• The Korean Journal of Pain
• /
• v.34 no.2
• /
• pp.156-164
• /
• 2021

Several types of pain occur following spinal cord injury (SCI); however, neuropathic pain (NP) is one of the most intractable. Invasive and non-invasive brain stimulation techniques have been studied in clinical trials to treat chronic NP following SCI. The evidence for invasive stimulation including motor cortex and deep brain stimulation via the use of implanted electrodes to reduce SCI-related NP remains limited, due to the small scale of existing studies. The lower risk of complications associated with non-invasive stimulation, including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), provide potentially attractive alternative central neuromodulation techniques. Compared to rTMS, tDCS is technically easier to apply, more affordable, available, and potentially feasible for home use. Accordingly, several new studies have investigated the efficacy of tDCS to treat NP after SCI. In this review, articles relating to the mechanisms, clinical efficacy and safety of tDCS on SCI-related NP were searched from inception to December 2019. Six clinical trials, including five randomized placebo-controlled trials and one prospective controlled trial, were included for evidence specific to the efficacy of tDCS for treating SCI-related NP. The mechanisms of action of tDCS are complex and not fully understood. Several factors including stimulation parameters and individual patient characteristics may affect the efficacy of tDCS intervention. Current evidence to support the efficacy of utilizing tDCS for relieving chronic NP after SCI remains limited. Further strong evidence is needed to confirm the efficacy of tDCS intervention for treating SCI-related NP.

• Journal of Magnetics
• /
• v.20 no.1
• /
• pp.52-56
• /
• 2015

The purpose of the current study was to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) in conjunction with mirror therapy on the balance function of patients with sub-acute stroke hemiparesis. This study was conducted with 36 subjects who were diagnosed with a hemiparesis due to stroke. Participants in the experimental (19 members) and control groups (17 members) received rTMS and sham rTMS during 10 minute sessions each, which were carried out five days per week for four weeks. This was followed by the mirror therapy over 30 minute sessions, which were carried out five days per week for four weeks. Motor recovery was assessed by balance index, dynamic limits of stability, Berg balance scale, and time up go test. The change values of the balance index ($-2.06{\pm}1.99$ versus $-0.41{\pm}1.11$), dynamic limits of stability ($3.68{\pm}2.71$ versus $1.17{\pm}2.38$), and time up go test ($-7.05{\pm}5.64$ score versus $-3.35{\pm}5.30$ score) were significantly higher in the experimental group than in the control group (p < 0.05). At post-test, balance index ($4.08{\pm}1.14$ versus $5.09{\pm}1.04$), dynamic limits of stability ($13.75{\pm}0.60$ versus $11.73{\pm}3.53$), and time up go test ($23.89{\pm}4.51$ versus $28.82{\pm}3.07$) were significantly higher in the experimental group than in the control group (p < 0.05). In the experimental group, significant differences were found in the pre- and post-test scores for the balance index, dynamic limits of stability, Berg balance scale, and time up go test (p < 0.01). In the control group, a significant difference was observed between the pre- and post-test only for the Berg balance scale and time up go test (p < 0.05). These findings demonstrate that the application of 1Hz rTMS in conjunction with mirror therapy can be helpful in improving the balance function of patients with sub-acute stroke hemiparesis, and this may be used as a practical adjunct to routine rehabilitation therapy.

• The Korean Journal of Pain
• /
• v.36 no.4
• /
• pp.408-424
• /
• 2023

Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.

• Physical Therapy Rehabilitation Science
• /
• v.13 no.1
• /
• pp.86-94
• /
• 2024

Objective: To evaluate the changes in bladder capacity and storage through non-invasive neuromodulation by application of repetitive Trans magnetic stimulation (rTMS) and genital nerve stimulation (GNS) in traumatic spinal cord survivors. Design: A Single Case Study. Method: The Patient was registered in trail with the clinical trial registry of India (CTRI/2022/05/042431). The Patient was interposed with rTMS on lumbar area, from T11-L4 vertebrae with 1 Hz and the intensity was 20% below that elicited local paraspinal muscular contraction for 13 minutes. GNS was placed over dorsum of the penis with the cathode at the base and anode 2 cm distally at 20 Hz, 200 microseconds, Continuous and biphasic current was delivered and amplitude of stimulation necessary to elicit the genito-anal reflex. For assessment, Neurological examination was done for peri-anal sensation (PAS), voluntary anal contraction (VAC) and bulbocavernous reflex (BCR), deep anal pressure (DAP), and American Spinal Injury Association Impairment Scale (ASIA scale). Outcome assessment was done using Urodynamics, Spinal Cord Independence Measure Scale Version-III (SCIM-III), American Spinal Injury Association Impairment Score (ASIA Score), Beck's Depression Inventory Scale (BDI). The baseline evaluation was taken on Day 0 and on Day 30. Results: The pre-and post-data were collected through ASIA score, SCIM-III, BDI and Urodynamics test which showed significant improvement in bladder capacity and storage outcomes in the urodynamics study across the span of 4 weeks. Conclusion: rTMS along with GNS showed improvement in bladder capacity & storage, on sensory-motor score, in functional independence of individual after SCI.

• Journal of Magnetics
• /
• v.19 no.2
• /
• pp.170-173
• /
• 2014

The purpose of the present study was to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) in conjunction with task oriented training, on cortical excitability and upper extremity function recovery in stroke patients. This study was conducted with 31 subjects who were diagnosed as a hemiparesis by stroke. Participants in the experimental (16 members) and control groups (15 members) received rTMS and sham rTMS, respectively, during a 10 minutes session, five days per week for four weeks, followed by task oriented training during a 30 minutes session, five days per week for four weeks. Motor cortex excitability was performed by motor evoked potential and upper limb function was evaluated by motor function test. Both groups showed a significant increment in motor function test and amplitude, latency in motor evoked potential compared to pre-intervention (p < 0.05). A significant difference in post-training gains for the motor function test, amplitude in motor evoked potential was observed between the experimental group and the control group (p < 0.05). The findings of the current study demonstrated that incorporating rTMS in task oriented training may be beneficial in improving the effects of stroke on upper extremity function recovery.

• Journal of Acupuncture Research
• /
• v.33 no.3
• /
• pp.117-127
• /
• 2016

Objectives : This study was performed to observe the effect of complex therapy, including electro-acupuncture and magnetic-acupuncture, on peripheral facial nerve palsy. Methods : Nine patients with peripheral facial nerve palsy were treated with acupuncture using electrical and magnetic stimulation. Acupoints in the face were stimulated with an electromagnetic field, as widely and as evenly as possible. To evaluate the effects before and after treatment we used Yanagihara's unweighted grading system, House-Brackmann scale, and Sunnybrook facial grading system and image once a week. Results : After treatment, the scores of Yanagihara's unweighted grading system, House-Brackmann scale and Sunnybrook facial grading system each improved (p-value < 0.05). Conclusion : Complex therapy using electro-acupuncture and magnetic-acupuncture might be an effective treatment to improve symptoms of peripheral facial nerve palsy. Further randomized-controlled trials are required to verify the efficacy and results of this study.

• Journal of The Korean Society of Integrative Medicine
• /
• v.11 no.4
• /
• pp.281-289
• /
• 2023

Purpose : In this study, we aimed to determine how frequencies different of repetitive transcranial magnetic stimulation applied to the less affected contalesional corticomotor area affect upper extremity motor function in patients with acute stroke within 3 months of onset. By doing so, we aimed to propose a new method of rTMS intervention based on the degree of damage and recovery status of the patient, rather than the generalized rTMS intervention that has been used uniformly. Methods : The rTMS intervention was applied on the contralesional side of the cerebral hemisphere damage. 15 subjects in the HF-rTMS group, 12 subjects in the LF-rTMS group, and 14 subjects in the SF-rTMS group were randomized to receive the rTMS intervention in each group for a total of 10 sessions on five consecutive weekdays for two weeks, and underwent FMA-U to determine changes in upper extremity function following the intervention in each group. FMA-U was performed within 24 hours before and after the rTMS intervention. Results : When the FMA-U was performed to determine the pre- and post-intervention changes in upper extremity motor function within the groups, no statistically significant differences were found in the SF-rTMS group before and after the intervention, but significant statistical differences were found in the HF-rTMS group (p=.006) and the LF-rTMS group (p=.020), with greater significance in the HF-rTMS group than the LF-rTMS group. Conclusion : This study confirmed that compensatory action by activating the less affected contralesional corticomotor area based on the bimodal balance-recovery model can support upper extremity recovery patients with acute stroke within 3 months of onset, depending on the degree of damage level and recovery status. Therefore, the results of the contralesional HF-rTMS application in this study may provide a basis for proposing a new rTMS intervention for upper extremity recovery in stroke patients.

• Annals of Rehabilitation Medicine
• /
• v.42 no.6
• /
• pp.777-787
• /
• 2018

Objective To examine the long-term effects of the low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with task-specific training on paretic hand function following subacute stroke. Methods Sixteen participants were randomly selected and grouped into two: the experimental group (real LF-rTMS) and the control group (sham LF-rTMS). All the 16 participants were then taken through a 1-hour task-specific training of the paretic hand. The corticospinal excitability (motor evoke potential [MEP] amplitude) of the non-lesioned hemisphere, and the paretic hand performance (Wolf Motor Function Test total movement time [WMFT-TMT]) were evaluated at baseline, after the LF-rTMS, immediately after task-specific training, 1 and 2 weeks after the training. Results Groups comparisons showed a significant difference in the MEP after LF-rTMS and after the training. Compared to the baseline, the MEP of the experimental group significantly decreased after LF-rTMS and after the training and that effect was maintained for 2 weeks. Group comparisons showed significant difference in WMFT-TMT after the training. Only in the experimental group, the WMFT-TMT of the can lifting item significantly reduced compared to the baseline and the effect was sustained for 2 weeks. Conclusion The results of this study established that the improvement in paretic hand after task-specific training was enhanced by LF-rTMS and it persisted for at least 2 weeks.

• The Journal of the Korea Contents Association
• /
• v.9 no.11
• /
• pp.289-296
• /
• 2009

In this study, I presented power control unit with potential use in the magnetic stimulation of biological systems. The effect of the magnetic stimulation depends on the geometry and orientation of the induced electric field as well as on the current pulse waveform delivered by the stimulator coil. TMS is achieved from the outside of the head using pulses of electromagnetic field that induce an electric field in the brain. There are numerous possibities in the applications TMS, such as diagnosis and therapy through the brain stimulation. These factors are very important to define the equipment requirements and characteristics in that the topology of the power supply and the size and geometry of the coil. The proposed solution is the generation of current pulses with variable amplitude and duration, according to a user defined input. Another solution is the topology that uses elements to store and transfer energy from the power source to the load. In addition to proposed topology, an adequate control strategy and right set of the power circuit parameters made possible to obtain unipolar waves and bipolar waves.

• Korean Journal of Acupuncture
• /
• v.33 no.4
• /
• pp.213-220
• /
• 2016

Objectives : The aim of this paper is to develop acupuncture needle heating system by utilizing the new method which uses high frequency(HF) time-varying magnetic field. Also, it is possible to make an assessment for reliability and clinical significance of the system. Methods : We designed the system with solenoid coils for generation of HF time-varying magnetic field that oscillates at 150 kHz. Acupuncture needles are quickly magnetized and heated by 150 kHz. We assessed clinical significance of system, such as body temperature, pressure pulse waveform. Results : Temperature of acupuncture needle increased up to 60 degree. In the result for clinical significance of system, in case of manual acupuncture stimulation(MAS), body temperature change was $0.373^{\circ}C{\pm}0.224$(p<0.05), rate of pulse energy change increased about 7.6%. In case of warm acupuncture stimulation(WAS), body temperature change was $0.645^{\circ}C{\pm}0.281$(p<0.05), rate of pulse energy change remarkably increased about 35.9%. Conclusions : We confirm that the system is able to be applied clinically to various warm acupuncture needle therapy in the area of oriental medicine.