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TMS: A novel treatment in neuro-psychiatry

  • TMS is rapidly gaining in popularity, and it may reduce or replace ECT use all over the world
- Ekantipur Report
TMS: A novel treatment in neuro-psychiatry

Jan 15, 2015-

At a time when psychiatry itself is questioned by many anti-psychiatry activists, it should not be surprising that there exist doubts and controversies around psychiatry’s treatment methods.  Electro convulsive therapy (ECT), also known as shock therapy, is perhaps one of the most stigmatised, debated and controversial methods of treatment.  The negative portrayal of its image in the media and showbiz, and the campaign against it by the human right activists, alleging it to be akin to torture, have been so effective that in many parts of world, the use of direct ECT (without using anesthesia) has been totally banned; and even the use of indirect ECT is only allowed after multiple tiers of scrutiny and recommendations.

But recently a novel method has been invented—Trans-cranial Magnetic Stimulation (TMS)—which may put an end to all the handwringing. This new technology, even as the evidence of its utility is still being established, is rapidly gaining in popularity, and it may reduce or replace ECT use all over the world.

What is Trans-cranial Magnetic Stimulation (TMS)?

TMS is a non-invasive method of brain stimulation in which the magnetic fields are used to induce electric currents in the cortex. TMS,

sometimes called “electrode-less electrical stimulation”, was originally invented to study the functional mapping of the brain.

The brain is made up of neurons and neuron clusters that are electrically excitable. It is postulated that different brain disorders are associated with altered neuronal activities. For example, migraines are associated with high neuron activity, depression with low. Hence, a magnetic coil, placed in a desired location, to modulate neuron activity, can be used in the treatment of such brain disorders.

The difference between ECT and TMS

In ECT, electric currents are directly passed through the scalp until a seizure is induced, but in TMS, magnetic stimuli are used, which in turn change electrical activities of specific areas inside the brain, without the need to induce seizure. Furthermore, the patient does not need to be anesthetised for TMS. The patient can remain fully awake during the procedure and walk out of the clinic instantly after the therapy. Besides, TMS has fewer side effects—in the form of headaches or muscle aches, and short-term changes in the hearing threshold, related to the noise generated during application. It is also more effective for treating many disorders, as evidenced by scientific studies, compared to ECT. TMS has proven useful even in the management of neurological disorders like Parkinson’s disease and other movement disorders, and for stroke, migraines and other chronic pain conditions. The success has been repeatedly replicated in treating depression, including drug-resistant ones; and for treating schizophrenia, anxiety disorders, panic disorder, post traumatic stress disorder, obsessive compulsive disorder and so on.

The new technology is widely being accepted in psychiatry as well as neurology, all over the world. The only obstacle to its popularity is the high cost of the machine, and obviously treatment sessions. Naturally, TMS has not yet become popular in developing countries, including Nepal. India too had only a couple of machines, for research purposes, in some of the premier medical institutes just five years back. But with the machines now being manufactured in India, their cost has significantly come down (it only costs about NRs 1.5 million, which is almost ten times less expensive than foreign machines).

The burden of psychiatric disorders in Nepal is not any less than in other parts of the world. It thus makes no sense to deprive sick people here from modern treatments. As it is, going abroad for treatment is not something the majority of Nepalis can afford. Thus, the concerned stakeholders—the government, the private sector and medical colleges—should try to introduce this machine in Nepal, for the sake of those suffering from psychiatric disorders.

Dr Shakya is an Assoc Prof and Head at the Patan Academy of Health Sciencesw

Published: 15-01-2015 09:00

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