Understanding Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation or TMS is a type of brain stimulation therapy. The treatment involves using electromagnetic pulses to stimulate nerve cells, which will improve neurological or mental health symptoms.

TMS is primarily used to treat depression. Moreover, it can help people who haven’t responded to antidepressant medication and psychotherapy. Over the time, rTMS has shown effectiveness in Anxiety, OCD, Hallucinations, Addictions, ADHD. The first device to administer Transcranial magnetic stimulation was introduced in 1985 by a renowned medical researcher Dr. Anthony Barker & his colleagues. 

Understanding Transcranial Magnetic Stimulation (TMS)

What is Transcranial Magnetic Stimulation?

TMS is a minimally invasive procedure that doesn’t include surgery, IV line implantation, or any other bodily incisions. Furthermore, anesthesia or sedation is not necessary. To target the left frontal cortex of the brain precisely, TMS delivers brief, intense magnetic energy bursts using a tiny electromagnetic coil that is controlled by a computer programme. Magnetic resonance imaging (MRI) machines produce magnetic fields similar in strength and type to those produced by TMS.

Above the prefrontal cortex—the brain region that is the focus of treatment—a treatment coil is attached to the head. Mood control is mediated by this area of the brain. TMS magnetic fields only go into the brain to a depth of two to three centimeters just below the treatment coil; they do not directly impact the entire brain. TMS magnetic fields generate little electrical currents when they penetrate the brain. It is believed that the electrical currents cause the brain’s cells to produce neurotransmitters.

Additionally, Transcranial Magnetic Stimulation (TMS) and Repetitive Transcranial Magnetic Stimulation (rTMS) are related techniques that involve the use of magnetic fields to influence neural activity in the brain. However, they differ primarily in their application and purpose:

TMS (Transcranial Magnetic Stimulation):

• Nature: TMS is a non-invasive neurostimulation technique that uses a single magnetic pulse to induce an electrical current in a specific area of the brain.
• Application: It is often used for diagnostic and research purposes, as well as in certain therapeutic interventions. Single pulses are typically applied to stimulate or inhibit specific brain regions temporarily.
• Frequency: TMS can involve both single-pulse stimulation and repetitive sessions, depending on the intended application.

rTMS (Repetitive Transcranial Magnetic Stimulation):

• Nature: rTMS, on the other hand, involves the repetitive application of magnetic pulses over time, targeting specific brain areas.
• Application: rTMS is primarily used as a therapeutic tool. It has been studied and applied in the treatment of various neurological and psychiatric disorders, such as depression, anxiety, and certain movement disorders.
• Frequency: The term “repetitive” in rTMS indicates the repeated application of pulses, often delivered in trains or patterns. The frequency and intensity of stimulation can be adjusted based on the specific therapeutic goals.

In addition, there is one more kind of TMS which is known as deep TMS. We will know about deep TMS in the upcoming section. 

How Does TMS Work?

Think of your brain as a complex electrical circuit. When depression hits, it’s like a power outage in a part of this circuit. TMS gently kickstarts this area, like a caring neighbor who comes over with jumper cables to revive a stalled car.

TMS for Specific Conditions

TMS for OCD: It’s like giving your brain a new set of tools to fix a persistent, nagging glitch.

TMS for Anxiety: For those whose minds are constantly racing, TMS can be like a soothing melody that slows down the frantic tempo.

TMS for Depression: It’s a beacon of hope for those navigating the foggy waters of depression, guiding them back to shore.

The TMS Procedure: What to Expect

Duration: Each session is a brief escape, a moment of respite, lasting just about as long as a lunch break.

Frequency: It’s a daily rendezvous, a commitment to healing, five days a week.

Sensations: You’ll feel a rhythmic tapping, like the gentle beat of rain on a rooftop.

Cost and Insurance Coverage

Transcranial Magnetic Stimulation Cost: The price tag varies, but it’s an investment in reclaiming your life.

Insurance Coverage: It’s a conversation worth having with your insurer – many are now boarding the TMS train.

What is Deep TMS & and What are the applications? 

Deep TMS therapy, commonly known as dTMS, is a non-invasive mental health treatment based on the idea of deep brain stimulation, or turning on the neurons and chemicals in the brain that influence mental health symptoms. It is trademarked by the BrainsWay firm.

The BrainsWay machine uses deep Transcranial magnetic stimulation therapy in which the patient wears a helmet-shaped device that delivers tiny, imperceptible electromagnetic pulses to the brain regions associated with their symptoms. The patient is made to feel comfortable during the procedure. The physician keeps an eye on brain activity using a screen to ensure that the targeted brain areas are being activated. A deep TMS session typically lasts for twenty minutes.

Transcranial Magnetic Stimulation in Treating Mental Health Conditions

Transcranial Magnetic Stimulation (TMS) has emerged as a promising and effective treatment for depression, particularly for individuals who may not respond well to traditional antidepressant medications. Here’s an overview of the efficacy and process of TMS for depression:

Efficacy:

• Clinical Effectiveness:

• Transcranial magnetic stimulation has shown efficacy in treating major depressive disorder (MDD), as well as other forms of depression.
• Research indicates that TMS can be particularly beneficial for individuals who have not responded to standard antidepressant medications.

• Remission Rates:

• Studies have reported remission rates, indicating a significant reduction or elimination of depressive symptoms, in a substantial percentage of patients undergoing TMS therapy.

• Duration of Treatment Effects:

• The effects of TMS treatment can be sustained beyond the active treatment phase, providing a potential longer-term benefit for individuals with depression.

Process:

• Pre-Treatment Evaluation:

• Before initiating TMS treatment, a comprehensive evaluation is conducted to assess the individual’s mental health history, current symptoms, and overall health.

• Brain Mapping:

• Neuronavigation or brain mapping techniques may be employed to precisely identify the target area in the brain associated with depression. This helps tailor the treatment to the individual’s neuroanatomy.

• Treatment Sessions:

• Transcranial magnetic stimulation is typically administered in daily sessions over several weeks. The exact duration and frequency of sessions depend on the specific treatment protocol prescribed by the healthcare provider.

• Procedure:

• During a TMS session, an electromagnetic coil is placed on the scalp over the targeted brain region. The coil delivers magnetic pulses, which stimulate nerve cells in the identified area.

• Session Duration:

• Each TMS session usually lasts about 20 to 30 minutes or 3 to 5 minutes in advanced theta burst mode. The individual can resume normal activities immediately after the session.

It’s crucial for individuals considering Transcranial magnetic stimulation for depression to consult with a qualified healthcare professional who can assess their specific situation and determine the most appropriate treatment approach.

Furthermore, If you suffer from OCD, you probably already know all too well the negative impact this illness can have on your life.  Transcranial magnetic stimulation (TMS) treatment may be the key to delivering you from this potentially crippling mental illness if OCD is having a major negative influence on your life or the lives of your child. 

In addition to reducing symptoms and improving quality of life, anxiety disorders remain among the most treatable mental health conditions. Regretfully, conventional methods of treatment do not always work for people with anxiety disorders. Transcranial magnetic stimulation, or TMS, is one additional unconventional therapy that might work for some. So, can anxiety be helped by TMS therapy?

We know that TMS therapy is highly effective in treating depression, but do the same benefits apply to those with anxiety? The answer is yes, it does. 

However, The standard treatment for anxiety disorders is not TMS therapy. It does not, however, imply that it is ineffectual. Numerous people still receive frequent assistance from TMS therapy in managing their anxiety problems.

Transcranial Magnetic Stimulation for Neurological Conditions

In recent times, migraine incidence has been growing continually, making it one of the most prevalent nervous system disorders globally. TMS is used in neurophysiology to assess neural conduction and to either stimulate or suppress the cerebral cortex’s electrical activity. 

The FDA has approved the Cerena Transcranial Magnetic Stimulator (TMS) from eNeura Therapeutics for commercial usage. This is the first device designed to treat migraine headaches that are preceded by an aura, which is a visual, sensory, or motor disturbance that occurs just before a migraine attack. Prescription devices like the Cerena TMS are used once migraine headache pain starts, usually after an aura. The user clicks a button to activate the occipital cortex in the brain, which may stop or diminish the discomfort associated with migraine headaches preceded by an aura. They hold the device against the back of the head with both hands.

During the past decade, transcranial magnetic stimulation (TMS) has become increasingly popular in neuroscience research, as demonstrated by the staggering increase in PubMed papers that result from searching for TMS: from 67 papers in 1990 to 1,488 in 2000 to 8,699 in 2012. Furthermore, there has been a correspondingly significant rise in the use of TMS for both therapeutic and diagnostic purposes. The FDA has approved the use of the NeuroStar TMS Therapy system (Neuronetics, Malvern, PA) and, more recently, the Brainsway Deep TMS system (Jerusalem, Israel) for the treatment of depression that is not responding to medicine. 

Technical Aspects of Transcranial Magnetic Stimulation

TMS Therapy has been approved by the FDA for treating Major Depression and other conditions. The following is a comparison of FDA-approved TMS devices.

• Brainsway

Brainsway is a company that develops devices to do deep Transcranial Magnetic Stimulation (Brainsway Deep TMS). These are approved by the FDA to treat OCD, smoking cessation, and treatment-resistant depression.

• MagVenture

MagVenture is a reputed Danish company that specializes in the creation of Transcranial Magnetic Stimulation TMS treatment systems. TMS is a non-invasive brain-stimulating procedure that stimulates brain nerve cells by applying magnetic fields. 

• NeuroSoft

1. The FDA has approved the use of Transcranial Magnetic Stimulation (TMS) for the treatment of Major Depressive Disorder in 37.5 and 19-minute treatments using the CloudTMS system, manufactured by Russia-based NeuroSoft. 

• NexStim

The “SmartFocus” brain mapping technology is produced by the Finnish business Nexstim. An FDA-approved version of this system, which was initially created to assist neurosurgeons in planning brain surgeries, is currently being used to treat depression.

• Soterix Medical

Transcranial magnetic stimulation (TMS) and neuronavigation are combined in a device made by Soterix Medical, which eliminates the need for line-of-sight techniques to deliver targeted brain stimulation. 

• Mag & More Apollo TMS

MAG & More is a German company that develops and produces the Apollo TMS therapy system. It is approved by the FDA for 37.5- and 19-minute treatments of major depressive disorder and is based on the HANS positioning system and touch-based Patient Management System.

• MagStim

The medical engineers at MagStim are some of the top innovators in the TMS industry. StimGuide, a system created by Magstim in the UK, is FDA-cleared for the treatment of depression.

In order to control the unease associated with migraine with aura, a prototype transcranial magnetic stimulation (TMS) device was created and built for use in clinical studies. This system delivers a half-sinusoid (or full-sine) TMS pulse into a circular coil. A switch located in the coil handle regulates the pulse triggering. The polarity and intensity of the pulse can be changed. The pulse parameters, which were measured and included a period of around 202 μs and a maximum magnetic field of approximately 0.7 T at the coil center, were within the predicted range for TMS hardware that is commercially available.

The highest current density was around 1.9 times the motor threshold, which ensured a significant margin for reaching the neuronal threshold in the target location. The maximum current density was determined using a basic model of brain anatomy, 3 cm below the coil.

 Practical Information about Transcranial Magnetic Stimulation

TMS has emerged as a highly effective treatment option for conditions such as depression that are resistant to other forms of therapy. However, many people may find the expense of a TMS session to be a barrier. A full course of treatment may involve multiple TMS sessions, with an average session costing between $300 and $500. Insurance coverage for TMS therapy is crucial because of how quickly these costs may add up. 

Is TMS covered by Medicare? 

 YES! Owing to the high patient success rates of TMS, Medicare has begun to pay for these treatments. The patient needs a Medicare-approved physician to diagnose them with severe major depressive disorder for them to be eligible for coverage. Medicare may cover 80% of the cost of treatment if all conditions are satisfied.

 To ensure that TMS therapy is covered by Medicare, make sure the doctor you choose is approved to administer the treatment. 

How to find the best TMS provider?

Let us walk you through the important things to think about while selecting a provider who satisfies these essential TMS treatment requirements.

• Eligibility & Qualification

When choosing a TMS supplier, qualifications have to be your priority. First, find out if the doctors have board certification in neurology or psychiatry. 

• Tools & Equipment

The field of TMS technology is dynamic and always evolving. Therefore, the equipment utilized has a big influence on how well your treatment works. In general, more recent devices are made with precision in mind, trying to more precisely target particular brain regions. This degree of precision frequently results in fewer adverse effects and more successful treatments.

• Treatment Customisation

A good practitioner will explain everything in advance of treatments. They ought to start by taking a close look at your medical history. Your evaluation should address any other health concerns you may have, as these might occasionally impact your treatment, in addition to your history of depression. 

• Accessibility and Location

Choosing a Transcranial Magnetic Stimulation provider requires careful consideration of accessibility issues. Since TMS treatment usually necessitates multiple visits, the hospital should be conveniently located for you to go to. Consider the amount of time it will take you to go to and from the facility if it is conveniently close to public transit, and the availability of parking choices.

• Reputation and Reviews

Last, but not least, it is crucial to consider the reputation of the provider. Word-of-mouth recommendations, internet evaluations, and testimonials can provide insightful information about patient satisfaction. You can get a more comprehensive picture of patient experiences by consulting sites such as social media or health forums rather than just the provider’s website.

Benefits and Limitations of Transcranial Magnetic Stimulation

It is highly advisable to speak with licensed healthcare providers who can evaluate their individual needs, medical history, and condition before contemplating TMS as a therapeutic option. Clinical judgments about the application of TMS ought to be grounded in a comprehensive assessment of each patient’s case as well as the most recent scientific data.

Here are some potential benefits of TMS for specific conditions, along with brief mentions of patient testimonials:

1. Major Depressive Disorder (MDD):

• Benefits: Reduction in depressive symptoms, improved mood.
• Patient Testimonials: Some individuals report significant improvements in mood, increased energy levels, and a better overall quality of life after undergoing TMS for depression.

1. Obsessive-Compulsive Disorder (OCD):

• Benefits: Reduction in obsessive-compulsive symptoms.
• Patient Testimonials: While research is ongoing, some patients undergoing TMS for OCD have reported decreased severity of obsessions and compulsions.

1. Migraine:

• Benefits: Reduction in the frequency and intensity of migraines.
• Patient Testimonials: Some individuals have reported a decrease in the frequency and severity of migraines after receiving TMS treatment.

1. Auditory Hallucinations in Schizophrenia:

• Benefits: Potential reduction in auditory hallucinations.
• Patient Testimonials: Testimonials regarding TMS for schizophrenia are less common, but some patients have reported improvements in their experience of auditory hallucinations.

Why TMS is Contraindicated for Cerebral Lesions?

Individuals must consider TMS undergo a thorough evaluation by qualified healthcare professionals. This evaluation helps determine the suitability of TMS based on the individual’s medical history, current health status, and the specific condition being treated. The decision to use TMS should always be made in consideration of the potential benefits and risks for each case.

 The Future of Transcranial Magnetic Stimulation

Driven by continuous research and improvements in neuroscience and technology, Transcranial Magnetic Stimulation (TMS) has tremendous promises for the future. Here are a few possible paths that TMS might take in the future:

• Precision Targeting:

Potential directions for further research could include improving TMS targeting accuracy. In order to precisely detect and activate particular brain regions, this may include enhanced navigation systems and neuroimaging techniques, enabling more individualised and successful therapies.

• Combined Therapies:

Researchers are looking into how TMS might work in conjunction with medication or psychotherapy, among other therapeutic techniques. When combined with other interventions, TMS has the potential to produce positive synergistic effects and better results, particularly in disorders like anxiety and depression.

• Home-based TMS devices

More compact and user-friendly TMS devices could be developed as a result of ongoing technological improvements and downsizing. 

Bottom Line

Transcranial Magnetic Stimulation (TMS) therapy holds a special place in the realm of mental health treatments today, offering people with a variety of mental conditions hope and healing. The science behind TMS empowers individuals seeking effective solutions for their well-being at Oasis Therapeutics.

It is a testament to the ever-evolving landscape of mental health care that TMS emerged from the science behind it. We are unraveling the intricate connection between brain function and emotional well-being, and TMS stands as a beacon of hope for those suffering from mental illness.

FAQs on Transcranial Magnetic Stimulation

Who invented Transcranial Magnetic Stimulation?

It was the brainchild of Anthony Barker and his team – true pioneers in brain health.

Does Transcranial Magnetic Stimulation work for everyone?

Like any treatment, it’s not a one-size-fits-all. It’s a journey of discovery, finding what works for each unique mind.

Where can I get Transcranial Magnetic Stimulation?

It’s spreading its wings across clinics and hospitals – a beacon of modern mental health treatment.

Why is TMS contraindicated for cerebral lesions?

It’s about safety – the magnetic fields and lesions could clash like two strong-willed dance partners, leading to complications.