“Repetitive Transcranial Magnetic Stimulation: A Promising Treatment for Neurodegenerative Diseases”

69-year-old Ms. Lin developed stiffness and tremors in her left limb five years ago, as well as unsteady walking and easy falls. Her family thought it was just aging. They went to the Neurology Clinic of the Affiliated Hospital of China Medical University for a detailed examination and found that Ms. Lin suffered from a rare Disease-Multiple System Atrophy (MSA).

Dr. Ao Yu from the Department of Parkinson’s and Movement Disorders of the Department of Neurology pointed out that multiple systemic degeneration is a non-hereditary multiple degenerative disease of the nervous system, which belongs to the type of atypical Parkinson’s disease: the patient has clinical symptoms such as balance disorder and autonomic nervous disorder In the beginning, frequent falls, Parkinson’s symptoms such as slow movement, stiffness and trembling will also appear. As the disease progresses, urinary function problems often occur; severe postural hypotension leads to frequent syncope is also a symptom that often causes trouble for patients .

According to further analysis by Dr. Ao Yu, the prevalence rate of multiple systemic degeneration is about 5 per 100,000 people in the world. It is a rare neurodegenerative disease, and the average age of onset is about 55 years old. However, current effective drug treatments for multiple systemic degenerative diseases are very limited. Patients often do not respond well to typical Parkinson’s disease drugs, and may even have side effects, resulting in a rather limited choice of drugs.

Dr. Ao Yu from the Parkinson and Movement Disorder Department of the Affiliated Hospital of China Medical University pointed out that patients suffering from neurodegenerative diseases often have poor motor function, poor quality of life, and the chance of concurrent depression is much higher than that of the general elderly group; Such patients are older and have more original systemic diseases (such as hypertension, diabetes, renal insufficiency, etc.), so the types of chronic disease drugs taken are more complicated.

Although Ms. Lin’s depressive symptoms can be treated with drugs, however, in the past clinical experience, patients often cannot tolerate the side effects of drugs, there are too many types of oral drugs, and drug interactions are prone to occur; Repetitive transcranial magnetic stimulation therapy can not only improve the depressive symptoms of Ms. Lin, but also avoid the above-mentioned treatment difficulties. It is indeed worth trying.

Dr. Ao Yu pointed out that due to neurological degeneration, Ms. Lin was gradually unable to move around and had to use a wheelchair to travel. Affected by the disease, her family members found that Ms. Lin’s mood became more and more depressed. When returning to the clinic, Ms. Lin often said to Dr. Ao Yu: “This is me ( This is the last time I came to the clinic to see you”, often have serious negative and self-abandoned thoughts, and repeatedly mentioned that she was ill for a long time, and even hoped to die early. The whole family was also shrouded in an atmosphere of sadness and sorrow for Ms. Lin’s illness. Although Dr. Ao Yu tried his best to adjust the antidepressant drugs, comfort the patient’s emotions, and cooperate with the wholehearted company of the family members, Ms. Lin still did not see any improvement. Even her emotional problems affected her willingness to take medication and her cooperation with rehabilitation treatment.

In order to improve Ms. Lin’s mood and improve the quality of life of Ms. Lin and her family, Dr. Ao Yu from the Neurology Department of the Affiliated Hospital of China Medical University suggested to Ms. Lin and her husband that repetitive transcranial magnetic stimulation be used for treatment. Non-drug, non-invasive neurostimulation method to improve Ms. Lin’s severe depression symptoms. Dr. Ao Yu said that repetitive transcranial magnetic stimulation (RTMS) is a non-invasive, highly safe treatment technique with few side effects.

Studies have shown that the frontal lobe function of patients with depression is lower than normal. Through repetitive transcranial magnetic stimulation, the activity of neurons in the frontal cortex of patients with depression can be improved, so as to achieve the purpose of treatment. It has been approved by the U.S. Food and Drug Safety Administration (FDA) since 2008, and Taiwan Food and Drug Safety Administration has also approved its use in the treatment of depression that does not respond well to drugs in 2018.

At present, the repetitive transcranial magnetic stimulation treatment in the Nerve Department of the Affiliated Hospital of China Medical University takes about 20 to 30 minutes each time. During the stimulation process, you will hear the rattling sound and the sound of the equipment fan, and feel the scalp gently tapping. I feel that I can go home after treatment without affecting my daily work and rest. After two consecutive weeks of treatment (Monday to Friday, a total of ten sessions), about half of the patients’ mood improved by more than half. After four consecutive weeks of treatment, the response to emotional improvement may be more ideal.

Dr. Ao Yu said that during the treatment process, doctors will evaluate the patient’s emotional and physiological changes at any time to ensure its safety. Dr. Ao also pointed out that in addition to treating patients with depression, academic research has also found that repetitive transcranial magnetic stimulation can For neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, hemiplegia symptoms after stroke, migraine, tinnitus, etc., there are some positive effects; although no definite clinical evidence has been obtained yet, But for such diseases that currently have no other confirmed treatment, it may also be a treatment direction that can be tried.

After the patient Ms. Lin received repetitive transcranial magnetic stimulation, her mood improved significantly, and she was less likely to have negative emotions and self-destructive speeches. She was more willing to take rehabilitation treatment, exercise, and medication; The amount of activity in life has increased, motor symptoms can be controlled better, the quality of life has improved, and the difficulty and pressure of family care has also been reduced.

Before the treatment, Ms. Lin was depressed and often had conflicts with her family members and foreign caregivers. After the treatment, the most profound feeling was her husband, Mr. Shi, who accompanied Ms. Lin all the way. Mr. Shi said that he can feel the effect of transcranial magnetic stimulation the most. The content of his wife’s speech and the emotional state of the whole person have improved after the treatment, which is a level that could not be achieved with the use of antidepressants before.

Finally, Dr. Ao Yu appealed that although many neurodegenerative diseases cannot be cured for the time being, the development of medicine is changing with each passing day. In addition to drugs, there are many other treatment methods, such as repetitive transcranial magnetic stimulation, which can relieve neurodegenerative diseases. Symptoms of patients, improve the quality of life of patients and their families, hope that patients and their families still have hope and confidence in the treatment, let the doctor accompany you to face the disease bravely.