*6.1.5 Migraine with aura*

Migraine with aura is another FDA approved indication which was announced in 2017. There are different protocols involving facilitatory stimulation over left dorsolateral prefrontal cortex or left motor cortex [34]. A meta-analysis shows effectiveness of TMS in treating migraine with aura [34]. Prophylactic inhibitory rTMS at vertex in patients with known migraine regardless of the presence of aura apparently also reduces migraine median frequency by 12 days per month and median intensity by 6 points [35].

#### *6.1.6 Motor rehabilitation*

Motor deficits after cranial or spinal insults are common. Stroke is one of the major causes. There is no standardized protocol. Inhibitory rTMS or cTBS over motor cortex of the non-lesional side and facilitatory rTMS or iTBS over motor cortex of lesional side are the common choices. Systematic reviews and meta-analyses show that rTMS


*Transcranial Magnetic Stimulation, Connectome and Its Clinical Applications DOI: http://dx.doi.org/10.5772/intechopen.109963*


#### **Table 1.**

*Summary of potential side effects of TMS.*

and TBS are effective in improvement of motor function after insult of the brain with 95% confidence interval 0.24–9.71 for upper limb Fugl Meyer assessment [36–38].

Spinal insults, including trauma and post tumor excision, can also lead to motor deficits. Although there are no insults in brain, the corticospinal tract is affected by the spinal insult. A lot of studies support the use of TMS (rTMS or iTBS) in spinal insult patients, particularly incomplete spinal injury cases, and one of the studies shows improvement in lower limb motor score of 5 points with p value 0.004 compared to 1 point in sham group [39–43].

#### *6.1.7 Parkinson's disease*

Parkinson's disease is a relative common but disabling disease. Neuromodulation is one of the treatment approaches. Unlike deep brain stimulation, TMS provides a method of neuromodulation without the need of incision and anesthesia. Currently there are no consensus for the protocol TMS in managing Parkinson's disease. There are different protocols available. Apparently motor symptoms of Parkinson's disease improve after TMS [44–47]. The Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale shows 6 points of improvement in Part III at 4 week post-treatment with p value 0.04 [45].

#### *6.1.8 Other therapeutic uses*

rTMS has been reported to be effective in improving nominal aphasia since 2005 [10]. It shows improvement by two standard deviations in Boston Diagnostic Aphasia Examination [10]. Since then, multiple trials have been conducted to test for the efficacy of rTMS on dysphasia. A recent systematic review confirmed that rTMS is an effective tool in post-stroke aphasia rehabilitation [9].

Tinnitus is one of disabling diseases that may not have any effective medical treatment. rTMS was found to be able to reduce the severity of tinnitus [48–50]. Over 16 points of improvement in Tinnitus handicap inventory scores at 6 months posttreatment was observed [49].

Spasticity is common after cerebral insults like stroke. A recent systematic review shows that TMS helps to improve Modified Ashworth Scale of the patients by 0.58 with p value <0.01 [51].

Neuropathic pain is one of the big topics in pain management, and TMS is shown to be an effective tool in managing those patients [52, 53].

rTMS is also shown to be effective in rehabilitation of dysphagia after stroke in recent published systematic reviews [54, 55]. The mean difference was −1.03 with p value <0.0001 in Penetration Aspiration Scale after completion of TMS [55].

There are some other fields that researchers and scholars are working on to see if TMS helps in the management. Examples include hemineglect, visual field impairment and epilepsy [56–58].
