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Cognition is a higher mental function which includes decision making, planning, attention, execution and memory. Mild cognitive impairment (MCI) is the condition in which individuals have cognitive deficits and memory impairment without impairments in daily activities.  This may progress and turn into dementia. In the early stages of the disease, complex behaviors (such as driving) are compromised, along with short-term memory, and sometimes behavioral problems, such as anger or aggressiveness, may occur. In many areas of the world, dedicated research is ongoing that can help patients to reduce their suffering from disability. Transcranial magnetic stimulation is such a novel innovative method that has shown promising results in recent studies. It is a painless, noninvasive method that modulates cortical excitability.

These all patients are potential candidates for TMS:

• Patients with cognitive decline might experience slow processing speed, poor decision making, attention and planning. May also have trouble in performing complex tasks such as driving.
• Due to slow processing speed, patients might also have increased risk of falls and slow walking speed.
• Patients start forgetting common things like names of the relatives like children or grandchildren, home address. Patients may get lost in their neighborhood.
• Patients do not find words and they stand confused.
• They might struggle with poor judgment skills, mixed up thought processes and poor emotional control. They are likely to feel irritable and show aggressive behavior.
• Even patients with pregnancy, hypertension, diabetes, thyroid disorders, kidney diseases, heart diseases etc. can take part in this treatment.
• Medical devices which are commonly used now-a-days like stents, pacemakers, coils, orthopedic implants etc. are usually MRI compatible so they usually do not interfere with the TMS.

TMS has been researched around the world since about the 1980s. Lots of literature has been published so far in peer-reviewed journals on TMS with positive outcomes and negligible adverse effects.

In Italy, a study was conducted wherein patients with mild cognitive impairment were randomized into two groups. Patients in the control group received cognitive training of memory and attention whereas patients in the intervention group received deep TMS alongside standard cognitive training. It was observed that patients in the intervention group experienced more improvement in memory than the patients in the control group and these changes were observed even 6 months post-treatment. (Mattioli et al 2021)

Method

• TMS is a non-invasive way of Neuromodulation.
• It involves low energy magnetic stimulation of the particular site of the brain through the skull
• This is delivered through a specially designed coil, incorporated in a helmet.
• When the patient comes in, the nurse will take a detailed history and update the doctor. The doctor will thereafter discuss the most suitable protocol with the patient, which will include the duration of each sitting, the frequency of sittings/week and the total no. of sittings.
• Once all confirmed, this will be fed in the computer
• Following this, necessary evaluation is done to determine the MT (Motor threshold) by imparting stimulation through the helmet.
• Based on the predesigned protocols, TMS will be administered to the patient.
• For the mild cognitive impairment, the patient will require about 16 sessions over the period of 8 weeks. Each session will be approximately 15-20 minutes long.
• The procedure does not require any sedation or anesthesia. Patient is not required to keep fasting before the procedure.

The Jaslok Hospital & Research Centre is one of the oldest tertiary care, multi-specialty Trust hospitals in the country. Jaslok Hospital has research activities ongoing in various fields in collaboration with other institutions in India & abroad. The hospital has a dedicated “Restorative and Regenerative Medicine” department including consultants in various fields with more than 20 years of experience.

The department has procured the state-of-art technology and equipment from internationally reputed and trusted “Brainsway” company. It contains the advanced technology of  H1-7 coils instead of conventional coils, that can deliver noninvasive deep TMS in precise manner to get maximum result. It has FDA and CE clearance for treatment of various neurological and psychiatric conditions. The conventional TMS can only deliver specific target sites, limiting their use and capabilities. Deep TMS can reach the following target sites; insula, cingulate gyrus, etc.

Magnetic brain stimulation aids those with memory loss.

Check the entire video at https://youtu.be/Ey2dRu61lhQ?si=6A6NO9Ob2uBpediC