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Interdisciplinary Transcranial Magnetic Stimulation (TMS) Lab


Director: Dr. Benzi Kluger, MD

Steering Committee: Marshall Thomas, MD; Margaret Schenkman, PhD

The UCD Interdisciplinary TMS Laboratory is dedicated to improving our understanding of diseases affecting the central nervous system and developing treatments for these conditions. Our associated faculty includes members of the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, Orthopedics, Internal Medicine, Psychology and Speech, Language and Hearing Sciences. Areas of research interest include the treatment of psychiatric disorders, improving rehabilitation and speech therapy outcomes, investigating the neurophysiology of movement disorders and integrating TMS with other imaging modalities (MRI, MEG and EEG).

Transcranial Magnetic Stimulation (TMS) is rapidly becoming one of the most important research tools in clinical neuroscience. TMS utilizes rapid magnetic pulses applied over the scalp with a small hand-held coil to induce precisely timed and localized electrical currents within the cortex of human subjects. TMS is also being used in clinical research in the diagnosis of diseases affecting the corticospinal tract, the planning of neurosurgical procedures and the treatment of many conditions, including depression, hallucinations, pain, tinnitus, Parkinson’s disease and stroke rehabilitation.


TMS set up

Effects of Mental Concentration on the Responsiveness of Intra-cortical and Corticospinal Pathways
Katrina Maluf, PT, PhD

Mental concentration can increase trapezius muscle activity in some, but not all, individuals. This project uses transcranial magnetic stimulation (TMS) to investigate individual differences in the effects of mental concentration on the responsiveness of intra-cortical and corticospinal pathways in subjects with and without chronic neck pain and cervical dystonia.


Optimizing Lower Extremity Muscle Function after Total Knee Arthroplasty
Jennifer Stevens-Lapsley, PT, PhD

The goal of this study is to investigate quadriceps force and reflex inhibition after TKA and explore rehabilitation strategies to minimize these deficits after TKA.


Study of the Neurophysiology of Central Fatigue
Benzi Kluger, MD, MS

The goal of this study is to determine how changes in tasks demands affect the neurophysiology of motor fatigability and to measure how changes in cortical excitability correlate with cognitive fatigability.


A Novel Approach to Cognitive Dysfunction in Parkinson's Disease
Benzi Kluger, MD, MS

This study combines rTMS and magnetoencephalography to investigate the etiology of cognitive dysfunction in Parkinson's disease as well as the potential of rTMS to ameliorate these symptoms.


Lab Director

 

Dr. Benzi Kluger

Dr. Kluger completed medical school and neurology residency at the University of Colorado. He then went to the University of Florida for research fellowships in Behavioral Neurology and Movement Disorders, including the application of transcranial magnetic stimulation as a research and therapeutic tool. Dr. Kluger's primary research interest is the neurophysiology and treatment of non-motor symptoms in Parkinson's disease and other neurological disorders. His research is supported by the Colorado Clinical and Translational Sciences Institute (CCTSI), National Institutes of Health, Department of Defense and Michael J Fox Foundation.

Steering Committee

Marshall Thomas, MD

Margaret Schenkman, PhD

Affiliated Departments/Programs and Investigators

Physical Therapy Program

Physical Medicine and Rehabilitation

Department of Neurology

Department of Psychiatry

Department of Speech, Language and Hearing Sciences

Department of Psychology

ACTIVE GRANTS

Department of Defense (ARO #56700-LS) 
Study of the Neurophysiology of Central Fatigue  
PI, Kluger B.
$325,000

NIH/NCRR Colorado CTSI (KL2 RR025779) 
Novel Approach to Cognitive Dysfunction in Parkinson’s Disease  
PI, Kluger B.
$338,700

NIH (R01-HD065900) 
Progressive Rehabilitation for Total Knee Arthroplasty 
PI: Stevens-Lapsley, Co-investigator: Kluger B.
$2,469,362

RECENTLY COMPLETED GRANTS

Michael J. Fox Foundation (R01-AR056704) 
Repetitive Transcranial Magnetic Stimulation for the Treatment of Apathy in Parkinson’s Disease (The ReStore Study) 
Fernandez HH, Principal Investigator; Co-investigator: Kluger B.
$400,000

Academy of Neurology Foundation (R01-AR056704) 
Study of the Neurophysiology of Central Fatigue in Parkinson’s disease and Stroke. 
PI, Kluger B.
$130,000

RECENT PUBLICATIONS

Kluger BM, Triggs WJ. Use of transcranial magnetic stimulation to influence behavior. Curr Neurol Neurosci Rep. 2007 Nov;7(6):491-7.

Triggs WJ, Ricciuti N, Ward HE, Cheng J, Bowers D, Goodman WK, Kluger BM, Nadeau SE. rTMS Treatment of refractory depression: Stimulus laterality effect exceeds rTMS effect. Psychiatry Res. In Press.

LABORATORY EQUIPMENT

 

The TMS Lab is equipped with Magstim standard figure of eight coils as well as specialized coils for repetitive applications and targeting of deeper cortical structures. Our stimulators are capable of delivering single pulse, paired pulse, and repetitive stimulation. Our Brainsight neuronavigation system allows stereotactic delivery of TMS pulses based on neuroimaging (MRI). We also have an advanced electromyography (EMG) system and Signal software for research applications.

The TMS facility, like MRI and MEG, is available as a fee for service. Basic service includes preparatory time and TMS stimulation time and is billed based on time of use. Training in the application of TMS paradigms and a TMS technician are also available for an additional fee. Investigators interested in using TMS will need to submit a Study Protocol Request (see link below) which will be reviewed by the steering committee. TMS faculty may also be consulted regarding aspects of experimental design and/or data analysis.

Services

Review of proposals using TMS, assistance with preparation of IRB materials for TMS projects, training in the use of TMS and stereotactically guided TMS, performance of TMS on human subjects for research and therapeutic purposes. Download a brochure about TMS

Fees

TMS conducted on human subjects will be $200/hour for internal users and $400/hour for investigators outside of the University of Colorado. Other services and discounts for collection of pilot data or junior investigators may be discussed with Dr. Kluger and the steering committee.

 

 Frequently Asked Questions

 

 How is the quality of your measurements evaluated – quality control?

Transcranial magnetic stimulation (TMS) stimulates and modulates cortical activity. This is most easily measured by examining motor response to motor cortex stimulation with EMG. Motor thresholds and motor evoked potentials are routinely performed even when the focus of TMS is a non-motor region to ensure adequate stimulation.1

 What is the turn-a-round time for the service you provide?

​For studies or indications with IRB approvals TMS can be provided within a few weeks. EMG data for motor studies can be provided within a week of TMS sessions.2

 Who documents the data provided and signs off on the data?

​Dr. Benzi Kluger, Director of the Interdisciplinary TMS Laboratory, will review all protocols prior to TMS, as well as data collection procedures with the PI of the study and TMS technician. TMS technicians will provide and document data. In cases of inconsistent data, Dr. Kluger will review the results and records of TMS sessions.3

 Have you had experience providing data for industry?

​No, but we are willing to provide TMS services to industry including measures of cortical excitability, transcranial direct current stimulation (tDCS) and repetitive TMS treatments.4

 Do you have a standard operating procedure manual?

​Yes, but only for depression treatments and current TMS studies. Operating procedures will be written up on an as needed basis for other protocols.5

 How will you track billing and financial aspects of your core?

​The TMS laboratory has its own cost center in the Department of Neurology which can track billing and sources of funding.6


LAB CONTACT INFORMATION

Lab Address:
   

Anschutz Medical Campus
Bldg 500, Rm EG305
13001 E. 17th Place
Aurora, CO 80045    

Phone: 303-724-5470
Fax: 303-724-0863

Email: TMS.Lab@ucdenver.edu

 

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