Minimal heating of titanium skull plates during 1Hz repetitive transcranial magnetic stimulation

Rotenberg, Alexander; Harrington, Michael G.; Birnbaum, Daniel; Madsen, Joseph R.; Glass, Iain E.S.; Jensen, Frances E.; Pascual‐Leone, Álvaro

doi:10.1016/j.clinph.2007.08.003

Cited by 32 publications

(28 citation statements)

References 6 publications

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“…Evidently, safety studies in patients with skull plates for other brain stimulation modalities (e.g. TMS; Rotenberg et al, 2007; Rotenberg and Pascual-Leone, 2009) cannot be substituted.…”

Section: Discussionmentioning

confidence: 99%

Transcranial direct current stimulation in patients with skull defects and skull plates: High-resolution computational FEM study of factors altering cortical current flow

2010

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Preliminary positive results of transcranial direct current stimulation (tDCS) in enhancing the effects of cognitive and motor training indicate this technique might also be beneficial in traumatic brain injury or patients who had decompressive craniectomy for trauma and cerebrovascular disease. One perceived hurdle is the presence of skull defects or skull plates in these patients that would hypothetically alter the intensity and location of current flow through the brain. We aimed to model tDCS using a magnetic resonance imaging (MRI)-derived finite element head model with several conceptualized skull injuries. Cortical electric field (current density) peak intensities and distributions were compared with the healthy (skull intact) case. The factors of electrode position (C3-supraorbital or O1-supraorbital), skull defect size, skull defect state (acute and chronic) or skull plate (titanium and acrylic) were analyzed. If and how electric current through the brain was modulated by defects was found to depend on a specific combination of factors. For example, the condition that led to largest increase in peak cortical electric field was when one electrode was placed directly over a moderate sized skull defect. In contrast, small defects midway between electrodes did not significantly change cortical currents. As the conductivity of large skull defects/plates was increased (chronic to acute to titanium), current was shunted away from directly underlying cortex and concentrated in cortex underlying the defect perimeter. The predictions of this study are the first step to assess safety of transcranial electrical therapy in subjects with skull injuries.

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“…Evidently, safety studies in patients with skull plates for other brain stimulation modalities (e.g. TMS; Rotenberg et al, 2007; Rotenberg and Pascual-Leone, 2009) cannot be substituted.…”

Section: Discussionmentioning

confidence: 99%

Transcranial direct current stimulation in patients with skull defects and skull plates: High-resolution computational FEM study of factors altering cortical current flow

2010

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“…Eddy currents induced in conductive surface electrodes and implants can cause them to heat up (Roth et al, 1992; Rotenberg et al, 2007). The temperature increase depends on the shape, size, orientation, conductivity, and surrounding tissue properties of the electrode or implant as well as the TMS coil type, position, and stimulation parameters.…”

Section: Safety Concernsmentioning

confidence: 99%

“…Radial notching of electrodes and skull plates can also reduce heating by interrupting the eddy current path. Skull plates made of titanium tend to have low heating, due to the low conductivity of titanium and radial notching (Rotenberg et al, 2007). Brain implants such as aneurysm clips and stimulation electrodes can heat as well.…”

Section: Safety Concernsmentioning

confidence: 99%

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Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Rossi

Hallett

Rossini

et al. 2009

Clinical Neurophysiology

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4,650

3,435

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This article is based on a consensus conference, which took place in Certosa di Pontignano, Siena (Italy) on March 7–9, 2008, intended to update the previous safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings. Over the past decade the scientific and medical community has had the opportunity to evaluate the safety record of research studies and clinical applications of TMS and repetitive TMS (rTMS). In these years the number of applications of conventional TMS has grown impressively, new paradigms of stimulation have been developed (e.g., patterned repetitive TMS) and technical advances have led to new device designs and to the real-time integration of TMS with electroencephalography (EEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Thousands of healthy subjects and patients with various neurological and psychiatric diseases have undergone TMS allowing a better assessment of relative risks. The occurrence of seizures (i.e., the most serious TMS-related acute adverse effect) has been extremely rare, with most of the few new cases receiving rTMS exceeding previous guidelines, often in patients under treatment with drugs which potentially lower the seizure threshold. The present updated guidelines review issues of risk and safety of conventional TMS protocols, address the undesired effects and risks of emerging TMS interventions, the applications of TMS in patients with implanted electrodes in the central nervous system, and safety aspects of TMS in neuroimaging environments. We cover recommended limits of stimulation parameters and other important precautions, monitoring of subjects, expertise of the rTMS team, and ethical issues. While all the recommendations here are expert based, they utilize published data to the extent possible.

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“…Further, the presence of a craniotomy with placement of skull plates might add another potential risk for application of these tools in TBI. 160,161 …”

Section: Safety Considerationsmentioning

confidence: 99%

Noninvasive Brain Stimulation in Traumatic Brain Injury

Demirtaş-Tatlıdede

Vahabzadeh‐Hagh²,

Bernabeu³

et al. 2012

Journal of Head Trauma Rehabilitation

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142

106

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Brain stimulation techniques have evolved in the last few decades with more novel methods capable of painless, noninvasive brain stimulation. While the number of clinical trials employing noninvasive brain stimulation continues to increase in a variety of medication-resistant neurological and psychiatric diseases, studies evaluating their diagnostic and therapeutic potential in traumatic brain injury (TBI) are largely lacking. This review introduces different techniques of noninvasive brain stimulation, which may find potential use in TBI. We cover transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), low-level laser therapy (LLLT) and transcranial doppler sonography (TCD) techniques. We provide a brief overview of studies to date, discuss possible mechanisms of action, and raise a number of considerations when thinking about translating these methods to clinical use.

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Minimal heating of titanium skull plates during 1Hz repetitive transcranial magnetic stimulation

Cited by 32 publications

References 6 publications

Transcranial direct current stimulation in patients with skull defects and skull plates: High-resolution computational FEM study of factors altering cortical current flow

Transcranial direct current stimulation in patients with skull defects and skull plates: High-resolution computational FEM study of factors altering cortical current flow

Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research

Noninvasive Brain Stimulation in Traumatic Brain Injury

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