efficacy of deep transcranial magnetic stimulation (dtms) in long standing multiple sclerosis (ms)...

Abstracts / Brain Stimulation 7 (2014) e17ee26 e25

five months, when he required another eight treatments. Heremained in recovery for 18 months.Conclusions: This is the first report dTMS in the treatment of MSassociated irritability, fatigue and parasthesias.

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Efficacy of Deep Transcranial Magnetic Stimulation (dTMS) InLong Standing Multiple Sclerosis (MS) Induced Gait Disorder:Case ReportAron Tendler MD C.BSM a, Heather Allsup AAS a,Abraham Zangen PhD b, Laura DeLuca MD a

aAdvanced Mental Health Care IncbBen Gurion University

Background: dTMS utilizes H coils that have the capacity to reach4cm below the skull and stimulate the lower limb. This has shownefficacy in improving function in patients who have suffered cere-bral strokes. Conventional rTMS has been efficacious in treating MSinduced fatigue and dexterity.Objective: We report on 66-year-old-woman with gait distur-bance, imbalance, bilateral lower extremity hyper-reflexia andright-sided proximal weakness from MS who had not improved insixteen years.Methods: Using the HMPCC coil over the motor strip, 18HZ, 90%resting motor threshold of the leg, 2second trains, 20second in-tervals, 55 trains, 1980 total pulses. Then the HMPCC was movedanteriorly 6cm over the medial prefrontal cortex, 18HZ, 100%MT, 2second trains, 20 second intertrain intervals, 55 trains, 1980 totalpulses.Results: After ten treatments, she felt a significant improvement inher balance. She no longer had to think about her balance when shewould stand up during the day or wake in themiddle of the night togo to the bathroom. After twenty treatments, she stopped using acane around the house and her right hamstring strength improvedfrom a 3/5 to a 4/5, her quad remained at a 3. This was without anyphysical therapy or independent workouts.Conclusions: This is the first report of dTMS treatment of an MSinduced gait disorder.

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Reversal of Motor Symptoms in Parkinson’s Disease using DeepTMS with the H1 Coil: Longitudinal Case SeriesAron Tendler MD C.BSM a, Elyssa Sisko BA a, Abraham Zangen PhD b,Marilyn Turcone BA a, Heather Allsup AAS a, Kaylin Raggi BA a,Veronica Holland LaSalle-Ricci PhD a, Laura DeLuca MD a

aAdvanced Mental Health Care IncbBen Gurion University

Background: Repetitive transcranial magnetic stimulation hasbeen proposed as a non-surgical method of treatment for medi-cated Parkinson’s disease patients with residual motor symptoms.Objective: We report here the treatment of two patients withParkinson’s disease using the H1 deep TMS coil that is currently FDAcleared for depression.Methods: We selected a TMS protocol combination that wouldsuppress over the motor cortex and subsequently stimulate overthe prefrontal cortex. We utilized the H1 coil over the motor cortex1HZ, 110% MT, 1000 total pulses, followed by an additional 2000pulses over the prefrontal cortex in a high intensity, high frequencyprotocol.

Conflicts of interest: Dr. Tendler, Dr. Zangen and Dr. DeLuca have financial interestin Brainsway.Conflicts of interest: Dr. Tendler, Dr. Zangen and Dr. DeLuca have financial interest

in Brainsway.

Results: Both patients demonstrated substantial improvement intotal Unified Parkinson’s Disease Rating Scale (UPDRS) scores. Themale patient’s UPDRS dropped from 90 to 37 and the female’s scorewent from 26 to 14. The most remarkable improvement was foundin the activities of daily living and the motor examination compo-nents. In addition, the male patient went from a Hoehn and Yahrstage 5 to a 2, and the female was able to completely discontinueher Carbidopa, Levodopa, and Etacapone.Conclusion: This is the first report using the H1 coil for Parkinson’sdisease treatment, demonstrating efficacy and durability with overone year follow up. It allowed lowering of total daily dopaminedosage while reducing Parkinson’s symptoms.

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Supra Threshold Deep Repetitive Transcranial MagneticStimulation (dTMS): Case SeriesAron Tendler MD C.BSM a, Mark DeLuca MD a, Laura DeLuca MD a,Kristie DeBlasio PhD d, Veronica Holland Lasalle-Ricci PhD a,Heather Allsup AAS-, Marilyn Turcone BA a, Kaylin Raggi BA a,Noelia Rodriguez MA a, Yiftach Roth PhD b, Abraham Zangen PhD c

aAdvanced Mental Health Care Incb Brainsway LtdcBen Gurion Universityd Private Practice

Background: Evidence suggests that some patients may notrespond as robustly to a second course of dTMS. How do you pro-ceed when more pulses or more daily treatments are not working?Objective: We report on five cases where we titrated the treatmentabove 120% of the motor threshold. These patients previouslyresponded or remitted at 120%MT but had relapsed and were nowsuicidal; they wanted an alternative to ECT.Methods: The H1 coil was positioned as anteriorly as possible.While avoiding hand shaking during the stimulation, the intensitywas increased to a maximum tolerated by the patients.Results: Three of the patients were titrated to 150%MT and after acourse of treatment were back in remission. One patient wastitrated to 135%MT where she responded. One patient was beingtitrated andwhile at 140%MT she felt numbness of her lips. This wasafter she was conversing and gesturing with her hands with theoperator in between trains. She had a generalized tonic-clonicseizure lasting w100 seconds. She subsequently continued twicedaily dTMS at 120% and went into remission.Conclusions: Supra threshold dTMS may be an effective approachfor patients who lose efficacy at 120%MT. It has a higher risk ofseizures, so patients should be advised to keep very still and notincrease the excitability of the motor cortex.

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Successful Treatment of Vulvodynia with RepetitiveTranscranial Magnetic Stimulation (rTMS): Case ReportAron Tendler MD C.BSM a, Shlomo Tendler MS b, Heather Allsup AAS a,Laura DeLuca MD a

aAdvanced Mental Health Care Incb Sackler School of Medicine

Background: Repetitive Transcranial Magnetic Stimulation (rTMS)with the Neurostar device is FDA approved for patients with majordepression who failed to achieve satisfactory improvement fromone medication in the current episode.

Conflicts of interest: Dr. Tendler, Dr. Laura DeLuca, Dr. Roth and Dr. Zangen have afinancial interest in Brainsway.Conflicts of interest: None