A non-invasive, non-pharmacologic treatment for major depressive and obsessive-compulsive disorders (MDD and OCD), and which is also showing efficacy for treating traumatic brain injury, PTSD, sleep disruption, migraine, anxiety, cerebral palsy, autism and some other conditions, is available for the first time in northeast Indiana.
PrTMS, the acronym for personalized repetitive transcranial magnetic stimulation, is a “new tool in my toolbox,” says Thomas Lazoff, MD, a physical medicine and rehabilitation specialist with Physical Medicine Consultants, 7201 Engle Road, Fort Wayne. He and his colleagues, Mark Zolman, MD, and David Stensland, MD, work with a spectrum of patients ranging from children with cerebral palsy to adults with chronic pain due to degenerative disease to athletes with acute injuries.
Personalized repetitive transcranial magnetic stimulation works by delivering painless, low amplitude magnetic pulses to a targeted area or areas of the brain to stimulate or suppress neurons that are out of sync with other neurons.
“The brain has a number of frequencies that can vary and create disharmony,” explains Kevin Murphy, MD, a radiation oncologist who specializes in treating brain tumors; he is also vice chair and director of CNS and Pediatric Radiation Oncology Services within the Department of Radiation Medicine and Applied Sciences at University of California San Diego.
“The brain’s neurons are electrical oscillators,” Murphy says, with electrical charges pulsing through them that send signals back and forth to each other. But things can go awry for a variety of reasons. “The brain’s response to trauma is to slow down.” For the brain to work at optimal level, the neurons need to function like a finely tuned orchestra, each instrument playing the right note at the right time, he says. “The back of the brain propagates signals for the front of the brain. We want them to be basically synchronized.”
When rTMS is used to treat MDD, for which it was approved in 2008 by the FDA, the magnetic coil is placed over the prefrontal cortex, the area involved with mood regulation. The magnetic pulses wake up neurons that have been functioning at too low “brainbeat” frequency or slow down those functioning at too high frequency.
For people with MDD, medication and psychotherapy – or as a last resort – electroconvulsive therapy (ECT) – are the usual treatments. But depression medications have numerous side effects and ECT can cause seizures and memory loss.
Traditional rTMS sends a preset level and duration of pulsing with no variance for how the brain is responding. The Mindset PrTMS system Lazoff is using was developed by Murphy, who founded San Diego-based PeakLogic, which makes the software that enables the system to compute individualized strength and duration of dosing based on EEG readings and clinical evaluation. When the initial 4-minute EEG reading of 19 areas of the brain, along with cognitive and clinical information, are analyzed by the software, the system provides a treatment protocol for the physician that tells what the stimulation dose should be
and at which part of the brain to apply it to get neurons functioning in sync.
Treatments are 30 minutes a day, 5 days a week usually for six weeks, sometimes longer. Lazoff says, “We usually know within the first two weeks if someone will be a responder,” adding, the response rate among more than 4,000 patients given PrTMS treatments by Murphy and other clinic sites is around 90 percent. Some people may later need “booster” treatments. No seizures have been reported with the treatment; only minor, temporary side effects such as headache, discomfort on the scalp and facial twitching have been noted.
Physical Medicine Consultants is just the 10th clinic site in the nation offering PrTMS, says Lazoff, who has a family member who was successfully treated for anxiety by Murphy, a University of Notre Dame grad, when Murphy was operating a PrTMS clinic in South Bend.
Nurse practitioner Tina Hermes and Jodi Isbell, RN, along with Lazoff, comprise the team that does the initial patient consultation, EEG testing and treatments.
While not considered curative for all conditions treated, Lazoff says during his training with Murphy, he saw PrTMS reduce spasticity in children with cerebral palsy, relieve chronic pain, help individuals with opioid addiction get off drugs, restore mood and function in people with brain injuries and improve behavior and learning in children on the autism spectrum. However, outside of MDD and OCD, the treatment’s usage is currently considered investigational. PeakLogic anticipates clearance by the FDA this summer for its PrTMS software system and the 19-point wireless EEG cap.
Address: 7201 Engle Road Fort Wayne, Indiana 46804
Phone: (260) 432-1800