In the X-Men movies, super-villain Magneto can bend metal with his mind. It’s an entertaining but farfetched proposition. But magnetism is one of the most powerful forces in the natural world. And now there is a treatment that uses it. Repetitive Transcranial Magnetic Stimulation (rTMS) is a magnetism-based therapy that is currently being studied as a possible treatment for stroke patients. It has shown potential to reduce or manage various stroke symptoms in many studies. A new study builds on previous ones that show this technology can help patients with language problems (aphasia). The study showed that patients who received rTMS made more improvement than patients who did not. The study also indicates that the Low-Frequency version of rTMS is better for aphasia patients than the High-Frequency version.
What is aphasia?
Aphasia is the scientific term for the language problems that many patients experience after brain injury or stroke. The symptoms include problems remembering vocabulary and grammar and using them to communicate in everyday situations. The causes of aphasia are complex and can include damage to the language centers of the brain and an imbalance in the relationship between the two hemispheres. Speech therapy is the most common conventional treatment for aphasia, but rTMS is making its way into aphasia therapy programs.
What is Repetitive Transcranial Magnetic Stimulation (rTMS)?
rTMS is a therapy that applies magnetic fields to the brain from outside the head. The treatment is non-invasive and has relatively few side effects. A trained technician uses an appliance held near the patient’s head to direct the desired type of magnetic field to the appropriate part of the brain. The technician will use higher frequencies to stimulate brain activity or lower frequencies to dampen it. The frequency used depends on the type of problem the patient is having. Sessions take approximately half an hour.
Using rTMS for stroke patients is relatively new but early research indicates that it could have a positive impact on some symptoms. However, the FDA has only officially approved rTMS as a treatment for medication-resistant severe anxiety and depression. Using rTMS for stroke symptoms is an “off-label” application that is legal but may not be covered by your insurance. Without insurance rTMS costs between $100 and $200 per session. Also, many facilities sell their treatments in blocks of 36 sessions because the FDA recommends that many to treat depression. This is a much higher number than is typically studied for stroke patients. The current study, for example, provided ten sessions. Fortunately, many facilities will negotiate both price and number of sessions for off-label patients. If a facility is unwilling to negotiate, it may be a sign that they are not flexible or patient-focused and might be a poor match.
The recent study by Chinese and American researchers randomly divided 40 left hemisphere stroke patients into four groups. All groups received a standard post-stroke therapy regimen of medication, physical therapy, and speech therapy. The patients in the control group received no rTMS therapy. Another control group – called a sham group — believed that they were receiving rTMS therapy but in fact did not. The therapists went through the motions of rTMS treatment but did not actually apply the therapy to anyone in this group. A third group received treatment with high-frequency magnetic pulses (HF-rTMS) meant to stimulate the language center in the unaffected right hemisphere. And a fourth group received treatment with low-frequency magnetic pulses (LF-rTMS) meant to dampen the language center in the unaffected right hemisphere. The rTMS patients received one ten-minute treatment per day for ten days.
Researchers tested the patients’ language skills just before the study start, just after study completion, and again two months after study completion. The LF-rTMS group scored better on a variety of language assessments than the other groups, including the one that received HF-rTMS, on both evaluations after the study. This finding led researchers to believe that dampening brain activity in the non-affected hemisphere may be more beneficial than stimulating it. A limitation of this study is its small sample size and further research is needed to confirm the results.
There are facilities offering rTMS in most metropolitan areas. You can ask your doctor or therapy team for a recommendation or search on the Internet.
The lead author of this study is Xue-yan Hu, Department of Neurorehabilitation, China Neurorehabilitation Research Center, Beijing, China.