1.
TRANSCRANIAL MAGNETIC
STIMULATION
DR. IMDADUL MAGFUR
MD PHASE-B RESIDENT (RSOMC-04)
DEPARTMENT OF PSYCHIATRY
SYLHET MAG OSMANI MEDICAL COLLEGE

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INTRODUCTION
Transcranial Magnetic Stimulation( TMS ) is a noninvasive procedure that has
shown positive results in treating depression. Typically used as a repetitive
treatment, also called rTMS, it can be done as a walk-in procedure where an
electromagnet is placed against the patient’s head, near the forehead, and
small magnetic bursts are released to stimulate the part of the brain
responsible for mood control. Repetitive transcranial magnetic stimulation
(rTMS) has evolved as a novel tool for improving not only depression but also
a wide range of neurological and psychiatric disorders.

3.
rTMS studies in chronic neuropathic pain (target: primary motor cortex).
• LF rTMS of M1 contralateral to pain side
• Recommendation: LF rTMS of M1 contralateral to pain side is probably
ineffective in neuropathic pain (Level B)
• HF rTMS of M1 contralateral to pain side
• Recommendation: definite analgesic effect of HF rTMS of M1 contralateral to
pain side in neuropathic pain (Level A)
• rTMS studies in motor symptoms of Parkinson’s disease
• Recommendation: possible antiparkinsonian effect of HF rTMS of bilateral
(multiple) sites in M1 (Level C)

4.
• rTMS studies in motor stroke (target: primary motor cortex)
• LF rTMS of the contralesional motor cortex: acute or post-acute stroke
• Recommendation: possible effect of LF rTMS of the contralesional motor cortex
in (post-)acute motor stroke (Level C)
• LF rTMS of the contralesional motor cortex: chronic stroke
• Recommendation: probable effect of LF rTMS of the contralesional motor cortex
in chronic motor stroke (Level B)
• HF rTMS of the ipsilesional motor cortex: acute or post-acute stroke
• Recommendation: possible effect of HF rTMS of the ipsilesional motor cortex in
(post-)acute motor stroke (Level C)
• HF rTMS of the ipsilesional motor cortex: chronic stroke
• Recommendation: possible effect of HF rTMS of the ipsilesional motor cortex in
chronic motor stroke (Level C)

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• rTMS studies in depression (target: dorsolateral prefrontal cortex).
• HF rTMS of the left DLPFC
• Recommendation: definite antidepressant effect of HF rTMS of the left DLPFC
(Level A)
• LF rTMS of the right DLPFC
• Recommendation: probable antidepressant effect of LF rTMS of the right DLPFC
(Level B)
• Studies comparing HF rTMS of the left DLPFC and LF rTMS of the right
DLPFC
• Recommendation: probably no difference in the antidepressant effect between HF
rTMS of the left DLPFC and LF rTMS of the right DLPFC (Level B)
• Recommendation: no recommendation for the antidepressant effect of bilateral
rTMS

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• rTMS studies in auditory hallucinations (target: temporoparietal cortex).
• Recommendation: possible effect of LF rTMS of the left TPC on auditory
hallucinations in schizophrenia (Level C)
• Recommendation: probable effect of HF rTMS of the left DLPFC on negative
symptoms of schizophrenia (Level B)
• rTMS studies in addiction/craving (target: dorsolateral prefrontal cortex).
• No recommendation for the effect of HF rTMS of the right or left DLPFC in alcohol
craving
• Recommendation: possible effect of HF rTMS of the left DLPFC on cigarette
craving and consumption (Level C)
• No recommendation for the effect of HF rTMS of the left DLPFC in food craving