Transcranial Magnetic Stimulation (TMS)

WHAT IS TRANSCRANIAL MAGNETIC STIMULATION (TMS)? Transcranial magnetic stimulation [TMS] is a non-invasive procedure that uses magnetic fields to arouse nerve cells in the brain, to trim down the symptoms of depression. TMS is typically used when other methods of the treatment of depression are futile.  When TMS is used to treat depression or other neuropsychiatric disorders, a train of pulses is applied, one after the other. These impulses are transmitted one after the other, again and again.  Because of this, when TMS is used for treatment, it is known as repetitive transcranial magnetic stimulation [rTMS]. Since rTMS is a type of TMS, the terms are often used interchangeably when talking about TMS therapy. A TMS STIMULATOR A transcranial magnetic stimulation [TMS] stimulator is a medical device that applies electrical pulses to the brain using a magnetic coil, held over the head.  An electromagnetic coil is placed over your head [scalp], near your forehead. The electromagnet painlessly sends a magnetic pulse that stimulates nerve cells in the region of your brain [the region responsible for mood control and depression].  Thus, the regions of the brain that have decreased activity in depression are activated. It is via that the stimulation appears to impact the liveliness of the brain, which in turn seems to ease symptoms of depression and improve mood.  The FDA has approved rTMS for the treatment of some kinds of depression. USES OF TMS THERAPY Transcranial magnetic stimulation therapy is used for the treatment of:

• Depression, which is in point of fact, a treatable condition.
• Other neuropsychiatric disorders.
• Pains.
• Obsessive compulsive disorder [OCD].
• Stroke.
• Parkinson’s disease.
• Migraine.
• Auditory hallucination.

ELIGIBLE CANDIDATES TMS therapy is best meant for patients who have fought with depression and have no relief from antidepressants, or those who can’t take antidepressants due to intolerable side effects. Standard care for depression, such as medication psychotherapy, may be recommended as ongoing treatment, after completion of a TMS treatment. COMPLICATIONS/SIDE EFFECTS OF TMS THERAPY Transcranial magnetic stimulator therapy carries some side effects or possible complications along with it. These include:

• Seizures.
• The discomfort of the scalp at the site of stimulation.
• Fainting.
• Transient perplexity or confusion.
• Hearing loss.
• Vision defects.
• Headache.
• Tingling. 
• Spasms or twitching of facial muscles.
• Lightheadedness.
• Mania [more than ever in people with bipolar disorder].

HOW TO PREPARE FOR TMS THERAPY PROCEDURES There are things to do before getting a repetitive transcranial magnetic stimulation (rTMS), some of which include:

1. Physical exam [and perhaps extra tests such as lab tests].
2. Psychiatric evaluation, which centers on discussing the subject of your depression.
3. Significant information to make known to your doctor or mental health provider, during the interaction, includes:

• If you are pregnant or expecting to be.
• Frequent or severe headache.
• Previous treatment with rTMS [in addition to whether it was a success in the management of your depression].
• A history of seizures or epilepsy down your family line.
• Other mental health disorders, e.g:
  • Bipolar disorder.
  • Misuse of substances.
  • Psychosis.
• Brain damage from illness or injury, e.g:
  • Brain tumor
  • Stroke.
  • Traumatic brain injury.
• Metal or implanted medical devices in your body [if any], owing to the strong magnetic field formed during rTMS. 

The procedure is not recommended for those who have the following devices:

• Implanted stimulators.
• Implanted vagus nerve or deep brain stimulators.
• Implanted electrical devices, e.g:
  • Pacemakers.
  • Medication pumps, etc.
• Stents.
• Aneurysm clips or coils.
• Electrodes for monitoring brain activity.
• Bullet fragments.
• Cochlear implants [for hearing].
• Any magnetic implants.
• Any other metal device or object implanted in your body.

Never forget to tell your doctor about medical conditions yours [if any]. TMS THERAPY Repetitive TMS treatment is usually done in a doctor’s office or clinic. The treatment–rTMS– requires a series of sessions to be effective.  A session of rTMS can last up to 30-60 minutes, only part of that time is the TMS stimulator being applied, and the rest of the time is used for set up.  Generally, sessions are carried out daily, five times a week for 4 to 6 weeks.

• Your First Treatment Procedure

Before the treatment begins, your doctor will identify the best place to put the magnets on your head, as well as the best dose of magnetic energy for you.  Your first appointment usually lasts about 60 minutes.  Probably, during your first appointment:

1. You will be taken to a treatment room, get seated in a reclining chair, and given earplugs to wear.
2. An electromagnetic coil will be placed over your head and switched off and on repeatedly, to produce stimulating pulses. A tapping or clicking sound that usually lasts for a few seconds shall be experienced, followed by a pause. Also felt is a tapping sensation on your forehead. This part of the process is known as mapping.
3. The magnetic energy needed will be determined by your doctor, by increasing the magnetic dose until your fingers or hands twitch. This is known as your motor threshold, and it is used as a reference point in determining the right dose for you, as the treatment proceeds.

During Each Treatment Having identified the coil placement and dose, you are ready to begin.

• You will sit on a comfortable chair, wear earplugs, with the magnetic coil placed against your head.
• The machine will be switched on. You will hear clicking sounds and feel tapping on your forehead.
• The procedure will last about 40 minutes, and you will remain awake and alert. Scalp discomfort will be felt during the treatment and afterward, for a short time.

After Each Treatment Normally, between treatments, you can walk and drive. You can also resume your daily activities after your treatment. SPECIALTY: A team of neurologists and psychiatrists. DURATION: Once daily, 5 times a week, for 4 to 6 weeks. RESULTS If your TMS is successful, your depression symptoms may improve or disappear completely. Relief of symptoms may take a few weeks of treatment.  It is expected that the effectiveness of TMS may be improved with the development of new techniques, the number of stimulations required, and the best sites on the brain to stimulate. COST In the U.S, these prices vary by provider, but repetitive transcranial magnetic stimulation therapy is typically in the range of $400-$500 per session for a total cost of about &15,000. ECT around $2,500 per session, $25,000 for 10 sessions, plus the cost of a one-week hospital stay in some cases.  Most insurance companies will cover ECT, and a growing number are covering TMS. In the UK, the cost of one course [20 sessions] of TMS treatment for depression is £4,000, at £200 per session. The initial consultations and follow-up fees are £400.

FAQ

Can you do TMS at home?

With at-home TMS, there is no need to travel to a clinic or interrupt your day to make appointments. The transcranial magnetic stimulator can be used whenever and wherever you need relief. Another major selling point of at-home TMS equipment is the price.

How long do TMS results last?

Because of the various factors influencing each person’s depression, there is no definitive answer to how long the TMS result will last. 

Most patients who complete the full course of treatment experience improvement in their symptoms, for 6 months and up to a year or even more.

Is TMS available on NHS?

The National Health Service [NHS] only offers TMS treatment for depression and/or anxiety.

What does TMS do to the brain?

Transcranial magnetic stimulation [TMS] is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, to relieve the symptoms of depression. TMS is typically used when other depression treatments have not been deemed effective or efficient.

Is TMS therapy painful?

TMS therapy is slightly painful. During the procedure and shortly after, you will feel some scalp discomforts. This fades off with time, but if it does not, pain relief tablets can help.