Friday, February 18, 2011


r-TMS a boon for mentally ill.
Repetitive trans-cranial magnetic stimulation (r-TMS), is upcoming method to deal with patients suffering from psychiatric problems, it has made evolution in the field of psychiatry. Limited treatment option in psychiatric treatment has presented with so many obstacles in treatment of chronically ill patients in psychiatry. Medications have always been gold standard of treatment with other psychological therapeutic measures. Conventional treatment modalities like Electro Shock therapy (ECT) though used extensively in developing countries like India is now being replaced by new modality called r-TMS world over. High Magnetic field created around brain can selectively stimulate or inhibit specific brain areas and can be used in treatment of neurological and psychiatric illness was first time reported in 1975. Extensive research in this field has come up with new hope for patient and family with psychological problems. r-TMS is being successfully used in western world for treatment of Depression, Obsessive Compulsive Disorder (OCD), Schizophrenia, BAD Mania, Parkinson’s disease, and other Neuro-psychological problems. As compared to conventional methods like ECT, there is no need to give anaesthesia to patient, no need to induce seizure, and no side effect other than mild headache. R-TMS can be done on outpatient basis in a hospital with trained personnel and patient remain awake and sited in chair. Procedure last for around 30 to 40 minute.

ABOUT rTMS - One very promising avenue for influencing the living brain has emerged in the last decade, based on the use of pulsed magnetic fields. Machines are now available which can give up to 50 stimuli per second (rapid-rate TMS, or rTMS) and their effects are more interesting. Among a wide range of possibilities, it is proved that rTMS do have a place in the treatment of mental illnesses. It is a non-invasive technique, without help of medication, apparently free of serious side-effects, capable of modifying the activity of specific brain areas and treatment of psychiatric problems like Depression, OCD, Schizophrenia.
Approved for clinical use by the United States Federal Drug Administration (FDA) in October 2008, Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that uses a magnetic field to induce a weak current in the part of the brain responsible for depression. "TMS is an exciting development in the treatment of depression symptoms," says Dr. Richard Bermudes, founder of Sacramento TMS center USA.
"It's really life changing, especially for patients who haven't been helped by traditional antidepressant medications, which is typically about 50 percent of those we see." our patients already have seen dramatic improvement with just a few treatments," says Bermudes (2010). How it works
The magnetic fields used in TMS are produced by passing current through a hand-held coil, the coil is held on the scalp - no actual contact is necessary - and the magnetic field passes through the skull and into the brain. Small induced currents can then make brain areas below the coil more or less active, depending on the settings used.
In practice, TMS and rTMS are able to influence many brain functions, including movement, visual perception, memory, reaction time, speech and mood.
Safety issues

Generally, TMS appears to be free from harmful effects. Research continues, but TMS is certainly free of obvious side-effects like those of electro-convulsive therapy (ECT), which still makes quite an impact on patients despite refinements in technique.
TMS / rTMS in the treatment of mental illness
Many mental illnesses can be demonstrated to stem from the abnormal behaviour of particular brain regions, in much the same way that diabetes is the result of malfunctioning cells in the pancreas.

It is believed that some mental disorders are the result of nerve cells being over- or under-excitable (in other words, it is too easy or too difficult for them to "fire" and work properly). In this context, successful psychiatric treatment is achieved by modifying these cells' behaviour. The range of effects produced by TMS are a clear indication of its potential to work in this way. - Dr Deshmukh. Of course, TMS could only be used to treat diseases whose functional causes are understood. Recent progress in understanding the mechanisms behind depression, obsessive-compulsive disorder, psychosis (schizophrenia) and neurological diseases like Parkinson's and Huntington's, offers some hope in these areas. The prospect of replacing ECT with a near-painless treatment, which does not require anaesthesia, would change these people's lives remarkably.

rTMS is now available in INDIA. Recently (last three month) few rTMS centers have been started in cities like Delhi, Mumbai, & Pune ( Maharashtra).
Considering high cost of standard imported rTMS machines of 3 tesla (High strength) and less trained doctors working on this tequnology, Dr Deshmukh (Pune) completed successful training and study on use of rTMS in Psychiatry. Currently in Puna- rTMS is only available at -Department of Neurology, Navalmal Firodia Super-speciality Center, Joshi Hospital, Deccan, Pune, under supervision of Psychiatrist Dr Deshmukh.

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