TMS Advances

TMS May Be Able to Help Treat Parkinson's

June 28, 2019

Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for depression, but evidence from a new study suggests it could also work as a treatment for Parkinson’s disease.

Parkinson’s disease is a neurodegenerative disorder, meaning it results in the loss of cells in the brain and/or spinal cord. As time progresses, this leads to physical, and sometimes mental, impairment.

Symptoms of Parkinson’s disease typically develop gradually and include tremor, slowness of movement, rigidity of limbs, and problems balancing or walking.

Continue reading to find out more about:

  • Parkinson’s Disease
  • TMS: What it is and how it works
  • What the study means

Parkinson’s Disease

Medical Background

Because Parkinson’s is neurodegenerative, it affects certain cells in the brain, specifically neurons that produce the chemical messenger dopamine. As dopamine levels deplete, brain activity can become abnormal, which can lead to symptoms of Parkinson’s.

Woman holds head in pain with multiple sets of hands
Other neurodegenerative conditions include Alzheimer’s disease and Lou Gehrig’s disease (ALS).

Little is known about what causes Parkinson’s. While the disease itself is not fatal, resultant complications are potentially very dangerous.

Complications caused by Parkinson’s include:

  • Difficulty thinking
  • Development of physiological conditions such as depression and anxiety
  • Difficulty chewing, swallowing, and eating
  • Development of sleep disorders such as insomnia and REM sleep behavior disorder
  • Bladder problems or constipation
  • Changes in blood pressure
  • Chronic pain
  • Fatigue

Age, genes, and sex all contribute to the risk of developing Parkinson’s. The disease is most common in adults who are middle-aged or older. If you have relatives with Parkinson’s, you are more likely to develop it due to specific genetic mutations that might cause it. Parkinson's disease is found more often in men than it is in women.

Disease Progression

Early signs of Parkinson’s are usually subtle, such as a slight hand tremor, arms ceasing to swing when walking, softened or slurred speech, and inability to make facial expressions.  

Most people with Parkinson’s start showing symptoms of the disease later in its course. During the beginning stages of Parkinson’s, symptoms are usually mild and do not interfere with daily activity. Unfortunately, this typically changes with the passage of time, and movement will start to slow and become more difficult. During the later stages of the disease, the person might require a wheelchair or around-the-clock care.

Traditional Treatment Methods

Parkinson’s disease can be treated with medication. Because Parkinson’s inhibits dopamine production, dopaminergic medications are commonly prescribed to help the patient produce more dopamine.

Surgery is another option when it comes to treating Parkinson’s. Today, the most frequent procedure involves the implantation of a deep brain stimulator, which is a device that uses electrical pulses to stimulate the parts of the brain responsible for movement. However, deep brain stimulators might negatively impact cognition or memory and are not effective in treating non-motor symptoms of Parkinson’s.

TMS

What is it?

TMS is a non-invasive treatment that uses a form of electromagnetism to stimulate specific areas of the brain.

Unlike most drugs, TMS has virtually no side effects, which makes it ideal for patients who have had negative experiences with medications for that very reason.

How does it work?

During a session of TMS, a coil is fitted against the patient’s head to conduct magnetic pulses emitted by a TMS machine and regulated by a trained technician. These magnetic pulses are similar to those used during MRIs.

TMS Treatment
The patient is seated and awake during the procedure, which is usually done once a day, five days a week for around six weeks. Image courtesy of HS Design.

The electromagnetic pulses administered during a TMS treatment are thought to stimulate activity in parts of the brain that are behaving abnormally or displaying signs of under-activity.

In patients with depression, TMS is used to reactivate stagnant areas of the brain by targeting mood centers in the brain.

TMS is relatively painless, although some patients might experience a slight headache or pain in the scalp following the treatment.

What can it treat?

Currently, TMS is only FDA-approved to treat Major Depression Disorder. However, other disorders are suspected to be respondent to TMS as well. These include bipolar disorder, attention-deficit/hyperactivity disorder, panic disorder, obsessive compulsive disorder, schizophrenia, ALS, and Parkinson’s.

The Study

Premise

Prior evidence suggested that both low and high frequency TMS could improve motor performance for patients who suffer from Parkinson’s disease. This study aimed to determine if one amount frequency was more effective than the other, as no experiment had directly compared the two before.

When it comes to TMS, frequency refers to the number of stimuli released in the same period of time. Image courtesy of Psych Central.

Method

Participants—all 52 of which had been previously diagnosed with Parkinson’s—were randomly separated into two groups. Over the course of the study, one group received low frequency TMS while the other received high frequency TMS.

The effects were analyzed using three forms of assessment: the Unified Parkinson’s Disease Rating Scale, Instrumental Activity of Daily Living, and a self-scored report by each participant.

Results

According the research article, which was published in the Journal of Parkinson’s Disease (vol. 9, no. 2), “there was a significant improvement on all rating scales after either [low frequency] or [high frequency] rTMS, but the effect persisted for longer after [high frequency] . . . Neither treatment affected motor thresholds, but [high frequency] rTMS increased [motor-evoked potential] amplitude and the duration of [inter-brain communications].”

As such, the researchers concluded that either form of TMS is effective in treating Parkinson’s, and high frequency TMS, specifically, has longer-lasting results.

Additionally, the effects were more noticeable in patients with akinetic-rigid Parkinson’s, which manifests itself in slowed and rigid movement, than in those whose symptoms were primarily tremor-related.

These results suggest that similar to a deep brain stimulator, TMS can reduce the motor impairments caused by Parkinson’s disease. However, TMS would not have the negative cognitive implications associated with deep brain stimulation, as there is no evidence that TMS affects memory or cognition of any sort.

Hope for the Future

There is no cure for Parkinson’s disease, but as medical technology progresses, more and more treatment options are emerging.

TMS seems to be a promising method to reduce Parkinson’s symptoms, and the results from this new study encourage this notion even further.

Alternatively, because depression is a possible non-motor symptom of Parkinson’s, TMS may be useful to Parkinson’s patients in this way as well.

It seems that the more TMS is studied, the more it reveals itself to be the future of medicine. Right now, TMS is bringing remission into the lives of patients with treatment-resistant depression—in time, TMS could also provide relief for patients suffering from other disorders, such as Parkinson’s disease.





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