A Somerset NHS scientist is exploring whether brain stimulation could help diagnose damage to the spine.
Diane Boothman, a clinical scientist and Somerset NHS Foundation Trust’s clinical service manager for neurophysiology, is conducting research as part of her doctorate to evaluate the potential of transcranial magnetic stimulation (TMS) in diagnosing degenerative cervical myelopathy (DCM).
This condition, caused by compression of the spinal cord, results in long-term spinal damage and is increasingly prevalent in the UK.
Ms Boothman said: “When our spinal team see a patient with signs and symptoms of spinal myelopathy, they’ll be sent for an MRI scan that often clearly indicates a problem, but the patient doesn’t necessarily have the right level of symptoms for a diagnosis or to be listed for surgery.
“At the same time, there’s also another group of patients who have clear symptoms of the condition, but the MRI scan doesn’t quite meet the criteria for a diagnosis.
“For these patients, an operation may appear the only option, but as the MRI scan isn’t clear enough, we can’t be entirely certain that surgery will work.
“The other option involves waiting until the symptoms get worse, which again isn’t ideal for the patient.”
This research was inspired by Ms Boothman’s participation in the national Higher Specialist Scientist Training programme, run by the National School of Healthcare Science.
She is investigating whether TMS can serve as an additional diagnostic tool for DCM.
Ms Boothman said: “When I looked at the literature review on this subject, it was clear that different techniques were being used across the world.
“It really wasn’t standardised, but as the number of patients being diagnosed with transcranial magnetic stimulation was so small, it simply wasn’t robust enough to routinely use in clinical practice yet.”
Patients for the study will be recruited from the orthopaedic assessment service after GP referral, based on their myelopathy symptoms.
The study involves neurological examinations, clinical questionnaires, and TMS, which involves placing a coil over the patient’s skull to record how fast the signal travels through their spinal cord.
The results from the TMS will be compared with surgical diagnoses to determine its efficacy as a diagnostic tool.
Ms Boothman said: “The great thing about the transcranial magnetic stimulation treatment is that there are no side effects, and the patient can go home straight after it.
“I’m hoping that if the transcranial magnetic stimulation works and proves useful, then we can integrate it into the regular way we diagnose the condition.
“We don’t know yet whether we can use it to give a firm diagnosis for all patients with myelopathy, but I’m really hoping that we’ll be able to use it for those patients who come into clinic through with suspected myelopathy, as we should then have enough information for our surgeons to make a diagnosis.
“If that works, then it’ll either mean that patients are not left suffering unnecessarily, and it might even avoid unnecessary operations altogether.”
Ms Boothman is looking for 400 participants for the study, half of whom have symptoms of myelopathy.
The remaining participants, who do not have symptoms, can be anyone over 18.
Ms Boothman said: “This group of so-called ‘normals’ are used as reference data so I can compare the two groups, so I’d encourage everyone to consider taking part – all you need to have is a quick transcranial magnetic stimulation session and you’ll be contributing to clinical research.
“There is an exclusion criteria, so people with a pacemaker or those with epilepsy, for example, won’t be able to take part – we’ll ask those questions before you book an appointment.”
For more information or to take part, email [email protected].
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