Noninvasive Brain Stimulation: What to Expect at Johns Hopkins
Noninvasive brain stimulation (NIBS) is painless and safe, it has minimal side effects, and it has been used in thousands of people worldwide. It aims to improve quality of life and reduce the effects of issues related to speaking, swallowing, movement, cognition and other functions. This can be achieved with one of two approaches:
- Stimulating the damaged area of the brain to help restore the affected function
- Stimulating a different area of the brain to compensate for the loss of function
Noninvasive brain stimulation can increase the excitability of targeted parts of the brain. Pairing it with individualized, task-specific, intense rehabilitation can lead to greater improvements in function than rehabilitation alone.
Our unique clinical program combines noninvasive brain stimulation with intensive, evidence-based neurorehabilitation. You can expect to participate in NIBS sessions five days per week for three weeks (15 total sessions, per therapy discipline). Therapy could include physical therapy, occupational therapy and/or speech therapy, depending on your needs.
Your NIBS program team will include:
- An NIBS physician — an expert in noninvasive brain stimulation and rehabilitation who is board certified in physical medicine and rehabilitation
- A brain stimulation technician — a specialist in administering brain stimulation
- Rehabilitation therapists, such as a physical therapist, occupational therapist or speech-language pathologist
The physician and therapists will work together to design your customized treatment plan. You will also have support from a program coordinator and research staff members who will manage scheduling, answer general questions and track your progress.
There are several ways to stimulate the brain externally (i.e., noninvasively). For rehabilitation purposes, we may use one or both of the following:
- Transcranial magnetic stimulation (TMS), which uses a magnetic field to electrically stimulate a part of the brain. During a treatment session, a stimulator coil is held over the scalp. The coil generates a brief electrical current that creates a magnetic pulse that crosses the hair, skin and skull to induce an electric current that stimulates the brain. Each session is approximately 20 minutes long. As the coil is placed over your head, you will hear a click and may feel a pulling sensation on the skin under the coil. TMS typically feels like dull thumps, pulses or tapping on top of the head. Depending on the stimulation setting, you may also feel nonpainful contractions of face or scalp muscles.
- Transcranial direct current stimulation (tDCS) uses weak electrical currents applied to the head to electrically stimulate the brain. During a treatment session, two small wet sponge electrodes are positioned on a person’s head using a rubber headband. Current passes from one electrode to the other to electrically stimulate the brain. Many people describe a brief sensation of tingling, itching, or pins and needles on the scalp, underneath the electrode. This sensation typically lasts less than a minute. Some people do not feel anything at all.
A therapy regimen will be created based on your individual needs. You will see a physical therapist, an occupational therapist and/or a speech-language pathologist. In all cases, you will receive high intensity, task and goal-specific therapy while receiving noninvasive brain stimulation. Treatments will be based on the most current research and scientific evidence.
The brain stimulation technician and therapy team will administer standardized tests throughout the program. These may include written questionnaires, performance measures and other tests. These measures will allow us to track your progress and compare your function from the beginning to the end of the program. These test results will provide the NIBS team with critical insight into the effectiveness of the noninvasive brain stimulation program for the treatment of your condition. Your test scores will be entered in your medical record.
If you consent to allow us to use your standardized test scores for research, your de-identified information will be entered in a database. We will compile your scores with those of others to track the program’s effectiveness. This information may be used to improve the quality of NIBS to assist in the treatment and rehabilitation of neurological disorders. We may use your de-identified scores to disseminate to the scientific and clinical community through published scientific articles.
Many patients who have enrolled in the NIBS clinical program have shown improvements in their function and choose to return for a second or third round of treatment to continue making progress. Candidates must be motivated to participate and must fully engage in the program to maximize benefits.
Currently there is no clear patient profile describing who would most benefit from NIBS or the ideal duration for NIBS treatment after an injury or disorder. Our NIBS team is developing guidelines in these areas.
TMS is not performed for people who have pacemakers, implanted pumps or stimulators, or those who have metal objects (e.g., shunts) in the eye or skull. Also, we exercise caution with patients who had a craniotomy, patients who have a history of seizures and those who take certain medications.
The risks vary depending on the stimulation approach and technology used. If you develop any problem during the tDCS or TMS sessions, we will stop the stimulation immediately.
TMS has been used in humans and animals for many years, and it has been safely used by many researchers to study brain function. There are no known significant risks associated with the TMS procedure, and the stimulation is not painful for most people. In rare cases, side effects can include headache, seizures, hearing loss and nausea.
- Headaches can occur due to strong contractions of scalp muscles.
- Brief seizures have been reported in about 10 human subjects worldwide since 1990 (less than one in 1,000 studies). In the unlikely event that TMS results in a seizure, you will receive immediate medical attention.
- Because the TMS device produces a clicking sound, some people experience a mild temporary effect on hearing. To minimize it, you will be offered protective ear plugs or headphones.
tDCS has also been used in humans and animals for many years. In recent studies involving several hundred people, very minor side effects were reported, such as itching, tingling and burning, as well as temporary headache, sleepiness and dizziness. There is no danger of heat to the brain or skin during tDCS. We take every precaution to maximize safety, including using insulated electrodes.
Although we encourage patients to complete the entire 15-day NIBS program to maximize the potential benefits, you can stop participating at any time for any reason. In certain rare cases, our team may recommend to halt the program due to patient safety concerns or for a reason of which we are not yet aware.
We recommend that patients in the NIBS program practice good sleep hygiene and minimize alcohol use. This will help ensure you are in top shape to participate in the program.
Talk to your physician if you are interested in trying brain stimulation — he or she can refer you to our program. Or you can call our appointment line at 443-997-5476 and request the noninvasive brain stimulation program to speak to our program coordinator for an evaluation to determine if this treatment is right for you.
If possible, before calling the NIBS program coordinator, please have your most current medical notes from your physician and therapists, a copy of your brain imaging (we prefer MRI, but computerized tomography (CT) is also accepted) and a list of current medications. For answers to questions, please contact the program coordinator.