Transcranial Magnetic Stimulation

In the treatment of depression, today it is customary to use multiple therapeutic approaches in an integrated manner. Generally, we talk about drug therapy and psychotherapy. 

Transcranial Magnetic Stimulation aims to remodulate neuronal activity through the magnetic impulses emitted by a device and can be used both as an integration to traditional therapies, drugs and psychotherapy, to improve the effects of traditional treatments, and as an alternative to medical therapy. In particular, it can be indicated, together with psychotherapy, for those patients who have contraindications to taking drugs due to other pathologies (heart disease, liver disease, nephropathy) or in patients who refuse drug therapy due to experienced side effects or simple personal aversion. A very recent study from 2021, published by Publimed confirms the effectiveness of TMS in regressing the symptoms of drug-resistant depression.

In patients with Parkinson’s, transcranial magnetic stimulation is used to support traditional pharmacological therapy, and the maximum benefit is obtained when the patient also follows courses of physiotherapy or, better to say, neuromotor rehabilitation. In this case, in fact, the area of the brain that is stimulated through the magnetic waves is the motor cortex, which is one of the main areas of the brain responsible for movement control. TMS in combination with physiotherapy allows the patient to have improvements on the motor symptoms of the disease.

In patients with Alzheimer’s, TMS remodulates the plasticity of the precuneus, an area of the brain involved in memory functions. Recent scientific evidence has shown that this brain structure is one of the first to ‘suffer’ from Alzheimer’s disease and is already compromised in the prodromal stages of the disease. However, in typical forms of Alzheimer’s, the brain structures primarily involved in degenerative phenomena are those located in the medial temporal lobes. In fact, the early stages of the disease are dominated by memory disturbances. The neuromodulatory strategy using TMS consists in stimulating the precuneus, which, at least in part, suffers due to mechanisms of disconnection with the medial temporal structures. This neuromodulation has been shown to be effective in slowing the progressive accumulation of cognitive deficits, the aggravation of which leads individuals with initial Alzheimer’s disease to a state of dementia.

Timing is therefore very important in treatment: in fact, stimulation is more effective in early Alzheimer’s. This makes a precise diagnosis from the first symptoms and a careful evaluation by the neurologist essential to maximize the benefits of the treatment, which must be administered with anatomical accuracy on the basis of neuroimages obtained with Magnetic Resonance. The ultimate goal is to improve memory, slowing down the degenerative process of the brain cells (neurons) of the precuneus and the structures connected to it, which perform important cognitive functions.

Transcranial magnetic stimulation, TMS, together with cognitive behavioral therapy, CBT (Cognitive Behavioral Therapy), helps reduce the desire to smoke or to consume other psychostimulant substances, if used frequently.

The brain regulates emotions especially through the limbic system, composed of a series of nuclei and deep nerve fibers that connect, among others, with the orbito-frontal cerebral cortex, an area of the brain that plays a fundamental role in the emotional response and in the subsequent decision-making. The regulation function of this system, both for its activation and for its inhibition, is carried out by neurotransmitters, chemical substances naturally present in the nervous system, which have the ability to excite or inhibit the brain circuits responsible for the development of emotions and many other functions of the nervous system.

Nicotine, and psychostimulants in general, interfere with the action of various neurotransmitters. Simply put, these substances alter the messages that the brain processes in particular in the limbic system. The mechanisms through which these substances carry out this action are different but, in general, it can be said that they modify the quantity of some neurotransmitters present in our brain such as dopamine, a neurotransmitter useful for consolidating memory and a mediator of pleasant sensations, and glutamate, which favors the exchange of information between neurons and has a stimulating and natural activation function of the circuits of our nervous system.

Psychostimulant substances or an excess of psychoactive drugs introduced into the body from the outside, through the activation of the circuits of the limbic system, intensify the sensation of pleasure and sense of gratification. Hence a sensation of false well-being which, in the event of problematic and prolonged use, leads to addiction and a desire that is difficult to control, defined as craving, to take the psychostimulant substance to which the whole organism, and in particular the brain, is by now used to it.

TMS and cognitive-behavioral therapy, used in synergy, are effective for treating patients who make problematic use of nicotine or other psychostimulant substances. The aim of treatment is for the person to have the opportunity to choose to stop using nicotine or other psychoactive substances, without being dominated by craving. This is possible only by restoring decision control, which occurs above all in the orbito-frontal area of the brain, freeing this function from the conditioning of false emotions. The process, from the initial clinical assessment of the patient to the completion of the series of TMS treatment sessions, takes approximately one month. In some cases it is useful to continue with boosters with TMS sessions in the following months.