Transcranial magnetic stimulation therapeutic applications on sleep and insomnia: a review

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique approved by the US Food and Drug Administration for use in treatment-resistant major depressive disorder. It works by generating localized magnetic fields that create depolarizing electrical currents in neurons a few centimeters below the scalp. This localized effect is believed to stimulate neural plasticity, activate compensatory processes, and influence cortical excitability. Additionally, rTMS has been used in a variety of clinical trials for neurological and psychiatric conditions such as anxiety, post-traumatic stress disorder and epilepsy. Beneficial effects in sleep parameters have been documented in these trials, as well as in major depressive disorder, and have led to an interest in using rTMS in the field of sleep medicine for specific disorders such as insomnia, hypersomnia, and restless legs syndrome. It is unknown whether rTMS has intrinsically beneficial properties when applied to primary sleep disorders, or if it only acts on sleep through mood disorders. This narrative review sought to examine available literature regarding the application of rTMS for sleep disorder to identify knowledge gaps and inform future study design. The literature in this area remains scarce, with few randomized clinical trials on rTMS and insomnia. Available studies have found mixed results, with some studies reporting subjective sleep improvement while objective improvement is less consistent. Due to the heterogeneity of results and the variations in rTMS protocols, no definitive conclusions have been reached, signaling the need for further research.

Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: An Updated Systematic Review and Meta-Analysis

“…Another review by Chou et al (52) also found that rTMS improves cognitive functions in mild cognitive impairment and Alzheimer's disease, where subgroup analysis revealed enhancements in memory for rTMS applied to DLPFC and enhancements in executive function for high-frequency rTMS applied to the right inferior frontal gyrus. For sleep, a review by Oroz et al (53) found mixed results, where most studies showed subjective sleep improvements, whereas only a few demonstrated 6. rTMS and quality of life. CI =confidence interval; DLPFC = dorsolateral prefrontal cortex; M1 = primary motor cortex; rTMS = repetitive transcranial magnetic stimulation; SD = standard deviation.…”

The Effect of Pramipexole Combined with rTMS on Sleep Disorders in Parkinson’s Disease Patients

“…rTMS has been reported to be effective for PD and this technique is gradually being widely used clinically [22]. Factors affecting rTMS include stimulation of the anatomic target, intensity and frequency [14]. Among these factors, low range of frequency seems to be the most important parameter of rTMS [23].…”

“…rTMS treatment can improve the sleep architecture and significantly decreases the body awakening level and provides a better long-term treatment effect [11]. The modulatory effect was locally inhibited when 1 Hz rTMS was applied to the occipital cortex [14], However, controversy exists. A study of LF rTMS over the vertex on sleep in PD did not show significant clinical benefit [15].…”

Devices and Technology in Transcranial Magnetic Stimulation: A Systematic Review

“…Later on, TMS was gradually applied as a mean of therapy for psychiatric problems such as depression [ 13 , 14 , 15 , 16 ], bipolar disorder [ 15 , 17 ], and schizophrenia [ 18 ], among others. Moreover, TMS therapeutic capabilities were tested with success in neurological disorders such as Parkinson’s disease [ 19 ], Alzheimer’s disease [ 20 ], dementia [ 21 ], sleep disorders and insomnia [ 22 ], stroke [ 23 , 24 ], and traumatic brain injuries [ 25 , 26 ].…”

“…Initially, TMS devices for brain mapping required short, but important, periods of time to recover before producing the next pulse. However, for therapeutic TMS, faster devices with shorter recovery times were designed for repetitive TMS (rTMS), which was proposed for the treatment of a wide variety of health problems [ 18 , 21 , 22 , 27 , 28 ]. Recently, theta-burst stimulation (TBS), another modality of TMS, has proved to be as effective as “classical” TMS, with shorter therapy sessions [ 29 , 30 ] for promoting neuroplastic effects in patients with cerebral diseases and trauma.…”