Transcranial Magnetic Stimulation (TMS) for Stroke Rehabilitation

Transcranial Magnetic Stimulation (TMS) for Stroke Rehabilitation

Stroke survivors might suffer from various disabilities, e.g. Impaired mobility, cognition, sensation, speech and swallowing function, which would significantly limit their daily activities and quality of life. Apart from conventional medical treatment and physical training, transcranial magnetic stimulation (TMS), a non-invasive interventional therapy, could potentially improve brain functions for stroke patients.

Transcranial magnetic stimulation (TMS) is a non-invasive procedure, which is usually well-tolerated with few side effects. Literature suggested that TMS is applicable in several neurological disorders, including stroke, Parkinson’s disease, cognitive impairment, migraine and chronic pain.

TMS Promotes Brain Functional Recovery with Excitatory or Inhibitory Effects

TMS is delivered via an electromagnetic coil placed against the scalp. Pulses of varying frequencies will generate magnetic fields, which in turn induce electric currents in cerebral cortex. By changing the stimulation parameters it can exert excitatory or inhibitory effects on different parts of the brain circuits, potentially allowing functional recovery and reorganisation.

The magnetic field generated by TMS machine is similar to that of an MRI, but it focuses on a few centimetres over the skull and does not affect the functions of other brain regions. Repetitive Transcranial Magnetic Stimulation (rTMS), which delivers continuous magnetic pulses to the brain, is one of the most commonly used protocols.

During TMS, a cap will be worn to facilitate localisation for stimulation. Performing physicians will tailor-made treatment plan for individual patients according to their symptoms and underlying conditions. Besides cortical stimulation, TMS can also be applied to other areas such as neck or limb muscles.

Each TMS session takes 20 to 45 minutes. Patient is awake with no sedation or analgesia needed. Earplugs may be used to dampen noise generated by machine during treatment. During procedure, patient may have feeling of tapping over stimulating region, sometimes with mild discomfort. Twitching of facial muscles might occur. Performing physicians will make adjustment accordingly to minimise discomfort. A typical treatment cycle takes four to six weeks, with two to three sessions every week. Treatment duration varies depending on individual’s response. Procedure can be terminated anytime if patient develops discomfort.

The most serious side effect of TMS is seizure. Patients are advised to inform treating physicians for relevant history such as epilepsy. TMS is also not suitable for those with implanted devices within 12 inches (30cm) from stimulation area.

Better Outcome with Allied Health Training

Comprehensive stroke care is essential to restore bodily functions after stroke. Early initiation of multi-disciplinary rehabilitation can significantly improve self-care ability, daily activities and neurological function. TMS, together with allied health training, could hasten the recovery process.