Well, your question actually has two parts, which I would summarize as: i) could we use TMS as a tool to assess brain death and ii) could we use it to resuscitate people (in the same way cardiac electric shocks are used as I understand)?

i) Probably, yes.

ii) Definitely not.

Let’s be a bit more constructive. But first, let’s consider what TMS technique we would be speaking of. Indeed, I don’t think that TMS of primary motor cortex in order to detect movement is an effective way, for several reasons. First, you might not know the past medical history of the patient, who might have had previous brain injuries. We know that severely brain injured patients have higher motor threshold and lower responses to TMS as compared to healthy subjects (e.g. see Lapitskaya et al. 2013). Second, the current event may prevent you from noticing any limbs movement at all (traumatic lesion, physical restrains …). Finally, you will only test for a very limited amount of cerebral cortex. You wouldn’t say that complete locked-in patients are dead would you? Well, primary motor TMS wouldn’t result in any movement.

So, you may want to use the combination of TMS with EEG. That way, you can interrogate much more of the cerebral cortex, and seek a local response. While I don’t know any study on TMS/eeg in brain dead people, the EEG response should be flat. That means, no response at all. We already know what to expect from acute and chronic severely brain injured patients (e.g. see Rosanova et al., Brain, 2012), and from healthy subject during general anaesthesia (see Ferrareli 2010) and sleep (see Massimini, 2005). So this could be an effective way to detect brain capacity for consciousness in patients who otherwise show no signs of life at all. But this also has several limitations. One of them is the availability of the equipment. Second is the time require for the set-up (TMS compatible EEG requires really really good impedances, so you might count at least half an hour for a team to fix the cap). Third is that you may not have your answer straight away, as the response can be somewhat subtle. Finally, we don’t know how prolonged cold or other condition would affect the response. So possible yes, but complicated.

For the second part of your question, the answer is definitely no. Indeed, TMS works by depolarizing a group of bent axons, leading them to discharge. That response then propagates to the rest of the cortex and sometimes (in the case of motor stimulation) to the spinal cord. But, as you know, cells don’t like death. They tend to die when that occurs. Especially neurons, which can only survive cardiac arrest for a couple of minutes. When they stop working, they stop making ATP (energy). Without ATP, the membranes pumps and some of the ions channels stop working. And the differential of potential disappears with the ions balance restored. And without a membrane potential, you cannot force bent axons to discharge. So, stimulating a dead brain won’t result in any sort of reaction. Even if the brain is only dying, not dead yet, I don’t see how stimulation parts of the brain would results in restoring life. What portion of the brain would you stimulate to achieve that? Cardiac shocks only works in restoring effective rhythm when in fibrillation, meaning firing anarchically. When the heart is stopped, asystolic, electric shocks wouldn't work either. Plus, cardiomyocytes have a far better resistance to ischemia than neurons (in the order of tens of minutes).

Hopes that helps, and sorry for the rather long answer.

Man 'Roused From Coma' By a Magnetic Field

http://abcnews.go.com/Technology/story?id=6043057&page=1

I don not know if your idea have been considered and has any research carried out.

I think if it works it would be a miracle!

Well, your question actually has two parts, which I would summarize as: i) could we use TMS as a tool to assess brain death and ii) could we use it to resuscitate people (in the same way cardiac electric shocks are used as I understand)?

i) Probably, yes.

ii) Definitely not.

Let’s be a bit more constructive. But first, let’s consider what TMS technique we would be speaking of. Indeed, I don’t think that TMS of primary motor cortex in order to detect movement is an effective way, for several reasons. First, you might not know the past medical history of the patient, who might have had previous brain injuries. We know that severely brain injured patients have higher motor threshold and lower responses to TMS as compared to healthy subjects (e.g. see Lapitskaya et al. 2013). Second, the current event may prevent you from noticing any limbs movement at all (traumatic lesion, physical restrains …). Finally, you will only test for a very limited amount of cerebral cortex. You wouldn’t say that complete locked-in patients are dead would you? Well, primary motor TMS wouldn’t result in any movement.

So, you may want to use the combination of TMS with EEG. That way, you can interrogate much more of the cerebral cortex, and seek a local response. While I don’t know any study on TMS/eeg in brain dead people, the EEG response should be flat. That means, no response at all. We already know what to expect from acute and chronic severely brain injured patients (e.g. see Rosanova et al., Brain, 2012), and from healthy subject during general anaesthesia (see Ferrareli 2010) and sleep (see Massimini, 2005). So this could be an effective way to detect brain capacity for consciousness in patients who otherwise show no signs of life at all. But this also has several limitations. One of them is the availability of the equipment. Second is the time require for the set-up (TMS compatible EEG requires really really good impedances, so you might count at least half an hour for a team to fix the cap). Third is that you may not have your answer straight away, as the response can be somewhat subtle. Finally, we don’t know how prolonged cold or other condition would affect the response. So possible yes, but complicated.

For the second part of your question, the answer is definitely no. Indeed, TMS works by depolarizing a group of bent axons, leading them to discharge. That response then propagates to the rest of the cortex and sometimes (in the case of motor stimulation) to the spinal cord. But, as you know, cells don’t like death. They tend to die when that occurs. Especially neurons, which can only survive cardiac arrest for a couple of minutes. When they stop working, they stop making ATP (energy). Without ATP, the membranes pumps and some of the ions channels stop working. And the differential of potential disappears with the ions balance restored. And without a membrane potential, you cannot force bent axons to discharge. So, stimulating a dead brain won’t result in any sort of reaction. Even if the brain is only dying, not dead yet, I don’t see how stimulation parts of the brain would results in restoring life. What portion of the brain would you stimulate to achieve that? Cardiac shocks only works in restoring effective rhythm when in fibrillation, meaning firing anarchically. When the heart is stopped, asystolic, electric shocks wouldn't work either. Plus, cardiomyocytes have a far better resistance to ischemia than neurons (in the order of tens of minutes).

Hopes that helps, and sorry for the rather long answer.

The fact that you may be able to activate corticospinal pathways is not nearly enough to say that a brain can be brought back to functioning. Already as it is it is perfectly feasible to assess if afferent pathways are intact and responding using sensory or visually evoked potentials, and that would have a stronger prognostic value as it is a physiological response. TMS is no more physiological than ECT, so in line with your suggestion one could just move the defib pads up to the head during resuscitation. Not a very interesting prospect I am afraid :-)

Those that have recovered from being "dead" for long times are often able to recount experiences of feeling still conscious while they were medically "dead."

This is not only interesting but important point in study that a person medically dead was feeling still conscious. So redefining the death is necessary. Another question is consciousness and death or life?

I agree with Mr Umberto Leon- Dominguez. The consciousness is result of multifocal co-ordination of brain centers/nuclei or vice versa?

Yes, further researches are necessary and a day may come when TMS Machine would be a part of ICU UNITS. Then we would not be declaring a person dead with possibility of surviving

I have a different opinion that were here exposed. First of all, I would like see the research about the case of a Japanese woman being resuscitated over four hours after being found dead. It´s hard for me believe that cause when the blood don´t reach the brain, it hurts acutely and rapidily. So, four hours is too much.

The second point is if TMS is an available method to resurrect people. I´m not sure of it, but some researchers point out the brain region of interest to resurrect people is the motor cortex. I´m completely disagree with that statement. I think there are several nuclei that need to be stimulated at the same time, and those nuclei are related to consciousness, no to motor performance. For instance, those nuclei may be: brainstem, midbrain, thalamus (focus the stimulation in intralaminar, reticular thalamic nucleus and midline nuclei), Precuneus, posterior cingulate cortex, and prefrontal cortex (mPFC and dlPFC). If you can stimulate all these nuclei, you are stimulating the loop that form consciousness... and only in doing so (and also stimulating the heart at the same time also), maybe we could have some possibility to resurrect people

On resusciation I also doubt any TMS-effect. Regarding brain-death I assume there might be use of TMS. But let's see what we got so far regarding brain-death criteria:

Well established brain-death criteria are still discussed (Pellegrino et al., 2008, "Controversies in the determination of death"; A White paper by the President's council on bioethics"). Until today, we have no definition of what death really is. 100 years ago, and already during Greek Antique death meant heart-death. Today we changed the criterium because we focused on the brain to be most relevant for the "life of human being". Death remained the same, our criteria changed.

Today, our criteria satisfyingly allow the assumption of brain death of a person. Nevertheless it is not fully conclusive. There are patient who fulfill brain death criteria giving birth (Susan Torres 2005, the so-called "Erlanger Baby" 1992) - even though these cases are rare. This is why we need to critically question the criteria.

If we intended to follow the neurocentric track to define death repetitive TMS might be of use. One central aspect of todays brain-death criteria is "irreversibility". This might be approached by examining wheter it is still feasible to induce changes in plasticity using rTMS-protocols in so-called brain death people. As a conclusion TMS will surely not clarify the issues as mentioned above, but may be useful as an additional apparative method.

Whether or not this is worth exploring needs to be discussed. Do we cause more trouble employing another apparative measure - confusion of our definition and stress for the dead? Could we enhance the credibility of brain death criteria (i.e. in a German study 30% of people tell they were not able to tell whether brain death equals death; Watzke, Schmidt & Stander, 2013, "Einstellung, Wissen und Verhalten...)

This would be my way to answer to your question.