Recently, I was giving a talk to physicians about TMS and had been asked about future uses of this technology. I began talking about the research I am familiar with, as I have tried to Chronicle the burgeoning research in the field in our website?? section called Solute. After I had mentioned about 15 diseases and conditions currently being researched, one physician sarcastically asked if TMS was a panacea for everything. I laughed and said that in the area of psychiatry and neurology, it may be true.
Our world has been forever changed by a binary code of 1?? and 0??. Working with just these two codes, computers bring us the complexity of symbols, sound, color, and movement which give us photographs, music and movies. In a similar way, neurons work in a binary fashion in our brains as they are either inhibitory, excitatory, and apparently some can do both at the same time. The original protocol to treat depression involving high-frequency TMS of ten magnetic pulses a second (10 Hz) is considered excitatory when applied to the left dorsolateral prefrontal cortex. The right sided low-frequency stimulation of 1 pulse per second (1Hz) is considered inhibitory as it treats anxiety by inhibiting or reducing the neuron activity.
If our brain function exists because of functioning neural pathways, the corollary must be true that illnesses are basically a dysfunction of the normal excitatory and inhibitory function in a particular area. If these areas of the brain dysfunction and can be identified and reached by magnetic pulses that can either excite or inhibit these areas or circuits, these conditions may be successfully treated. For example, the FDA has recently approved TMS of treatment over the right orbitofrontal cortex or OFC, where previous studies had shown hypermetabolism in that area. Low-frequency treatment of 1 Hz has been shown to reduce OCD symptoms supporting the idea that a binary treatment, excitatory or inhibitory stimulation, can treat so many different brain conditions.
So, the next time you hear the litany of conditions responding to TMS treatment and you think snake oil, remember that snake oil is binary.
Robert A. Sammons, M.D., Ph.D., Chief Medical Officer, TMS Solutions