Transcranial Magnetic Stimulation (TMS)

Overview

Transcranial Magnetic Stimulation (TMS) is an FDA-approved procedure that utilizes magnetic fields to stimulate nerve cells in the brain, offering relief for symptoms associated with major depression, obsessive-compulsive disorder (OCD), migraines, and aiding smoking cessation when traditional methods have proven ineffective. This noninvasive technique does not involve surgery or skin incisions, making it a preferred option after other treatments have been unsuccessful. TMS, also known as repetitive TMS or rTMS in depression, OCD, and smoking cessation, delivers repeated magnetic pulses to target specific brain regions. Ongoing research explores additional potential applications for TMS, such as in epilepsy management.

Types

TMS can be conducted through various methods, which primarily differ based on the strength of the magnet used or the techniques employed to administer the magnetic field.

• Magnet strength: The tesla (T) is the unit used to measure a magnet’s strength. The majority of TMS magnets produce magnetic fields between 1.5 and 2 T, which are comparable to those produced by MRI scanners. The TMS magnet is far smaller than an MRI magnet, hence the magnetic field’s area is much smaller.
• Pulse patterns: Different pulse patterns can potentially be used by TMS for therapeutic purposes. Theta-burst stimulation is one instance of this (TBS). Three 5 Hz bursts occur during TBS, for a total of fifteen pulses in a second. Treatment is accelerated by using these burst patterns, about five or six times faster than with other techniques.
• Pulse frequency: There is a pulse every time the magnetic field switches on and off. The frequency (measured in hertz, abbreviated Hz) is the number of pulses per second. TMS can use high-frequency pulses at 5 Hz to 10 Hz (5 pulses per second to 10 pulses per second) or low-frequency pulses at 1 Hz (1 pulse per second). Repetitive TMS (rTMS) is TMS that employs repeating pulses.
• Magnetic coil type and stimulation target: Different brain structures can be targeted by different types of magnetic coils. Using an H-shaped helmed coil, deep TMS (dTMS) targets deeper brain areas than rTMS and TBS. Studies indicate that dTMS is useful in the treatment of disorders including obsessive-compulsive disorder (OCD).

Reasons for undergoing the procedure

When other forms of treatment are ineffective, TMS is frequently a helpful option. Its noninvasiveness makes it an advantageous option as well. In cases where electroconvulsive therapy (ECT) is not an option or is ineffective, transcranial magnetic stimulation (TMS) can provide an alternative.

The conditions that TMS is fully authorized to treat may differ from country to country. Four conditions are approved for treatment with TMS:

• Obsessive-compulsive disorder (OCD).
• Migraines.
• Planning to stop smoking.
• Major depressive disorder (MDD)

Risk

TMS carries a relatively low risk of complications. Seizures are perhaps the most serious side effect of TMS. These are also incredibly uncommon. The most frequent side effects, which are typically minor and go away in a matter of minutes following a session, are as follows:

• Headache.
• Pain at the scalp or neck.
• Dizziness or lightheadedness.
• Tingling sensation in the muscle of the face or scalp.
• Temporary ringing in the ears or tinnitus.
• Increase sensitivity to sound.

Before the procedure

Before undergoing Transcranial Magnetic Stimulation (TMS), it’s crucial to be referred to a specialist with expertise in administering this treatment. The specialist will conduct an assessment to ensure you meet the criteria for TMS and to identify any contraindications.

Reasons for not undergoing TMS may include:

• Presence of electronic implants or magnetic metal implants such as cochlear implants or skull plates. TMS involves a powerful magnet that can interact with these implants, potentially causing pain or injury.
• History of seizures, epilepsy, or other neurological conditions. Although rare, TMS can trigger seizures, especially in individuals with predisposing conditions or those taking medications that lower the seizure threshold.

If deemed suitable and safe, the provider will discuss the recommended treatment schedule. TMS typically involves multiple sessions, usually three to five per week, spread over several weeks. For FDA-approved protocols for depression, a common regimen consists of daily treatments over six weeks, totaling 30 sessions. However, newer protocols may condense the treatment duration to as little as a week.

Due to variations in treatment protocols, it’s essential to consult with your provider for personalized guidance on the recommended course of sessions tailored to your specific needs and circumstances.

During the procedure

TMS, a noninvasive procedure, involves preparing by removing metal objects like glasses or jewelry for safety reasons. During the procedure, the patient is seated comfortably while wearing ear protection to mitigate the loud sound produced by the magnet. The magnet, housed in either a helmet or attached to an extension arm, is positioned on the patient’s head by the provider. Prior to commencing treatment, the provider conducts single-pulse stimulations to determine the optimal location and settings. Throughout the session, the strength of magnetic pulses is gradually increased, eliciting sensations like tapping and twitches in the patient’s hands. Treatment sessions vary in duration, ranging from a few minutes to half an hour, depending on the type and pattern of magnetic field pulses applied. The provider ensures the patient’s comfort and safety throughout the process, making adjustments as necessary.

After the procedure

After a treatment session, you can resume your daily activities or schedule as usual. Your healthcare provider may advise you to wait a few minutes before leaving if you have any persistent side effects, such as twitching or strange sensations in your head or face.

Following a therapy session, the majority of symptoms are low and subside quickly.

Outcome

TMS is a helpful treatment because of its numerous advantages.

• You don’t need to have surgery for this noninvasive procedure, and after a session is over, you can resume your normal activities. Additionally, no anesthesia of any type is used.
• It’s safe to use and the the most frequent and severe side effect of TMS is seizures, however they are very rare. With TMS, the chance of experiencing a seizure is less than 0.01% every session. The majority of other negative effects are minor and subside quickly.
• While TMS success rates differ depending on the disease, the evidence that is now available strongly supports its efficacy.
• Major depressive disorder, one of the primary conditions treated by TMS, has the potential to be so severe as to cause suicide. When TMS reduces or eliminates depression completely, it can literally save lives by improving symptoms of depression.
• TMS is frequently used alongside several therapeutic approaches, including prescription drugs, mental health counseling, and more.

As advised, you need to schedule visits with your healthcare provider. Attending all of the suggested sessions is essential for determining whether TMS is effective. Treatment effectiveness is decreased when sessions are missed. Additionally, you want to get in touch with your healthcare provider if you experience any mild, moderate, persistent, or non-resolving adverse effects even a few hours following a session.