may be associated with a risk of suicide. Therefore, the identification of the cognitive functions of depressed patients and the introduction of effective interventions on these factors are highly important. This study aimed to compare the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) and Theta Burst Stimulation (TBS) to improve selective attention, working memory, and response time of depressed individuals with and without a history of suicide.

This applied quasi-experimental study was conducted based on a pretest-posttest design. The population included 40 depressed patients referring to the clinics of Mashhad, Iran, in 2020. The samples were divided into four groups, namely individuals with a history of suicide subjected to treatment with rTMS, without a history of suicide receiving treatment with rTMS, with a history of suicide undergoing treatment with TBS, and without a history of suicide administered with TBS (n = 10 each). The data were collected using the Stroop Color and Word Test, Corsi block test, and reaction time tests and statistically analyzed using multivariate analysis of covariance.

The results confirmed the effectiveness of the intervention on the congruent reaction time, incongruent reaction time, working memory, simple reaction time, and selective reaction time in all four study groups (P < 0.05). The results of multivariate analysis of covariance showed that the group had a significant effect on the variables of congruent reaction time, simple reaction time, and selective reaction time (P < 0.05); however, it had no significant effect on the variables of incongruent reaction time and working memory (P > 0.05).

Compared to the rTMS method, the TBS had a greater effect on the variables of congruent reaction time, simple reaction time, and selective reaction time.

Repetitive transcranial magnetic stimulation (rTMS) is a novel technique that may improve recovery in patients with stoke, but the role of rTMS as an applied and practical treatment modality for stroke rehabilitation has not been established yet. This study was conducted to determine the effects of a rehabilitation program (RP) in conjunction with rTMS on functional indices of the paretic upper limb in the subacute phase of stroke. In this experimental study, twenty patients in the subacute phase of stroke were randomly assigned into two groups: The high frequency rTMS (HF-rTMS) in conjunction with RP (experimental group), and the RP group (control group). The experimental group received 10 sessions of 20 Hz rTMS on the affected primary motor cortex and the other group received 10 sessions of RP. In experimental group, RP for the paretic hand was conducted following rTMS session. Box and block test (BBT), Fugl-Meyer Motor Assessment for upper limb (FMA-UL), grip strength and pinch strength were used to assess motor function before the first session and after the last session of treatment. Significant improvement in BBT, FMA-UL, grip strength and pinch strength was observed in both groups. Improvement of BBT and grip strength was significantly greater in the experimental group rather than the control group (p <0.05). FMA-UL score and the pinch strength were greater in the experimental group, although the differences were not statistically significant. HF-rTMS in conjunction with RP is effective to improve the function of upper limb. It seems HF-rTMS is a novel feasible and safe technique for hemiparesis patients in the subacute phase of stroke.

Repetitive transcranial magnetic stimulation (rTMS) is recommended as an effective treatment for both major depressive disorder (MDD) and treatment‐resistant depression.

According to the possible impact of rTMS on cognitive psychological characteristics, this study aimed to determine the effectiveness of rTMS in meta‐worry and neuropsychological functions among MDD patients.

This quasi‐experimental study was conducted on 30 patients with MDDreferring to Atieh Clinical Neuroscience Center, Tehran, Iran, in 2019. The participants were randomly divided into two groups of intervention and control (n=15 each).The data collection tools included the Beck Depression Inventory, meta‐worry subscale of the Anxious Thoughts Inventory, and Cambridge Neuropsychological Test Automated Battery.

The comparison between the two groups showed that the scores of the meta‐worry scale improved after the intervention in patients undergoing rTMS, compared to those in the control group (Z=‐3.41; P=0.002); however, no difference was observed between the two groups in the follow‐up (Z=‐2.02; P=0.053). The assessment of neuropsychological functions among the patients undergoing rTMS and those in the control demonstrated thatneuropsychological functions (i.e., Minimum Spanning Tree, Rapid Visual Information Processing, and Spatial Working Memory) were significantly different immediately after the intervention and in the follow‐up (P<0.05) except for the Difficulty Maintaining Sleep (DMS) subtest. In addition, the mean depression score was significantly differentbetween the two groups (Z=‐4.17; P<0.005). There was a significant relationship between depression and all the subtests of neuropsychological functionsexcept for DMS (P>0.05).

In summary, the results of the current study indicated that the use of rTMS was an effective method inthe improvement of neuropsychological functions except for DMS in patients with depression. However, the obtained findings did not demonstrate the persistent effect of multiple rTMS on meta‐worry.

Methamphetamine use has been associated with higher rates of depression and anxiety. Themesocorticolimbic dopaminergic reward system seems to play a crucial role in inducing depression andanxiety in methamphetamine users. High-frequency repetitive transcranial magnetic stimulation (rTMS) hasbeen shown to alter dopaminergic neurotransmission considering the acute rewarding and reinforcing effectsin the subcortical structure. The aim of this study was to investigate the efficacy of rTMS in reducingdepression and anxiety symptoms in methamphetamine users.

In a single-subject method with concurrent multiple baseline designs, in 2017, in Iran, eightmethamphetamine users were included, which compared 15 days of active versus placebo stimulation andcontrol group. Two subjects received rTMS on the right dorsolateral prefrontal cortex (DLPFC) and twosubjects received rTMS on the left DLPFC. We carried out the measurement using the Beck Anxiety Inventory(BAI) and Beck Depression Inventory (BDI) before, during, and after 15 and 30 days of the procedure.

Right and left DLPFC stimulation significantly reduced depression and anxiety, but the reductionof depression and anxiety by the right DLPFC stimulation was noticeable in this study.

High-frequency rTMS is useful for the treatment of depression and anxiety in methamphetamineusers.

Methamphetamine is considered as one of the potent psychological stimuli with high addiction capacity. Drug craving is one of the most critical factors in drug addiction, leading to drug use relapse once withdrawn. The objective of the present research was to evaluate the effect of Transcranial Magnetic Stimulation (rTMS) on the drug craving in patients using methamphetamine.

This study was conducted in a double-blind sham-controlled design on 31 patients in Summer 2016. The patients were randomly assigned into 3 groups (each group comprising10 subjects) and rTMS was performed at the left Dorsolateral Prefrontal Cortex (DLPFC) with frequency of 15Hz and the left Orbitofrontal Cortex (OFC) with a frequency of 1 Hz. One day before the onset of the intervention and one week following the completion of it, the subjects were evaluated using Hamilton Rating Scale for Depression (HRSD), The Brief Psychiatric Rating Scale (BPRS), and visual cue-induced craving assessment task. In a 6-month follow up after the completion of the sessions, the patients were asked whether they tended to be hospitalized (psychiatric service, campus) for psychiatry or substance was collected in a self and family report manner by phone call. Two patients in the DLPFC group, 1 in the OFPFC, and 4 patients in the control group were hospitalized. However, these frequencies were not statistically significant (p=0.343, χ2=2.139).

Repetitive magnetic stimulation failed to significantly reduce craving, but in a 6-month follow up, most cases of substance related hospitalization were reported to be in the control group.

rTMS can reduce the complications of using methamphetamine, such as the number of substance related hospitalizations.

To explore the effect of Motor Level peripheral Stimulation (MLS) on Corticospinal Excitability (CSE) in healthy participants and those with neurological disorders, and to establish stimulation parameters best suited to this purpose.

Methods and Materials:

 A comprehensive search strategy was developed for identification of papers answering the review question. The studies identified were used to do meta-analyses.

Following motor-level stimulation, there was a significant change in CSE from baseline: 57.66% (95% CI). Subgroup analysis showed that there was a significant change in the 100Hz subgroup: 68.31% (95% CI) and the 20-50Hz subgroup: 80.14% (95% CI), but not in the <10Hz subgroup: 9.97% (95% CI). In addition, CSE changes was greater where intervention time = 30mins: 83.19% (95% CI), then where intervention time >30mins: 53.14% (95% CI). CSE showed no significant changes following ‘no stimulation”: 69.61% (95% CI).

The findings indicate that MLS leads to increases in CSE; however, magnitude of change depends on the stimulation frequency and the area stimulated. It also appears that stimulation durations of longer than 30mins do not result in greater changes. Significance: The present review article hopes to catalyze further research into the determination of appropriate MLS treatment parameters for specific muscle groups.

The purpose of this study was to compare the efficacy of transcranial magnetic stimulation and cognitive-behavioral therapy in reducing anxiety and depression in patients referred to psychiatric clinics in Tehran.

This clinical trial was conducted on clients referred to psychology clinics in Tehran during 2015 with diagnosis of depression and anxiety by psychiatric commission. Sixty individuals were selected by convenience sampling method. They were randomly divided into three groups (two experimental and one control). The research tool was Beck Depression Inventory and Beck Anxiety Inventory. One group received 12 sessions of cognitive-behavioral therapy and the other group received transcranial magnetic stimulation for 20 sessions. The control group did not receive any intervention. Data were analyzed by SPSS software using covariance analysis.

There was a significant difference between transcranial magnetic therapy and cognitive-behavioral therapy in reducing anxiety and depression in clients (P<0.01).

It seems that transcranial magnetic stimulation and cognitive-behavioral therapy are effective in reducing anxiety and depression but cognitive-behavioral therapy can reduce depression and anxiety more than transcranial magnetic stimulation.

Stroke is a primary source of disability and mortality globally. The incidence of stroke is dramatically increasing in both developed and developing countries and the age at which those that are afflicted is becoming younger. Studies have shown that 33 million individuals suffer a stroke on an annual basis and approximately half will experience problems performing their activities of daily living (ADL). Practical solutions with a focus on neurorehabilitation are vital. Functional electrical stimulation (FES), and repetitive transcranial magnetic stimulation (rTMS) may be two advantageous treatments for reducing disability post-stroke. We propose that rTMS would activate cortical regions especially areas related to the primary motor cortex and FES would activate peripheral nerves that can lead to improvements in motor function of both the upper and lower limbs in patients post-stroke. It is proposing that this concurrent use of rTMS and FES will be of benefit in improving the motor function of this population.

Balance impairment is a common problem and a major cause of motor disability after stroke. Therefore, this study aimed to investigate whether low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) improves the postural balance problems in stroke patients.
This randomized double blind clinical trial with 12 weeks follow-up was conducted on stroke patients. Treatment was carried with 1 Hz rTMS in contralateral brain hemisphere over the primary motor area for 20 minutes (1200 pulses) for 5 consecutive days. Static postural stability, Medical Research Council (MRC), Berg Balance Scale (BBS), and Fugl-Meyer assessments were evaluated immediately, 3 weeks and 12 weeks after intervention.
A total of 26 patients were enrolled (age range=53 to 79 years; 61.5% were male) in this study. Administering rTMS produced a significant recovery based on BBS (df=86, 7; F=7.4; P=0.01), Fugl-Meyer Scale (df=86, 7; F=8.7; P According to the findings, rTMS as an adjuvant therapy may improve the static postural stability, falling risk, coordination, motor recovery, and muscle strength in patients with stroke.

Transcranial magnetic stimulation (TMS) is a useful tool for assessment of corticospinal excitability (CSE) changes in both healthy individuals and patients with brain disorders. The usefulness of TMS-elicited motor evoked potentials (MEPs) for the assessment of CSE in a clinical context depends on their intra-and inter-session reliability. This study aimed to evaluate if removal of initial MEPs elicited by using two types of TMS techniques influences the reliability scores and whether this effect is different in blocks with variable number of MEPs.
Twenty-three healthy participants were recruited in this study. The stimulus intensity was set at 120% of resting motor threshold (RMT) for one group while the stimulus intensity was adjusted to record MEPs up to 1 mV for the other group. Twenty MEPs were recorded at 3 time points on 2 separate days. An intra-class correlation coefficient (ICC) reliability with absolute agreement and analysis of variance model were used to assess reliability of the MEP amplitudes for blocks with variable number of MEPs.
A decrease in ICC values was observed with removal of 3 or 5 MEPs in both techniques when compared to all MEP responses in any given block. Therefore, removal of the first 3 or 5 MEPs failed to further increase the reliability of MEP responses.
Our findings revealed that a greater number of trials involving averaged MEPs can influence TMS reliability more than removal of the first trials.

Intermittent theta burst stimulation (iTBS) is a repetitive transcranial magnetic stimulation (rTMS) protocol that influences cortical excitability and motor function recovery.
This study aimed to investigate the effects of iTBS on manual dexterity and hand motor imagery in multiple sclerosis (MS) patients.
Thirty-six MS patients were non-randomly assigned into sham (control) or iTBS groups. Then, iTBS was delivered to the primary motor cortex for ten days over two consecutive weeks. The patients’ manual dexterity was assessed using the nine-hole peg test (9HPT) and the Box and Block Test (BBT), while the hand motor imagery was assessed with the hand mental rotation task (HMRT).
iTBS group showed a reduction in the time required to complete the 9HPT (mean difference = -3.05, P = 0.002), and an increase in the number of blocks transferred in one minute in the BBT (mean difference = 8.9, P = 0.001) when compared to the control group. Furthermore, there was no significant difference between the two groups in terms of the reaction time (P = 0.761) and response accuracy rate (P = 0.482) in the HMRT.
When iTBS was applied over the primary motor cortex, it significantly improved manual dexterity, but had no significant effect on the hand motor imagery ability in MS patients.

Many researchers are focusing on different medication and intervention methods to treat problems associated with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) is one of the novel techniques that currently have been investigated as a treatment for certain symptoms of autism. The aim of this study was to review the available evidence to determine the efficacy of TMS in autism. Medline, Embase, CINAHL, Web of Science, Scopus, Wiley, Ovid and Google Scholar databases were searched for relevant controlled clinical trials. The terms “autism, autism spectrum disorders combined with transcranial magnetic stimulation, repetitive transcranial magnetic stimulation” were used as text words. Most of these studies targeted the dorsolateral prefrontal cortex (DLPFC) and used low-frequency stimulation. These studies had some limitations; however, the results of all of them showed that TMS is effective in improvement of ASD symptoms. Moreover, repetitive TMS might become useful in the rehabilitation of ASD patients. Finally, integrated approaches utilizing TMS together with other rehabilitation techniques, as well as using TMS to target the objective problems in ASD are proposed.

Post-stroke dysphagia is common and is associated with the development of pneumonia. To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with traditional dysphagia therapy (TDT) on swallowing function in patients with post-stroke dysphagia.
In this single-subject study, four patients with dysphagia post-stroke included. The patients received the rTMS applied to the intact cerebral hemisphere at 1 Hz with train of 1200 for 5 consecutive days combined with TDT 3 days per week for 6 weeks. The main outcome measure was the Mann Assessment of Swallowing Ability (MASA). Measurements were taken before, after the end of 5th, 10th, 15th treatment sessions, and after the end of the treatment (18th session).
The MASA scores improved in all patients following treatment. The maximum and minimum change in level between the baseline phase and treatment phase was and . The greatest percentage improvement was observed after 5th treatment sessions ranging between 11 and 35%. The treatment trend was upward shown by the directions of the slopes indicated by positive values (.1-.7). The dysphagia was resolved after 10th treatment session in all participants. The aspiration resolved in two participants after the 5th treatment session and resolved in another 2 participants after the 10th treatment session.
The combination therapy of rTMS plus TDT improved swallowing function in patients with post-stroke dysphagia. Further research with a larger sample size is recommended.