Organisation and operations of the Centre of Excellence in Neuromodulation Therapies

The Turku University Hospital Neurocenter is responsible for the specialised medical care, rehabilitation and emergency care of neurological and neurosurgical patients in Southwest Finland. The Neurocenter includes neurology and neurosurgery inpatient wards, the cerebrovascular disorders monitoring unit, the rehabilitation ward, and neurology and neurosurgery outpatient clinics.

The Neurocenter employs a versatile range of neuromodulation methods in the treatment of patients. The most important methods include deep brain stimulation (DBS), vagus nerve stimulation (VNS) and intrathecal baclofen (ITB) therapy. In the spring of 2022, Neurocenter deployed Neuro-HIFU, focused ultrasound brain therapy for movement disorders, as the first university hospital in the Nordic countries.

Scientific research related to neuromodulation therapies is actively pursued at the Neurocenter, especially related to DBS and Neuro-HIFU therapies.

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The Pain Clinic is responsible for the treatment of severe chronic and postoperative prolonged pain in Southwest Finland. The approach is multi-professional and based on a biopsychosocial framework. The Pain Clinic carries out multi-professional assessments and demanding diagnostics, provides treatment and rehabilitation recommendations, and initiates and implements demanding therapies (such as demanding pharmacotherapies, demanding invasive pain management methods, and cognitive-behavioural group rehabilitation on an outpatient basis). Patients are treated in collaboration with other specialties, primary care and rehabilitation units. The operations are led by an anaesthesiologist. The multidisciplinary pain management team includes anaesthesiologists, a neurologist, a neurosurgeon, a dental specialist, a psychologist, a social worker, and nurses.

Indications for stimulator therapy include neuropathic pain and CRPS when other pain management methods have not yielded an adequate response. Decisions on the commencement of therapy are made in a multidisciplinary pain management working group. The stimulator treatments provided by the Pain Clinic include spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation. After a two-week test period, a permanent power supply can be installed. The treatment includes regular check-ups at the Pain Clinic. Other pain management will thereafter be transferred to primary healthcare where possible, with the Pain Clinic only assuming responsibility for the patient’s stimulator therapy. The stimulator team currently includes 2 anaesthesiologists and 2 nurses.  

The Pain Clinic actively collects data on the impact of stimulator therapies on the patient’s quality of life. Efforts are made to increase investments in research following the increasingly more common use of stimulator therapies in pain management so as to develop and target therapies appropriately as possible. 

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Clinical Neurophysiology was the first in Finland to start non-invasive neuromodulation therapies together with the Psychiatric Neuromodulation Unit in 2011. The neuromodulation therapies provided by Clinical Neurophysiology include repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) for the treatment of pain, epilepsy, tinnitus, various movement disorders and depression. The staff includes neurophysiologists, laboratory technologists, nurses, and hospital physicists.

Non-invasive rTMS and tDCS neuromodulation therapies can be used to modulate the function of neural networks in the brain, either to accelerate or inhibit their function, and to release endogenous neurotransmitters such as dopamine, analgesic opioids, or mood-boosting serotonin. These promote favourable neuroplastic changes in the disrupted brain function modulated by the disease. With clinical trials, the quality of evidence on the efficacy of rTMS therapy in the treatment of depression and neuropathic pain and in cerebral palsy rehabilitation is of class A already, and it is used as current care for depression and severe pain in Turku University Hospital. tDCS therapy yields almost the same efficacy as rTMS. Its advantages include a device suitable for home use, which is lent to the patient for home care to save time and cost resources in healthcare. All non-intrusive neuromodulation therapies have the advantage of very good tolerability without any significant side effects when the safety guidelines are duly observed when patients are selected.

Clinical Neurophysiology has studied the effectiveness of rTMS and tDCS therapy since 2006 in both healthy subjects and in the treatment of various diseases, such as neuropathic pain, CRPS pain, and tinnitus.

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The Radiology section of Turku University Hospital is responsible for the emergency and elective imaging of neurological and neurosurgical patients, and for interventional radiology treatment in Southwest Finland. Medical imaging is carried out in all radiology imaging units. Interventional radiology treatments are carried out at the Turku University Hospital Interventional Radiology and HIFU treatment units. The staff includes radiologists, radiographers and hospital physicists.

The Radiology section employs a versatile range of neuromodulation methods in the treatment of patients. The principal methods include thrombectomies in acute stroke situations and, as the first university hospital in the Nordic countries, focused ultrasound brain therapy (Neuro-HIFU) for movement disorders. The therapeutic indications of the Neuro-HIFU methods are highly diverse as it can be used in the treatment of not only movement disorders, but also for tumours, chronic pain, and obsessive-compulsive disorders.

Scientific research focuses on the applications of the Neuro-HIFU method in particular.

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All neuromodulatory therapies for psychiatric conditions within the region of Southwest Finland are provided by the Psychiatric Neuromodulation Unit. The neuromodulatory therapies provided by the unit include electroconvulsive therapy (ECT), ketamine infusion therapy, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). The Neuromodulation Unit working group includes a medical specialist, a specialising physician, nurses, and a department secretary. When ECT is administered, the team also includes an anaesthesiologist and an anaesthesia nurse.

The research projects pursued at the Centre of Excellence in Neuromodulation Therapies are nearly always carried out jointly by several specialties, with the Psychiatric Neuromodulation Unit contributing to them from the psychiatry point of view. The unit participates in the writing of scientific reviews and textbooks on psychiatric neuromodulation therapies. The Psychiatric Neuromodulation Unit provides training on neuromodulation therapies in Finland and abroad and is responsible for the design and implementation the national quality register for psychiatric neuromodulation therapies and its coordination with the Swedish national quality register for psychiatric neuromodulation therapies.

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The Medical Physics Unit employs about twenty hospital physicists and ten specialising physicists. The hospital physicists play a key role in the purchase and commissioning processes of new equipment. 

At the PET Centre, a hospital physicist is involved in numerous PET, PET-MR, MR and fMRI examinations, in addition of pursuing their own research projects. In the field of clinical neurophysiology, a hospital physicist is involved in both the planning and implementation phases of rTMS therapies and DBS surgeries, for example. At Radiology, hospital physicists plan and optimise, e.g., MR sequences for best results and, most recently, play a crucial role in the deployment and modelling of Neuro-HIFU.

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Founded in 2011, Turku Brain and Mind Center (TBMC) gathers more than twenty research groups from various fields of neuroscience in Turku. The southwest Finland node of Neurocenter Finland in operates as a part of TBMC. TBMC organises and coordinates neuroscience education at University of Turku, including a master’s degree programme in human neuroscience starting from autumn 2018. The ‘Minor in Neuroscience’ study module is open to all students at the University of Turku.

Operating as part of TBMC, the TurkuBrainlab research group is actively engaging in research into invasive and non-invasive neuromodulation. The research combines the locating of new treatment areas using brain imaging methods with the study of neurobiological responses to brain stimulation and clinical treatment studies. TurkuBrainlab conducted the first DBS-PET measurements in Finland in 2020.

Read more about Turku Brain and Mind Center.