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Transcranial magnetic stimulation application prospect in the convalescence of

Author: XuTao ChenQiong MaXiangZuo From: www.yourpaper.net Posted: 2010-06-24 16:10:58 Read:
[Abstract] Objective To investigate the by transcranial magnetic stimulation therapy in nursing work.Methods according to the object of service conditions in nursing homes using the related parameters of transcranial magnetic stimulation for targeted therapy care.Results transcranial magnetic stimulation therapy and nursing work closely with, at sanatorium is a play.Application and development prospect of transcranial magnetic stimulation in the sanatorium has very good, should as soon as possible the development and utilization of.
[Key words] transcranial magnetic stimulation; sanatorium; Prospect
[Abstract] Objective To investigate the application prospects of transcranial magnetic stimulation therapy in the convalescent work.Methods Related parameters of the transcranial magnetic stimulation were used for treatment and health care of patients in the sanatorium according to their conditions.Results Transcranial magnetic stimulation closely combined with convalescent work was very useful in the sanatorium.Conclusion The transcranial magnetic stimulation has a very good perspective of application and should be developed and applied earlier.
[Key words] Transcranial magnetic stimulation (TMS); Sanatorium; Perspective
Transcranial magnetic stimulation (transcranial magnetic stimulation, TMS) is in certain areas of the brain is not a new technology of invasive to magnetic stimulation, mainly used for the treatment of basic neuroscience research and neuropsychiatric diseases.Since 1985 Barker for the first time with the single pulse TMS caused by cerebral cortex cell depolarization and its clinical application of [1] is recommended, and its applications in expanding.From birth to now 20 years, the world of transcranial magnetic stimulation as a new technology of non-invasive, painless application in the field of rehabilitation is increasingly enhanced [2], combining with the characteristics of TMS and the sanatorium, the prospects of using TMS in sanatorium.
1 TMS
The basic principle of   1.1 TMS;
TMS is the principle of Faraday's law of electromagnetic induction, is a time-varying magnetic field can produces electric field, when the excitable tissue changes in the magnetic field, the electric field and current organization.When the current exceeds the threshold excitation tissue, causing membrane depolarization to local, excitation.TMS is produced by metal induction coil induction magnetic field rapidly changing, acting in the brain and the brain has a weak reverse parallel inductive current of pyramidal neurons in the cerebral cortex, to generate action potentials, so that the brain physiology and functional changes.
1.2   mechanism of TMS;
Induced current induced by TMS may be caused by the intracortical excitability of pyramidal neurons and the nearby gamma-aminobutyric acid (GABA) can inhibitory interneurons potential changes, thus changing the function of the cortex, the corticospinal tract of spinal cord anterior horn motor neurons after arrival, excited motor evoked potential; also can transmit to the target muscle excitation compound muscle action potential.The rTMS in the neurons should not period of stimulation, connecting neurons to excited more level, produce excitatory postsynaptic potential sum, interrupted cortex between excitatory inhibitory connections.Different frequencies of stimulation of rTMS have different effects on cortical metabolism and cerebral blood flow, high frequency stimulation (15 ~ 25 Hz) may lead to increased local metabolism level, while the low frequency stimulation (1 ~ 5 Hz) may reduce the local metabolism.Short-term effects of low frequency rTMS cerebral blood flow state, the stimulation of the ipsilateral cerebral blood flow reduction, increase the subsequent contralateral cerebral blood flow compensation.Given the health people on the left side of the prefrontal back to 1 Hz, 80% MT rTMS 30 min, PET imaging showed regional glucose metabolic rate decreased in the left superior frontal gyrus, and ipsilateral occipital lobe cuneus, glucose metabolic rate increased [3].These results suggest that low frequency, low intensity of rTMS can reduce the stimulation of local blood flow and metabolism, reduce the excitability of local and regional, the distant parts of the change on the contrary, it may play a role in the change of regional cerebral blood flow and glucose metabolism.RTMS can cause the change of neurotransmitters, such as dopamine (DA), 5- serotonin (5-HT), glutamate, which may be rTMS on affective disorder disease or Parkinson's disease valid reason, human study found that frontal rTMS caused by basal ganglia area increased the release of DA [4], projection fibers that cortex and basal ganglia (cortical veins fiber) may release DA.DA increases neurotransmitter release will be beneficial in the treatment of Parkinson's disease, provide the basis for the treatment of Parkinson's disease.In addition, rTMS also has an obvious effect on the regulation of neuronal excitability and gene expression, Khedr uses a single blind randomized controlled design, 26 caused by middle cerebral artery occlusion of the patients with hemiplegia were randomly divided into two groups, experimental group 3 Hz, 10 s, 50 series, intermittent period of 10 consecutive D true rTMS stimulation or false rTMS stimulation, during the period of the two groups of patients received rehabilitation intervention measures in general, results using two factors analysis of variance statistics, found that patients in the experimental group the paralyzed side hand function was significantly improved, and sham control group efficacy significant differences compared to [5].Grisaru reported 10 cases of PTSD patients received unblinded left and right motor cortex to slow rTMS treatment, in the treatment of symptoms after temporary improvement in 1 ~ 7 d.Functional neuroimaging studies suggest that PTSD patients have the right frontal lobe activity [6].
1.3 parameters of   TMS;
The TMS function and the shape of the coil and the specification of the circular coil, big strong penetrating power and the limitations of poor, small "figure 8" coil space limitations on the motor cortex, the spatial resolution of up to 0.5 ~ 1 cm, but the penetration is relatively weak, stimulation can only reach the brain 3 cm depth.TMS includes a single pulse TMS (sTMS), double pulse TMS (pTMS) and repetitive TMS (rTMS) three kinds of stimuli.It includes several adjustable parameters: frequency of stimulation, the stimulation intensity, time interval.The stimulation frequency range is usually 1 ~ 25 Hz, the stimulus intensity range is usually 80% ~ 110% motor threshold (motor threshold, MT).
1.4 TMS     indication;
TMS is currently used to Parkinson's disease, cerebral infarction, depression, posttraumatic stress disorder, obsessive compulsive disorder, in addition to observe the motor evoked potentials excited motor cortex, foreign language, central location of epilepsy, cognitive disorder.
The security of TMS 1.5
In the aspect of safety, TMS from birth to now have 20 years, from the current related research, with little side effect of TMS on the human body, the skin, subcutaneous tissue and skull resistivity is far greater than the brain, TMS only a very small current through the scalp and skull, the subjects of basic no discomfort feel, have good security.The main adverse reactions were headache, head discomfort, pure tone hearing impairment, tinnitus, but has a history of epilepsy, intracranial permanent metal clip or pacemakers should not use, pregnant women should be used with caution.TMS headache is a tension headache, and advances in scalp and head muscle contraction,
Application of sedative (such as aspirin) or rest can relieve and prevent; tinnitus or hearing impairment can be prevented by wearing earplugs.If operating according to guidelines published in 1998 in [7], TMS is considered to be safe, guide that epilepsy is a relative contraindication to rTMS.The adverse effects of TMS people are most concerned about is whether it can cause seizures.So far, the study of the worldwide tested thousands of cases, only 7 cases of seizures, and epileptic TMS induced seizures are self-limited, temporary, no long-term effect of [8]. 2 TMS analysis of feasibility of the treatment of development sanatorium
2.1   environmental characteristics of sanatorium;
Our sanatorium are mostly located in the beautiful scenery, the scenery is coastal, lakes, mountains, forests, grasslands, mineral spring scenery, beautiful wooded river, wide sea, forests, the vast grassland, fresh air, pleasant climate and so on through the sensory effects on the body, adjust and improve the cortical function and the psychological state of mind, is to relax the tense mood, alleviate the psychological stress and anxiety, improve sleep, elimination of fatigue, so as to achieve the purpose of psychosomatic health and rehabilitation.
2.2 sanatorium medical features of
All the sanatorium is service to guarantee and promote the objective convalescent physical and mental health.So from the equipment to the personnel have very strong medical characteristics with.Doctors, nurses were graduated from medical colleges, to master the diagnosis, treatment, and supporting the medical equipment can be effectively for recuperators provides a reliable means of diagnosis and treatment.
2.3 psychosomatic health needs   convalescents;
For convalescents from Parkinson's disease, stroke rehabilitation, rTMS through the stimulation of the brain cortex (mainly M1) can cause irritation and adjacent regions of cortical excitatory or inhibitory, but does not affect the performance of simple.Cortical excitability in patients with stroke is not damaged side enhancement, if not damaged side function is restrained, the inhibitory effect decreased between the hemispheres, excitatory ipsilesional increase, enable patients to improve motor function of [9].Similarly, sub-health phenomenon in many literatures recuperators generally, psychosomatic disease incidence in the sanatorium of higher.In particular, in 2008 July after the national various sanatorium convalescent began to earthquake relief staff, are in the sub-healthy state, a lot of earthquake relief staff there have been varying degrees of fatigue, anxiety, insomnia, depression, nervous, psychological adaptation.TMS is often used in the clinical depression, posttraumatic stress disorder, obsessive compulsive disorder, mood disorder, appear for the rehabilitation of sleep disorders in TMS treatment, whereas TMS physics and non-invasive characteristics, easy to be convalescent acceptance, so as to improve the treatment compliance.
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