Repetitive Transcranial Magnetic Stimulation(R-TMS) for spastic Cerebral Palsy

Authors

• Dr. Arun Mukherjee
  Founder and Director (FSMHP-UDAAN)
  MD, MBBS, Fellow and Faculty Medical Academy of Paediatric Special-needs, USA.
• Dr. Dinesh Bhatia
  HOD and Associate Professor (Biomedical Engineering)
  North Eastern Hill University, Meghalaya, India
• Dr. Meena Gupta
  Research Fellow (Senior Paediatric and Neuro Physiotherpist)
  North Eastern Hill University, Meghalaya, India
• Mr. Bablu Lal Rajak
  Research Fellow (IT)
  North Eastern Hill University, Meghalaya, India

Magnetic pulsations have a phsyiological effect in modifying brain functions. Instead of applying it as a continuous field, a therapeutic potential has been observed when it is applied in pulses. initially it was applied a a serios of large ring magnegs attached veritcally onto a non-magnetic wooden bed at regular intervals. the patient was made to lie inside it, and a plused current was applied to build up a paulsed magnetic field arround the patients body. In the mid 2000s, PMFT was tried in 6 Spastic CP Children who were on Standard Therapy ONLY, whose parents wanted to try this therapy. The children were placed inside the series of ring shaped electromagnetic coils as shown in the picture. The duration of each session was half an hour. The Pulsed Electro-Magnetic Field Therapy (PMFT) modified electrical activity of the brain (spasticity causing areas) and possibly the nerves, to induce relaxation in spastic muscles. The benefits were observed up to six months. rTMS is an advance on PMFT, as it ises a ring shaped coil over the affected area of brain as identified by clinical evaluation and SPECT Hybrid Scan. rTMS is an effective , non invasive and pain free alternative for the large number of patients not responding to medication or who cannot tolerate side effects of medication.It does not require any anesthesia. Clinical trial and experience from clinics offering this treatment show excellent result in term of response rate or even complete remission. This system delivered magnetic pulses to stimulate nerve cells in the part of the brain controlling the mood and various brain activities. During this treatment the machine is connected with the patented scale to deliver the magnetic pulses to the human brain cortex through scalp via placing the magnetic coil on human skull as shown. rTMS is the new intervention techniques for treating various psychological and neurological conditions like depression, stroke and dementia. This is clinically approved by Food and Drug Administration of USA, for many neurological conditions. We are using this technique to improve the physical function in spastic cerebral palsy patient to improve their quality of life where only rehabilitation is the way to make them independent. The approach of this technique with the standard therapies like physical and occupational therapy increase the rate of improvement in the cerebral palsy patient. Emphasis on RTMS There is no need to take anesthesia and oral medication to use RTMS. It has deep penetration which excitates the neuron of brain cell and its non invasive technique of treatment in Spastic cerebral palsy which is approved by Food and Drug Administration. Mode of Action RTMS excited the brain cells and neurons which generate new pathways in hypoxic brain and helps in Neuroplasticity Major Clinical therapeutic uses Psychological conditions Schizophrenia Depression Stress Headache Dementia Neurological conditions Cerebral palsy Stroke Hypoxic brain injury Traumatic brain injury Neural Developmental Disorder

Side Effect

• Mild headache
• No other side effect recorded in literature and during patient feedback
• Rarely, may cause relapse of epilepsy

Acknowledgements