Safety and feasibility of accelerated low-frequency repetitive navigated transcranial magnetic stimulation (rnTMS)

OBJECTIVENavigated transcranial magnetic stimulation (nTMS) in combination with diffusion tensor imaging fiber tracking (DTI FT) is increasingly used to locate subcortical language-related pathways. The aim of this study was to establish nTMS-based DTI FT for preoperative risk stratification by evaluating associations between lesion-to-tract distances (LTDs) and aphasia and by determining a cut-off LTD value to prevent surgery-related permanent aphasia.METHODSFifty patients with left-hemispheric, language-eloquent brain tumors underwent preoperative nTMS language mapping and nTMS-based DTI FT, followed by tumor resection. nTMS-based DTI FT was performed with a predefined fractional anisotropy (FA) of 0.10, 0.15, 50% of the individual FA threshold (FAT), and 75% FAT (minimum fiber length [FL]: 100 mm). The arcuate fascicle (AF), superior longitudinal fascicle (SLF), inferior longitudinal fascicle (ILF), uncinate fascicle (UC), and frontooccipital fascicle (FoF) were identified in nTMS-based tractography, and minimum LTDs were measured between the lesion and the AF and between the lesion and the closest other subcortical language-related pathway (SLF, ILF, UC, or FoF). LTDs were then associated with the level of aphasia (no/transient or permanent surgery-related aphasia, according to follow-up examinations).RESULTSA significant difference in LTDs was observed between patients with no or only surgery-related transient impairment and those who developed surgery-related permanent aphasia with regard to the AF (FA = 0.10, p = 0.0321; FA = 0.15, p = 0.0143; FA = 50% FAT, p = 0.0106) as well as the closest other subcortical language-related pathway (FA = 0.10, p = 0.0182; FA = 0.15, p = 0.0200; FA = 50% FAT, p = 0.0077). Patients with surgery-related permanent aphasia showed the lowest LTDs in relation to these tracts. Thus, LTDs of ≥ 8 mm (AF) and ≥ 11 mm (SLF, ILF, UC, or FoF) were determined as cut-off values for surgery-related permanent aphasia.CONCLUSIONSnTMS-based DTI FT of subcortical language-related pathways seems suitable for risk stratification and prediction in patients suffering from language-eloquent brain tumors. Thus, the current role of nTMS-based DTI FT might be expanded, going beyond the level of being a mere tool for surgical planning and resection guidance.

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Faculty Opinions recommendation of Effect of high- and low-frequency repetitive transcranial magnetic stimulation on visuospatial neglect in patients with acute stroke: a double-blind, sham-controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976316.793474418 ◽

2013 ◽

Author(s):

Shyam Prabhakaran ◽

Shawna Cutting

Keyword(s):

Transcranial Magnetic Stimulation ◽

Acute Stroke ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Low Frequency ◽

Double Blind ◽

Visuospatial Neglect

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Repetitive transcranial magnetic stimulation as a prophylactic treatment in migraine

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00254-4 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Azza B. Hammad ◽

Rasha E. Elsharkawy ◽

Ghada S. Abdel Azim

Keyword(s):

Transcranial Magnetic Stimulation ◽

Serum Level ◽

Pain Intensity ◽

Magnetic Stimulation ◽

Prophylactic Treatment ◽

Repetitive Transcranial Magnetic Stimulation ◽

Low Frequency ◽

Control Group ◽

Neurokinin A ◽

Abortive Treatment

Abstract Background Clinical applications of transcranial magnetic stimulation (TMS) have shown promising results in the treatment of headache disorders, with migraine being one of the most encountered. Objective To assess the role of low-frequency repetitive transcranial magnetic stimulation as a preventive treatment of migraine (with and without aura) and correlate the results with the serum level of the inflammatory biomarker (neurokinin A). Methods Forty patients, with age ranging from 15 to 55 years, diagnosed with migraine (30 migraine without aura and 10 with aura) and 20 apparently healthy individuals, who were age and sex matched with the patient group, were included in this study. A low-frequency (1 Hz) rTMS protocol was applied for all patients for five consecutive days interictally. Assessment of pain intensity using visual analogue scale and frequency and duration of attacks as well as number of pills taken by patients as an abortive treatment according to the Basic Diagnostic Headache Diary for 4 weeks before and 4 weeks after TMS sessions was done. In addition, the Migraine Disability Assessment scale (MIDAS) was applied to assess the severity and degree of disability caused by migraine. Measurement of neurokinin A serum level was done by using ELISA for all patients before and after TMS and for control group once. Results There was a significant reduction in pain intensity, frequency and duration of migraine attacks, migraine disability scores, and number of pills taken as abortive treatment for attacks after rTMS (P < 0.001). Also, serum level of neurokinin A in the patients was significantly reduced after rTMS (P < 0.001). Conclusion Low-frequency rTMS is an effective prophylactic treatment for migraine with and without aura.

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Beneficial Effects of Cerebellar Low Frequency Repetitive Transcranial Magnetic Stimulation on the Patient with Meige's syndrome

2020 IEEE International Conference on E-health Networking, Application & Services (HEALTHCOM) ◽

10.1109/healthcom49281.2021.9398973 ◽

2021 ◽

Author(s):

Xue Shi ◽

XiaoLin Su ◽

Guo Yi

Keyword(s):

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Low Frequency ◽

Beneficial Effects

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Low frequency transcranial magnetic stimulation in subacute ischemic stroke: Number of sessions that altered cortical excitability

Neurorehabilitation ◽

10.3233/nre-203156 ◽

2020 ◽

Vol 47 (4) ◽

pp. 427-434

Author(s):

Mohammed S. El-Tamawy ◽

Moshera H. Darwish ◽

Saly H. Elkholy ◽

Engy BadrEldin S. Moustafa ◽

Shimaa T. Abulkassem ◽

...

Keyword(s):

Ischemic Stroke ◽

Transcranial Magnetic Stimulation ◽

Physical Therapy ◽

Upper Limb ◽

Magnetic Stimulation ◽

Cortical Excitability ◽

Low Frequency ◽

Cortical Reorganization ◽

Therapy Program ◽

Physical Therapy Program

BACKGROUND: Cortical reorganization between both cerebral hemispheres plays an important role in regaining the affected upper extremity motor function post-stroke. OBJECTIVES: The purpose of the current study was to investigate the recommended number of contra-lesion low frequency repetitive transcranial magnetic stimulation (LF-rTMS) sessions that could enhance cortical reorganization post-stroke. METHODS: Forty patients with right hemiparetic subacute ischemic stroke with an age range between 50–65 yrs were randomly assigned into two equal groups: control (GA) and study (GB) groups. Both groups were treated with a selected physical therapy program for the upper limb. Sham and real contra-lesion LF-rTMS was conducted for both groups daily for two consecutive weeks. Sequential changes of cortical excitability were calculated by the end of each session. RESULTS: The significant enhancement in the cortical excitability was observed at the fourth session in favor of the study group (GB). Sequential rate of change in cortical excitability was significant for the first eight sessions. From the ninth session onwards, no difference could be detected between groups. CONCLUSION: The pattern of recovery after stroke is extensive and not all factors could be controlled. Application of LF-rTMS in conjugation with a selected physical therapy program for the upper limb from four to eight sessions seems to be efficient.

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