The American Academy of Neurology recently held its 76th Annual Meeting, a hybrid event held in person in Denver, Colorado, with online content available to remote attendees as well. Dylan Edwards, PhD, was among six speakers invited to present in the “Neurology Year in Review” plenary session on April 18th. The speakers discussed the latest developments in a broad range of clinically relevant topics: Car-T cell therapy, gene transfer therapy, migraine management, Long-COVID and the autonomic nervous system, transcranial magnetic stimulation (TMS), and the future of amyotrophic lateral sclerosis (ALS).
In his presentation on TMS, Dr. Edwards highlighted recent technical advances that have resulted in improved electrical field modeling for the targeting of stimulation. He described how TMS can be now used to localize muscle representations on the primary motor cortex in three dimensions for an individual based on their own cortical anatomy.1 This approach is more accurate and personalized compared to prior targeting methods where an estimate of the center of the TMS coil and the electric field would be generated and mapped based on the depth of stimulation in two dimensions. This is a transformative advance, but it requires substantial analysis and computation. which can take several hours or more.
To overcome computational barriers to make the approach more clinically relevant, Dr. Edwards explained how researchers developed a fast, accurate TMS solver that can now determine TMS electrical fields for any coil type in near-real time.2 This represents a substantial breakthrough that could allow clinicians to have an estimate of electric field distribution in a region of interest in a matter of seconds. Other important developments in the field that Dr. Edwards featured were the use of robotic arms for automated precision-targeting (including his own research being conducted at MRRI), as well as emerging technology that shows an alternative approach with static multi-coil arrays.3-4
Dr. Edwards also shared progress in research using repetitive TMS (rTMS) for neuromodulation to facilitate motor recovery after stroke and spinal cord injury. Clinical and translational studies using TMS are showing benefits for recovery of motor function when treatment is started early in post-stroke recovery.5 Future work in this area will continue to pursue individualized targeting and parameter selection based on contemporary theory, potentially selecting targets based on neural networks.
Dr. Edwards finished his presentation by sharing research that he and colleagues have been working on using rTMS to facilitate regeneration and recovery after spinal cord injury. Following promising results in animal models,6 Dr. Edwards is now translating this rTMS protocol in a phase I randomized controlled trial in patients with spinal cord injury.
Substantial headway has been made in TMS research within the past year, and this continues to be a growing field of study with broad potential clinical relevance spanning diagnostic, prognostic, and therapeutic applications. Dr. Edwards’ presentation was well-received by a large audience attending this session. The American Academy of Neurology’s Annual Meeting is the largest international meeting of neurologists and neuroscience professionals in the world, and the selection of TMS as one of the six hot topics to feature in this year’s “Neurology Year in Review” plenary session further attests to the significance of this technology in neurology and beyond.
References:
1) Weise, et al., Nature Protocols, 2023
2) Makaroff, et al., Scientific Reports, 2023
3) Navarro de Lara et al., NeuroImage, 2021
4) Daneshszand et al., Brain Stimulation, 2023
6) Boato et al., Science Translational Medicine, 2023
Photos courtesy of the American Academy of Neurology