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TMS and the Neurology of Motorneurone Disease

Basic findings

Encompassing the varied forms of diseases affecting the motor neurones, motorneurone disease (MND) includes amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP) and progressive muscular atrophy (PMA). There is sometimes difficulty providing a definitive diagnosis as it relies on ruling out other neurological conditions. TMS has been shown to be a sensitive means for the assessment and monitoring of excitatory and inhibitory upper motor neurone function in MND (Triggs et al 1999, Mancini 2008).

Ongoing findings

Monitoring The Disease

TMS can objectively discriminate corticospinal tract involvement in ALS from controls, which may be used to assess the progression of ALS. Additionally, the decrease in TMS amplitude may provide a useful marker of disease progression (Floyd et al 2009). In summary, TMS provides important diagnostic information for prediction of ALS in MND patients presenting with clinically equivocal UMN impairment, and is currently used in the clinical setting.

Modulating The Disease

It has been proposed that glutamate-related excitotoxicity may promote motor neuron death in ALS. TMS can be used to activate glutamatergic circuits of the motor cortex. rTMS of the motor cortex, at frequencies that decrease cortical excitability, has been shown to cause a slowing in the progression rate of ALS. Evidence has been found that rTMS also contributes to the modulation of MND by stimulating the production of the neural survival factor brain-derived neurotrophic factor (BDNF) (Dileone et al 2010).

Links


References

  • Dileone et al., CNS & Neurological Disorders - Drug Targets, 2010.
  • Floyd et al., Neurology, 2009.
  • Mancini. Chapter XIII. Motor Neuron Disease Research Progress. 2008.
  • Triggs et al., Neurology, 1999.

Products

  • Magstim 200²
    A single pulse, monophasic stimulator used for cortical and peripheral stimulation.
  • Magstim BiStim² & Upgrade
    The BiStim² is an extension of the 200². Two of the single pulse systems are combined through a connecting module, so that paired pulses can be delivered through one coil.
  • Magstim Rapid², Super Rapid², & the Super Rapid² Plus¹
    The Magstim Rapid² is a single pulse and repetitive stimulator with high frequency capabilities. It is ideal for therapeutic applications as well as a wide variety of research fields.
  • Articulated Coil Stand
    The Magstim Articulated Coil Stand arm is an elegant multi-movement mechanism capable of holding a stimulating coil over an exceptionally wide range of movement.
  • Interface Module
    The Magstim Stimulator Interface Module provides additional interface functionality for all of the 2nd generation Magstim Stimulators (200², BiStim² and Rapid²).
  • Magstim Innovations
    Developed to meet research requirements, Magstim Innovations products can help push the boundaries of neuromodulation and brain stimulation with systems that meet your specific needs.
  • Neuronavigation
    Magstim is working to develop applications that will further advance the field of Neuronavigation, and supports ANT's Visor System.
  • Air Film Coil
    The Magstim Air Film Coil is the first of a new generation of stimulating coils which allow users to stimulate for extended periods of time. This improvement has been achieved as a result of an advanced, registered method of coil design and manufacture
  • Double 70mm Coil
    The Double 70mm coil is capable of accurate stimulation of cortical areas and spinal nerve roots.
  • Double 70mm Cooled Coil System
    The cooled coil is available in the double 70mm configuration and can be run for extended periods of time without overheating thus removing the need to replace coils during protocols of stimulation.
  • Double Cone Coil
    The Double Cone Coil elicits responses from relaxed muscles of the lower pelvic floor and lower limbs.
  • Double Small 25mm Coil
    The Double Small 25mm Coil has been designed for enhanced positional accuracy in peripheral stimulation.
  • High Power 90mm Circular Coil
    The High Power 90mm Coil can be used for central motor conduction studies. The design of the coil allows between 120 and 160 stimuli at the maximum power level before requiring a few minutes to cool.
  • Medium 70mm Circular Coil
    The 70mm coil is designed for Paediatric and Infant use.
  • Small 50mm Circular Coil
    The 50mm coil is focal and effective for nerves 5-15mm deep.
  • HDCkit
    A cost-effective modular system for Direct Current (DC) stimulation, designed specifically for both research and clinical use.

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