Repetitive Transcranial Magnetic Stimulation (rTMS)

To understand how the rTMS works, it is vital first to understand how the brain responds to head trauma. Our partnering specialist, Dr. Keifer explains the complexities that follow a brain injury and how rTMS is used to heal the brain.

Dr. Keifer Decodes the Complexity of Concussion:

When a concussion happens, it sparks a chain reaction in your brain, set off by the powerful impact. Think of it as a series of events triggered by the disruption of your brain's delicate balance. This disruption makes the protective membranes of your brain cells permeable, unleashing a cascade of changes. To break it down:

Mechanical Forces Unleash Chaos: The impact creates mechanical forces that disrupt the equilibrium of your brain cells.
Cell Membranes Turn Porous: The stretching and shearing forces induce porosity in cell membranes, leading to the outflow of intracellular potassium and widespread neuronal depolarization. This marks the beginning of the acute neurometabolic cascade.
Key Changes Unleashed: This cascade involves a dance of neurotransmitters, including glutamate and GABA, along with shifts in potassium, calcium, and glucose. These changes contribute to hyper- and hypometabolic phases lasting for about 10-14 days.

Now, let's delve into the aftermath and the subsequent energy crisis:

Brain Energy Crisis Unfolds: Following the initial impact, there's an increased demand for energy in the brain, triggering heightened neuronal glycolysis for several weeks.
Triphasic Response in Blood Flow: The flow of blood in the brain responds in three phases, influenced by regulatory compromise, vasoreactivity disturbances, and structural vessel changes, especially in areas linked to autonomic regulation and emotion processing.

Moving on to the microstructural damage and its effects:

Axonal and Cytoskeletal Injury: The rapid deceleration of the head induces microstructural axonal damage, peaking within the first 1-2 days. This can disrupt the brain's electrical signaling and the regulation of the hypothalamic-pituitary-adrenal (HPA) axis and stress responses.

Now, the inflammatory response and its persistence:

Neuroinflammation Unleashed: Microglial activation, increased inflammatory cytokines, and immune cell infiltration correlate with persistent symptoms.
Blood-Brain Barrier Drama: Dysfunction in the blood-brain barrier, indicated by structural alterations and temporal variations in permeability, suggests a biphasic course, with "late" dysfunction observed months post-injury. Chronic neuroinflammation in brain-injured populations has been reported months to years later.

Though cell death is limited, neuroimaging reveals structural changes:

Limited Cell Death: In mild traumatic brain injury (mTBI), cell death is restricted, but neuroimaging shows diffuse volume loss, atrophy, and regional changes. However, these morphological alterations are subtle and require expensive and less accessible imaging techniques for detection.

Understanding how the brain responds to injury is vital for targeted interventions:

Crucial Insights for Targeted Interventions: To develop effective interventions, understanding the neurobiological responses is crucial. Dr. Keifer's concussion assessment and brain treatment program, boasting a 90% success rate, relies on clinically useful and measurable biomarkers, including functional (neuroelectric) and neuroendocrine studies.

Brain Mapping: Clinical Biomarker in Concussion Assessment and Brain Treatment

With a data set including thousands of brain maps, including amateur and professional athletes and military professionals, Dr. Keifer's identification of biosignature differences in high-performance athletes compared to others plays a crucial role in developing personalized plans and protocols – a departure from the conventional, generalized approach to concussion treatment and rTMS.

Now, let's explore how Brain Health Hawaii's program, led by Dr. Keifer, leverages brain mapping for a personalized approach:

Data-Driven Examination with Brain Mapping: This is like creating a detailed map of the cerebral cortex, assessing functions and the electrical nature of brain injuries.
Specific Function Spotlight: Identifying areas responsible for vital functions such as planning, memory, sensory integration, and emotional control.
Nuanced Approach to Treatment: Acknowledging the uniqueness of each brain injury, emphasizing a need for a personalized and nuanced approach to treatment.

Moving on to personalized treatment based on brain wave patterns and biosignatures:

Biosignature-Driven Treatment: Dr. Keifer, armed with thousands of brain maps, identifies biosignature differences, tailoring treatments for each individual. This marks a departure from the conventional, generalized approach to concussion treatment and rTMS.
Real-Time Adaptation: Brain mapping tracks response to treatment in real-time, allowing for ongoing monitoring and adaptation of treatment strategies, ensuring a holistic understanding of the patient's recovery progress.

In the Brain Health Hawaii program, brain mapping is frequent:

Frequent Brain Mapping: Utilizing brain mapping every 5 treatments, the program offers a visual understanding of brain function, guiding personalized treatment, and tracking responses over time. This significantly contributes to improving outcomes for individuals recovering from concussions.
Precision and Individualization: Dr. Keifer's approach and outcomes in athletes and military underscores the importance of precision and individualization in the evolving landscape of concussion assessment and treatment.

Brain Health Hawaii's Brain Treatment Program and Personalized rTMS

Dr. Keifer's Brain Health Hawaii program stands out internationally for its focus on identifying biosignature differences, addressing neuroinflammation, and utilizing brain maps and personalized neurostimulation:

Brain Maps in Action: Utilizing brain maps during assessment and after every 5 treatment sessions.
Personalized rTMS Procedure: Administering personalized rTMS treatments in a relaxing environment. Magnetic pulses are gently applied to multiple locations on the head to restore disrupted brain activity. The enhanced brain treatment outcomes are a result of Dr. Keifer’s expertise with sequencing and dosing personalized rTMS protocols.
Global Success Stories: The clinical outcomes of Brain Health Hawaii's brain treatment approach have been demonstrated in thousands of patients.

Dr. Keifer firmly believes in the power of early and effective treatment, not only for concussion but also for reducing the future risk of chronic traumatic encephalopathy (CTE) in athletes and military professionals. His clinical expertise extends to other conditions consistent with brain injury and neural electrical disruption, including stroke, Long COVID, and PTSD.

Studies: