Transcranial Magnetic Stimulation: Giving Epilepsy and Autistic Patients Increased Access to Pioneering Treatments

This grant was used to purchase a transcranial magnetic stimulation (TMS) device for inpatient use. This device is used therapeutically for patients with epilepsy, including those with autism and other brain disorders whose symptoms may include seizures. The device is also used in research studies to benefit patients with these profiles. Previously, Beth Israel was limited to TMS devices for outpatient use and this additional device, for inpatient use, expanded its ability to provide treatment and to conduct research studies for the benefit of these patients.

TMS is a non-invasive technique that uses the principle of electromagnetic induction to focus currents in the brain and modulate the function of the cortex. TMS helps to treat a wide range of patients with neurological diseases and disorders. This tool is also helpful in treating epilepsy patients who are diagnosed with autism spectrum disorders (ASD). As many as 40 percent of individuals with ASD and intellectual disability have epilepsy. The treatment for this subpopulation is challenging because of difficulties with medication side effects. TMS is unique in that it can deliver targeted, non-pharmacologic therapy that works via a different mechanism than all known medications, and may be effective when conventional medications fail. Because it is targeted to a specific brain region, it also does not produce any systemic side effects. TMS can also be used in a variety of diagnostic and therapeutic research studies to benefit patients with neurologic diseases, including epilepsy and autism. For example, conventional electroencephalography (EEG), the test typically used to help diagnose epilepsy, is an imperfect tool that tries to capture brain activity as it occurs spontaneously. Since seizures are intermittent, EEG rarely captures them, and we rely on finding interictal “spikes” to help diagnose epilepsy. However, these spikes may not always be present in individuals with epilepsy, and can also be present in individuals with other neurologic disorders. For example, studies have suggested that up to 60 percent of individuals with ASD but without known epilepsy had interictal spikes. Consequently, better tools are needed, including a better biomarker for epilepsy. Because TMS enables us to stimulate the brain and assess how it responds, this technique may be a useful tool in this regard. TMS can be used in research studies of new treatments. For example, many individuals with ASD but without known epilepsy have interictal spikes on their EEG. In some cases these spikes are frequent, clearly associated with intellectual regression. Treatment with conventional seizure medications can significantly improve cognitive function. In the majority of cases, however, there is no such clear improvement. This may in part be because the seizure medications do not completely suppress the spikes, and because the seizure medications often themselves have cognitive side effects. Since TMS can be used to deliver treatment specifically to the spike focus, and without general cognitive side effects, TMS treatment could be helpful in improving cognitive function in individuals with ASD with interictal spikes.

This new TMS machine has enabled BIDMC to expand services to inpatients with epilepsy, including those with autism, by giving physicians increased access to this pioneering treatment and expanding the ability to conduct related research.