Treating Balance Impairment of the Elderly with TMS-induced Brain Connectivity

Summary Falls and fall-related injuries are a growing public health concern, particularly in regions of the world in which high proportions of the population are elderly. When older adults are affected with neurological conditions such as stroke, neuropathies, Parkinson's disease, multiple sclerosis, Alzheimer's disease, the risk for falling increases substantially. Falls and the resulting fear of falls can mark the beginning of a decline in function, participation in social activities, and independence, thus negatively affecting the quality of life. One in three people over the age of 65 years who are living in the community experience at least one fall each year. About 10% of these falls are associated with serious injuries such as traumatic brain injury and hip fractures. Injuries resulting from falls are the leading cause of hospitalization and financial hardships in older adults. Loss of balance is one of the common precipitants of falls. Interventions in the form of walking, cycling, structured exercises, and general medications are available, but do not significantly reduce the risk of falling. Older adults often have alterations in the brain balance circuit that cause ineffective responses to prevent a fall when balance is challenged. In this proposal, we present early data from human studies in which transcranial magnetic stimulation (TMS) was guided by magnetic resonance imaging [MRI] and electroencephalography [EEG] to focus on the supplementary motor area in elderly subjects with balance disorders. These data show that the balance-circuit activation patterns in those elderly patients changed to patterns resembling young healthy subjects, and that short-term balance was improved (long-term balance improvement was not evaluated). Our aim in the proposed Phase I project is to conduct a more comprehensive clinical study of these guided TMS methods in the treatment of balance deficits in elderly patients with a history of falls. If we are technically successful in this Phase I project, we intend to conduct Phase II definitive studies that will validate the science to the satisfaction of the Food and Drug Administration. We would then commercialize the technology by streamlining workflow and increasing patient access through the fusion of the MRI, EEG, and TMS functionalities into a single compact mobile device (aimed at treating balance deficits and other neurological disorders of the elderly). The new balance-treatment device could be placed in geriatric or otolaryngology clinics, driven to patient's homes, or rotated among nursing home facilities.