July 16, 2012

Transcranial Magnetic Stimulation (TMS): Can It Treat Speech Disorders that Result from Strokes or Parkinson's?

At my weekly Parkinson's support group meetings, there's an oft-repeated phrase: "Speak up, please. We can barely hear you." So, I was excited to read that researchers at Australia’s University of Queensland reported last week that transcranial magnetic stimulation (TMS) could revolutionize treatment for language and speech disorders associated with Parkinson’s disease and stroke.

Professor Bruce Murdoch of the Centre for Neurogenic Communication Disorders Research within UQ's School of Health and Rehabilitation Sciences reported that the new therapy would bring life-changing improvements for people who had experienced language problems with neurological causes. “When present, these disorders have a serious impact on quality of life, often leading to an inability to communicate with family and friends, social isolation, loss of vocational standing and financial hardship,” he said.

The non-invasive process involves delivering a series of magnetic pulses to the brain using a figure eight-shaped stimulating coil held over specific areas of the head. Citing the brain’s astonishing plasticity – its ability to change and even heal itself – Murdoch explained that the TMS pulses had the effect of “switching on” disabled parts of the brain in patients with PD, and “switching off” trouble-making parts of the brain in people whose language problems were stroke related.

Murdoch reported positive results for patients within a week to two months after TMS treatment. He also said that patients continued to record improvement a year after stimulation.

The technology isn’t new. In fact, it’s FDA-approved as a depression therapy for patients -- including people with Parkinson's -- who do not respond to more standard approaches, like antidepressant drugs or psychotherapy. TMS has also been used to treat insomnia and anxiety, conditions that sometimes afflict PWPs.

How TMS Works
A non-invasive process, TMS does not require surgery or electrode implantation. Unlike electroconvulsive therapy – another “last resort” depression treatment – it does not require seizure inducement or sedation.

Patients typically experience a series of TMS treatments – perhaps five sessions a week for a month or so -- on an out-patient basis in their doctor’s office or clinic. Before undergoing TMS, patients should advise their doctors if they’re pregnant or considering getting pregnant, if they have metal or implanted devices, if they’re taking medications, or if they have a history of seizures or mania.

Once approved for the procedure, the patient sits in a comfortable, reclining chair. She wears earplugs. The magnetic coil is placed against her head, and switched on and off, up to ten times a second. During this initial process, the doctor decides exactly where to position the coil, and how much magnetic energy is appropriate. Once coil placement and energy dosage are determined, the treatment begins, and typically lasts for about 40 minutes.

Limited Side Effects
Side effects are usually mild and diminish as treatments continue. They can include headache, scalp discomfort where the coil was positioned, tingling or twitching of facial muscles, light-headedness, and discomfort from treatment noise. More serious side effects are apparently rare, and include seizure, loss of consciousness, mania, and hearing loss.

After treatments, patients are able to perform all normal functions, including driving themselves home from their doctor’s office or clinic.

Like all other new therapies for any medical condition, more and larger studies are necessary to assess both the benefits and risks of TMS. As one might expect, it’s been difficult creating a “placebo” component for the magnetic procedure.

In any case, Murdoch and his fellow researchers press on. Working with colleagues at the University of Hong Kong, he is expanding the research to determine if TMS has therapeutic application for stroke-related swallowing disorders. In addition, the Michael J. Fox Foundation is currently funding two TMS studies, on controlling depression and improving motor function, and another on treating dyskinesia. Perhaps we'll see the Foundation help investigate the promise of TMS to improve speech and language problems for people with Parkinson's.


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