A Practical Guide to Transcranial Magnetic Stimulation Neurophysiology and Treatment Studies

by Robert Chen, Paul B. Fitzgerald, Daniel M. Blumberger

Overview

Transcranial magnetic stimulation (TMS) is a widely used non-invasive brain stimulation technique. It represents an exciting new frontier in neuroscience research and can be used to examine neural processes, providing insights into pathophysiology and treating a variety of neuropsychiatric illnesses.

A Practical Guide to Transcranial Magnetic Stimulation Neurophysiology and Treatment Studies presents an overview of the use of TMS as both an investigational tool and as treatment for neurological and psychiatric disorders. The chapters include an overview of the history and basic principles of TMS and repetitive TMS (rTMS), the different types of TMS coils, different stimulation approaches, the use of neuronavigation, and safety considerations. The utility of single and paired TMS techniques to measure cortical inhibition, facilitation, connectivity and reactivity in motor and non-motor brain areas, the different methods of using TMS to induce brain plasticity, and use of TMS in cognitive studies are explored. It also covers TMS and rTMS combined with electroencephalography (EEG) in neurophysiological studies. The authors provide a summary of the clinical applications of TMS in neurological and psychiatric disorders including depression, schizophrenia, stroke, Parkinson disease, and pain.

This up-to-date volume provides a compendious review of the use of TMS and rTMS that will help guide the utility of this methodology in both clinical and research settings. This practical guide will be a useful resource for those new to the field, as well as experienced users, for both research and clinical settings.

Product Details

ISBN-13:	9780199335848
Publisher:	Oxford University Press
Publication date:	08/02/2022
Pages:	336
Product dimensions:	6.91(w) x 9.96(h) x 0.67(d)

About the Author

Dr. Robert Chen is currently a Professor of Medicine (Neurology) at the University of Toronto, the Catherine Manson Chair in Movement Disorders, Senior Scientist at the Krembil Brain Institute, and Editor-in-Chief of the Canadian Journal of Neurological Sciences. He received his MA and medical degrees (MBBChir) from the University of Cambridge and an M.Sc. from the University of Toronto. He undertook a Neurology residency at the Western University and fellowship at the National Institute of Neurological Disorders and Stroke. His research interests are human motor physiology, brain plasticity and understanding the pathophysiology and the development of new treatments for movement disorders such as Parkinson's disease and dystonia.

Dr. Daniel M. Blumberger is the Temerty Chair in Therapeutic Brain Intervention at the Centre for Addiction and Mental Health and a Professor in the Department of Psychiatry at the University of Toronto. He received his MD from the University of Toronto where he also completed psychiatry residency and a fellowship in neurostimulation and geriatric psychiatry. He is involved in training and mentoring on the clinical delivery neurostimulation treatments. His research broadly spans the use of neurostimulation therapies for refractory psychiatric disorders with a focus on clinical intervention trials and understanding the neurophysiology of treatment resistant depression across the lifespan.

Paul Fitzgerald is Professor of Psychiatry at Monash University and Director of the Epworth Centre for Innovation in Mental Health. He is a qualified psychiatrist, with an MBBS degree, Masters of Psychological Medicine, and research PhD from Monash University. He has conducted an extensive range clinical trials of novel brain stimulation and pharmacological interventions to improve treatment options for patients with depression, schizophrenia, obsessive compulsive disorder, PTSD, autism and Alzheimer's disease along with many experimental studies. He has established multiple clinical TMS services and founded several device and clinical service companies, as well as the first TMS training program in the southern hemisphere.

Table of Contents

Preface xi

Acknowledgments xiii

Section I TMS Neurophysiology

1 The History of TMS and Basic Principles of TMS and rTMS 3

1.1 Introduction 3

1.2 The Development of the Sciences Underpinning TMS 4

1.3 Modern TMS 5

1.4 Basic Principles 6

1.5 Repetitive TMS 8

2 TMS and Neuronavigation Equipment 11

2.1 Basic Components of TMS 11

2.2 Neuronavigation 15

3 Single-, Paired-, Triple-Pulse TMS for Motor Physiological Studies 23

3.1 Single-Pulse TMS Measurements 23

3.2 Paired-Pulse TMS Studies 44

3.3 Conditioning Stimulation from the Cerebellum or Peripheral Nerves 50

3.4 Stimulation of Other Cortical Areas: Intrahemispheric (Ipsilateral) Cortical Connections to the Motor Cortex 54

3.5 Interhemispheric Cortical Connections 62

3.6 Interaction Between Cortical Circuits 68

3.7 Assessment of Cortical Versus Spinal Excitability 69

3.8 Number of TMS Pulses Required and Optimal Intertrial Intervals to Assess Corticospinal Excitability 72

3.9 Clinical Diagnostic Utility of TMS 73

3.10 Conclusion 74

4 Induction of Motor Cortical Plasticity with Transcranial Magnetic Stimulation 88

4.1 Introduction 88

4.2 Paired Associative Stimulation 89

4.3 Regular Repetitive Transcranial Magnetic Stimulation 106

4.4 Theta Burst Stimulation 110

4.5 TMS at I-Wave Frequency 117

4.6 Disinhibition Stimulation 118

4.7 Quadripulse Stimulation 120

4.8 Comparisons Between Different Plasticity Protocols 121

4.9 Summary of Differences Among Plasticity Protocols 122

5 TMS in Nonmotor Neurophysiological Studies 132

5.1 Introduction 132

5.2 Induction of Phosphenes by TMS 132

5.3 Stimulation of the Primary Somatosensory Cortex 135

5.4 Use of TMS to Investigate Action Inhibition 137

5.5 Conclusion 138

6 TMS in Cognitive Studies 141

6.1 Introduction 141

6.2 Methodologic Considerations for TMS 142

6.3 Potential Mechanisms of Cognitive Impairment and Enhancement 145

6.4 Potential Applications: Understanding and Improving Cognitive Impairments 147

6.5 Conclusion 149

7 TMS with EEG 154

7.1 Introduction 154

7.2 Outcome Measures of TMS-EEG 155

7.3 Artifacts 162

7.4 Testing Parameters and Considerations 165

7.5 TMS-EEG Applications 168

7.6 Conclusion 173

8 Combining TMS with Neuroimaging 181

8.1 Introduction 181

8.2 Offline TMS-Neuroimaging Studies: Studies of Single Stimulation Sessions 183

8.3 Online TMS-fMRI 189

8.4 Conclusion 191

Section II rTMS as Treatment of Neurological and Psychiatric Disorders

9 The Use of rTMS and Other Forms of Brain Stimulation in the Treatment of Neuropsychiatric Disorders 197

9.1 Introduction 197

9.2 The Selection of Stimulation Location 198

9.3 Determination of a Relevant Method to Ensure That Stimulation is Applied Accurately to the Chosen Location 200

9.4 Frequency of Stimulation 203

9.5 Treatment Scheduling and Dose 204

9.6 Stimulation Intensity 205

9.7 Coil Orientation 206

9.8 Brain Activation 206

9.9 Conclusion 208

10 Clinical Applications of Transcranial Magnetic Stimulation in Stroke 211

10.1 Introduction 211

10.2 Role of TMS in the Prognosis of Recovery from Stroke 211

10.3 Role of TMS in Understanding the Pathophysiology of Stroke and in Outcome Assessment 213

10.4 rTMS as Treatment of Stroke 214

10.5 Conclusion and Future Perspectives 218

11 rTMS as Treatment for Movement Disorders 224

11.1 Introduction 224

11.2 Parkinson's Disease 224

11.3 Dystonia 231

11.4 Functional Movement Disorders 232

11.5 Conclusion 233

12 rTMS as Treatment for Other Neurological Disorders 237

12.1 Introduction 237

12.2 Epilepsy 237

12.3 Multiple Sclerosis 238

12.4 Pain 240

12.5 Tinnitus 244

13 rTMS for the Treatment of Depression 250

13.1 Introduction 250

13.2 Therapeutic Effects of rTMS in Depression 251

13.3 Improving Efficacy and Efficiency 254

13.4 Scheduling and Maintenance Approaches 257

13.5 rTMS for Special Populations with Depression 259

13.6 Current Challenges and Future Directions 262

13.7 Conclusion 264

14 rTMS for Other Psychiatric Disorders 273

14.1 Introduction 273

14.2 Schizophrenia 273

14.3 Mania 278

14.4 Obsessive Compulsive Disorder 279

14.5 Posttraumatic Stress Disorder 281

14.6 Other Anxiety Disorders 281

14.7 Disorders of Addiction 282

14.8 Conclusion 283

15 Safety Considerations and Management of TMS Side Effects 289

15.1 Introduction 289

15.2 Safety Considerations 290

15.3 Potential Adverse Effects 292

15.4 Safety Guidelines 296

15.5 Mitigating and Managing Risks 298

15.6 Managing Emergencies 302

15.7 Conclusion 303

Index 309