New developments in medical equipment and technology

Lt. Col. Geoffrey Grammer, M.D., who is chief of inpatient psychiatry at Walter Reed and one of the first doctors in the world to systematically use rTMS therapy, says the device has not only offered his patients a new line of treatment but has also opened up the opportunity to reevaluate even his worst cases. 

“TMS therapy offers hope to the men and women in the Armed Forces who have tried a multitude of treatment options with little success.” Grammer said. “It’s not a cure-all, but for the patients that it works on, it’s simply amazing.” 

New Kind of Therapy

Dr. Grammer explains rTMS to a patient before application

The rTMS process begins with a motor threshold test. People respond to a wide spectrum of magnetic fields, so in order to determine the most effective strength Dr. Grammer fires weak magnetic pulses at the primary motor cortex, gradually increasing their strength until he can involuntarily move a patient’s hand. Involuntary movement indicates that the brain is responding to electromagnetic induction.

Once the proper strength is determined, the treatment coil is moved to the prefrontal cortex – where mood regulation is controlled – and rTMS can begin. Magnetic fields are fired at rates faster than one pulse per second for thirty seconds at a time. As these pulses penetrate brain tissue, they create electric currents which excite neurons and trigger brain activity. 

Therapy is split into two phases. Phase one runs for four weeks, and consists of daily treatment sessions lasting for just under 40 minutes. During phase two, which lasts for another three weeks, Grammer tapers down the number of treatments from four to two sessions per week. 

Many patients respond well to the treatment. When this happens, Grammer says the results are astounding.

“I watched one patient go through the process from beginning to end,” said Grammer. “By the time she completed therapy she literally began looking and acting like a new woman.”

But roughly half of patients receive maintenance therapy to prevent the return of depressive symptoms; the other half remain symptom free at 6 months without further therapy. 

These treatment results match statistics from the manufacturer’s clinical studies, which showed a 22 percent efficacy in double blind, placebo testing, but roughly 50 percent effectiveness outside of clinical trials. 

Thanks to its effectiveness, electromagnetic induction is also being considered for a number of other applications. Currently, Dr. Grammer is compiling a team of researchers to develop new uses for the system and continue his research on the therapy, which is not widely available in hospitals.

For example, he thinks the treatment could also be used to “exercise the brain” of traumatic brain injury patients, much in the same way physical therapists exercise damaged limbs. 

He also believes the stimulation could have applications for post-traumatic stress disorder patients and service members with post-amputee pain syndrome. The potential benefits, he speculates, could forever change the way mental health issues in the military and the civilian sectors are addressed.

A Needy Demographic

Repetitive Transcranial Magnetic Stimulation (rTMS)

Both the Department of Defense (DoD) and the Department of Veterans Affairs (VA) have increasing numbers of service members and veterans in their ranks who require effective mental health treatments. If rTMS therapy catches on, it could become an important asset in the tool chest of military mental health providers.

In fact, recent research shows that soldiers, sailors, airmen and Marines with combat experience are developing depression and other mental health issues at faster rates than their civilian counterparts. 

Dr. Tyler Smith, the principal investigator at the Millennium Cohort Study, which studies health outcomes in the military, says the link between battlefield experience and depression is solidifying.

“To date, results from the Millennium Cohort Study have consistently shown that individuals who deploy in support of operations in Iraq and Afghanistan and report combat exposures are at elevated risk for health outcomes, including Post Traumatic Stress Disorder, depression, and hypertension when compared with those who do not deploy or deploy but do not report combat exposures,” said Smith.

Over the past eight years, the Military Health System (MHS) has responded to this increase in invisible injuries with a shift in focus to issues pertaining to psychological health. But barriers to care still exist and until rTMS therapy came to Walter Reed, service members were left with few options outside of standard (and oftentimes unattractive) drug therapies.

Now, service members and veterans have an alternative option which offers new hope to treat the symptoms of depression. 

With practically no side effects, no risk of long term health concerns and high efficacy ratings, rTMS could potentially extinguish many of the barriers inhibiting service members from seeking mental health treatment. And with Walter Reed stepping up as one of the first medical facilities, military or civilian, to bring rTMS into its spectrum of care, the global medical community is watching closely to see if it catches on.

Source: David J. Loebsack

Date: 03/15/2018

Source: MCIF 1/2010