TMS Therapy for Stroke Patients

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Transcranial magnetic stimulation (TMS) therapy is a form of non-invasive treatment that is gaining increasing attention in the medical world, and for a good reason. Although further research is needed, studies have shown that this particular treatment can promote better motor recovery and can ease the symptoms of post-stroke depression if conventional therapy has not worked.

TMS therapy has a multitude of benefits. Unlike other forms of brain stimulation therapy, such as electroconvulsive therapy that requires an anesthetic, TMS does not involve sedation or an overnight hospital stay. This means that those who take advantage of TMS therapy can fit it into their daily lives and continue their day after sessions.

Transcranial magnetic stimulation is already used as an approved form of treatment for depression and obsessive-compulsive disorder (OCD) due to the way it influences brain activity. This means that it has the potential to be an effective and popular form of therapy in treating depression in those who have experienced a stroke.

Alongside other rehabilitation therapies, such as physiotherapy, transcranial magnetic stimulation therapy can also improve motor function in those with a stroke-related disability and help the brain become more receptive to other forms of rehabilitation.

What Is TMS Therapy?

TMS therapy, or transcranial magnetic stimulation therapy as it is otherwise known, is a non-invasive brain stimulation that has been shown to improve the symptoms of major depressive disorder significantly. A Food and Drug Administration (FDA) approved treatment frequently used to treat depression and OCD, TMS therapy also aids those attempting to quit smoking.

Related: What is deep TMS

In addition to the above, transcranial magnetic stimulation therapy shows promising results in treating a range of other mental health disorders, such as anxiety, substance use disorders, and post-traumatic stress disorder (PTSD).

Unlike traditional treatments, transcranial magnetic stimulation treatment employs magnetic brain stimulation through the use of magnetic pulses. An electromagnetic coil is placed over the prefrontal cortex over the client's scalp during transcranial magnetic stimulation treatment. This is the area of the brain called the left prefrontal cortex, which is thought to be responsible for controlling well-being and mood.

The coil gives out magnetic pulses, which are entirely painless, to activate parts of the brain. Generally, the lower the frequency of the pulses, the calmer the activity in the brain will be. The higher the frequency, the greater the brain activity.

TMS therapy sessions vary greatly depending on the mental health disorder being treated. Some people will experience higher frequencies, while others require lower frequencies.

What Is a Stroke?

A stroke is a severe medical condition resulting from limited blood supply reaching parts of the brain. When blood supply is restricted, brain cells begin to die. Sadly, strokes can result in brain damage, disability, and in some cases, death, especially when immediate medical treatment is not sought.

In the United States, strokes are the third most common cause of death and the first for long-term disability. The types of stroke can fall into the following categories:

Ischemic stroke. Ischemic strokes occur when a blood clot stops blood supply from reaching the brain due to a blocked or narrowed artery. 85% of stroke cases are a result of ischemic stroke.
Hemorrhagic stroke. A hemorrhagic stroke transpires when a weakened blood vessel that supplies blood to the brain bursts.
Transient ischemic attack (TIA). Otherwise known as a mini-stroke, TIA is the same as a stroke. However, it often lasts for a shorter amount of time. Usually, TIA often serves as a warning of a full stroke in the near future. For this reason, TIAs should be treated rapidly.

Although each person is different, and the outcome of a stroke cannot be determined before undergoing medical tests, both the location of the stroke and its size influence the after-effects.

Depending on the stroke location and the part of the brain it affects, the outcome will be different for each individual. For example, if a stroke impacts the left side of the brain, which holds language abilities, the individual may experience language and communication problems.

Furthermore, the greater the size of the stroke, the more severe the secondary effects will be. In contrast, a mild stroke is easier to treat, and the side effects are less intense.

What Are the Effects of a Stroke?

Short-term and long-term effects such as disabilities and emotional trouble can arise depending on the location and severity of a stroke. Some consequences following a stroke can include one or more of the following:

Emotional changes. A stroke is an extremely overwhelming experience, and the after-effects can leave sufferers feeling as though they have lost access to the life they were previously living. As strokes can take a toll on people's mental health, feelings of depression are widespread.
Memory impairment. It is quite common for those who experience a stroke to struggle with memory loss.
Trouble thinking and making judgments. Thinking and making judgments can be much slower and more confusing in stroke survivors.
Delusion and hallucination. Roughly one in 10 people who experience a stroke report side effects such as delusions and hallucinations.
Behavioral changes. Upon suffering a stroke, the way people react to situations may differ from the way they may have reacted before their stroke. Often, strokes leave people feeling apathetic, withdrawn, and easily irritated.
Paralysis and decreased ability to move muscles. Many people lose control of their muscles following a stroke, and paralysis can occur. This is due to damage inflicted on the part of the brain responsible for motor function.
Trouble communicating. It is common to struggle with communication after a stroke. Aphasia, which is when understanding and communicating are affected, can ensue. Strokes can also impact writing and reading ability as language becomes hard to comprehend.
Difficulty talking. Apraxia of speech is another side effect related to strokes. This side effect surfaces when muscles in the face do not move in the intended order when speaking, making it hard for people to talk. Dysarthria may also be experienced if someone who has had a stroke has trouble controlling the muscles in their face, mouth, or throat. This particular condition makes speech difficult and can result in a slurred, slow voice.
Trouble swallowing. The lack of control over mouth and throat muscles post-stroke can make swallowing challenging, which leads to difficulty eating.
Foot drop. Foot drop is experienced when the muscles in the foot become weak after a stroke. It can make a person's gait different, leaving them raising their foot higher than normal when walking, making moving around difficult.
Fatigue. Many people experience fatigue after a stroke.
Pain. Pain, tingling, and numbness are all common bodily sensations post-stroke.
Altered sensations. Those recovering from a stroke may experience altered sensations and feelings.

Who Is at Risk of Stroke?

When people age, arteries narrow, making it more likely that they will become blocked. For this reason, older people are more at risk of stroke.

Other risk factors include:

Heavy alcohol use
Lack of physical exercise
Being overweight
Use of illegal drugs, such as cocaine and methamphetamine
High cholesterol
Diabetes
High blood pressure
Smoking
Obstructive sleep apnea
Birth control pills or hormone therapies that include estrogen
Cardiovascular disease
Family history of stroke, heart attack, or TIA

How Can Repetitive Transcranial Magnetic Stimulation Therapy Work for Stroke Recovery?

Repetitive transcranial magnetic stimulation therapy works by stimulating the brain. When brain neurons are activated, they engage in what is known as neuroplasticity, which enables the brain to rewire itself.

For example, the brain's right-hand side controls movement in the left side of the body, and the left-hand side of the brain controls the right. Therefore, someone who experiences a stroke on the right-hand side of the brain will find that the left side of their body is affected.

However, repetitive transcranial magnetic stimulation therapy targets both the injured side of the brain and the non-injured side. Doing so encourages both sides of the brain to work together. This happens as moving a body part on the right-hand side requires the left-hand side of the brain to activate an excitatory motor signal. Likewise, the right-hand side needs to activate an inhibitory one to balance movement.

How Can TMS Therapy Help With Motor Recovery?

Some of the most prominent benefits of repetitive transcranial magnetic stimulation therapy revolve around the ways it affects movement, especially as transcranial magnetic stimulation has been shown to be effective in stroke survivors who have impaired motor function.

Post-stroke, the healthy side of the brain often becomes overactive to compensate for any brain damage that may occur on the opposite side. This prevents the damaged part from recovering successfully. However, the outcomes of repetitive transcranial magnetic stimulation therapy suggest that it could improve the brain's ability to re-learn motor function.

Repetitive transcranial magnetic stimulation therapy has also shown promising results in those with motor impairment in their arms. Post-stroke, many people experience upper limb motor function damage. But low-frequency repetitive transcranial magnetic stimulation may help with motor recovery.

Although studies are currently limited, repetitive transcranial magnetic stimulation therapy has shown to be advantageous in improving walking speed in stroke survivors. When combined with other therapies, repetitive transcranial magnetic stimulation therapy can improve lower limb motor function and gait speed in acute, subacute, and chronic stroke clients.

How Can TMS Therapy Help Treat Post-Stroke Depression?

Post-stroke depression affects up to 50% of stroke survivors. As with major depressive disorder, treatments such as medications and talk therapies have been approved to alleviate symptoms. However, not everyone responds to these therapies. Repetitive transcranial magnetic stimulation therapy could be an excellent option for this group of people.

A preliminary clinical trial conducted in 2020 has shown that accelerated repetitive transcranial magnetic stimulation therapy is a safe and viable option for those suffering from post-stroke depression. For this reason, repetitive transcranial magnetic stimulation therapy could be an excellent alternative for therapy or an additional therapy for stroke survivors.

Conclusion

Although further research is needed to fully assess the efficacy of transcranial magnetic stimulation therapy in post-stroke rehabilitation, there have been promising results. This is especially true when it comes to reviewing how magnetic brain stimulation improves motor recovery and eases symptoms of post-stroke depression.

Alongside other treatments, such as physical therapy and occupational therapy, transcranial magnetic stimulation therapy has favorable results in stroke recovery as it enables the brain to become more receptive to additional therapies, leading to improved outcomes.

If you would like to find out more about repetitive transcranial magnetic stimulation therapy and the way it can be used to treat post-stroke side effects, contact us today.

At GIA Miami, we would be more than happy to discuss treatment outcomes with you and share how repetitive transcranial magnetic stimulation therapy in a rehabilitation setting could benefit you or a loved one.