First used in 1985, TMS has been used by researchers around the world to help understand the function of different parts of the brain. Several hundred manuscripts have been published regarding its use in stimulating select regions of the brain. Since the mid 1990s, TMS has been studied as an antidepressant therapy.

 

In 2006, the largest randomized, controlled study ever conducted with TMS Therapy was completed. This study was sponsored by Neuronetics and utilized the NeuroStar TMS Therapy system. FDA Approval in October 2008: Recently, the NeuroStar TMS Therapy system, was cleared by the U.S. Food and Drug Administration for the treatment of adult patients with major depressive disorder who have failed to receive satisfactory improvement from prior medication antidepressant treatment 4 attempts of which 1 was adequate in the current episode. TMS is also approved for other medical uses

What is TMS?

Transcranial magnetic stimulation or TMS, procedure used to treat major depressive disorder (MDD) or sometimes termed as "major depression". The technique involves use of an electromagnetic coil to create electromagnetic pulses in the brain which have an antidepressant effect. It is an FDA-approved treatment for major depression.

TMS works by stimulating neurons through electromagnetic pulses. The TMS machine delivers a brief magnetic field when positioned over the head, which passes through the skull. This field is sufficient to induce an electrical current in brain tissues. With TMS, it is possible to stimulate a small, targeted brain region. This is in contrast to electroconvulsive therapy (ECT), which induces a generalized seizure and requires anesthesia.

 

Who should get TMS?

Usually, TMS is considered after a person has tried one or more antidepressant medication trials and still has significant depressive symptoms. Significantly it offers hope to those patients who cannot tolerate antidepressant medications because of the side effects which can range from having troublesome side effects such as weight gain to others as in problems in sexual functioning.

Exclusions: Women who are pregnant and patients who have metal in the brain (such as a surgical cup) or a pacemaker are excluded from this treatment

 

How effective is TMS?

Studies have concluded that the current method for administering TMS is effective in about half of the patients who receive it. Research is now underway to evaluate alternative ways to administer a similar treatment in order to make it more effective. An alternative to TMS, Electro-convulsive therapy (ECT), or "electric shock treatments" is between 60% and 90% effective in the treatment of major depression. In addition to antidepressant medications, other modalities such as Psychotherapy or "talk therapy" and counseling also offers considerable hope either by itself or along with TMS/ECT/antidepressant medications.

Why TMS

  • No systemic side effects, such as weight gain, sexual dysfunction, sedation, nausea, or dry mouth.
  • No adverse effects on concentration or memory.
  • No seizures.
  • No device-drug interactions.
  • The most common adverse event related to treatment was scalp pain or discomfort at the treatment area during active treatments, which was transient and mild to moderate in severity. The incidence of this side effect declined markedly after the first week of treatment.
  • There was a less than 5% discontinuation rate due to adverse events.
  • During a 6-month follow-up period, there were no new safety observations compared to those seen during acute treatment

FAQs About TMS

     

How is TMS administered?

Duration: Each treatment lasts for approx. 40 minutes. The patient is awake and alert during the treatment; there is no anesthesia involved.

What to do during treatments: You can read or simply listen to some soothing music of your choice. In the first TMS session, the healthcare professional that is administering the treatment will find the motor threshold of the patient. The motor threshold is the minimum amount of brain stimulation that will cause the patient's finger to twitch involuntarily. This is done by placing the magnet on the top of the patient's head over the brain's motor strip in the area that affects the hand, and then stimulating, first at a low intensity, then higher until the finger twitch is seen. This threshold differs in each person, and can vary somewhat day to day. This is a one time experience for the patient. Each treatment is given at intensity relative to the motor threshold (for example, 110% of motor threshold) with usually adequate comfort in the remainder of the treatments.

 

How often are treatments given?

TMS is given in a series of treatments. Usually it is given five times per week on Monday through Friday for up to six weeks. TMS is an outpatient procedure, which means that no hospitalization is necessary, and patients receiving TMS can continue working throughout the treatment schedule. After a course of TMS treatments, the patient then takes medications to help prevent a relapse of depressive symptoms. Some patients have found maintenance TMS quite helpful.

How long are treatments given?

After the scheduled treatments for 4 to 6 weeks, decision to have TMS as maintenance treatment with or without antidepressant medications/therapy is made after re-evaluation by your TMS psychiatrist in close consultation with your clinician/psychiatrist. If you have been successfully treated with TMS we will advise to have your follow-up with your clinician/psychiatrist. TMS has also been recommended by some to be given as a maintenance treatment.

 

Should I stop my medications while having TMS treatment?

No, you should not stop medications prescribed for any medical problems. However if you have been prescribed any antidepressant medications or mood stabilizers, then discuss about it with your TMS treatment psychiatrist who will liaise with your psychiatrist/primary care provider.

 

Is TMS a safe treatment?

Transcranial magnetic stimulation can be given safely to adults of nearly all ages. The FDA oversees studies using TMS and defines the safe parameters for treatment.

 

What side effects can be expected from TMS?

Side effects reported from TMS are minimal. Some patients experience a brief headache and pain or tingling at the treatment site. If you experience these symptoms, it is recommended that you take acetaminophen (Tylenol) to relieve the pain. No adverse memory effects have yet been reported as a result of receiving TMS. The stimulator can emit a loud clicking sound when the treatment is administered, so patients may be asked to wear protective ear inserts.

Seven subjects worldwide have suffered a seizure while undergoing magnetic brain stimulation. All of those treatments were done at higher parameters than that which the FDA allows us to do in studies in the United States. Patients who are at high risk for having seizures are excluded from receiving treatment.

The long-term effects of TMS are unknown.

Insurance coverage.

Typically many insurance companies do not cover for medical treatments which involve TMS. This is the number one question that we receive from our clients.

NeuroStar TMS Therapy may be covered on a case-by-case basis. Patients can work with their provider and the NeuroStar Care Connection (NCC) program to seek case-by-case coverage. The NCC is staffed by trained case managers to help providers and patients with the reimbursement process. Neuronetics, the developer of the NeuroStar system, has developed this program to help patients secure coverage and reimbursement for NeuroStar TMS Therapy.

The NeuroStar Care Connection program is available to you as part of the cost of the system. This program is necessary because new therapies like NeuroStar TMS Therapy are often not included in health insurance plans when they first become available to patients. It usually takes time for health insurance plans to establish coverage policies for newly approved technologies such as NeuroStar TMS Therapy. The objective for NeuroStar Care Connection program staff is to assist you in gaining access to NeuroStar TMS Therapy as quickly as possible by assisting in securing coverage and reimbursement.

In the mean time, out-of-pocket payment for NeuroStar TMS Therapy is required. There are some programs that assist the patient to receive TMS therapy as soon as possible. NeuroStar TMS Therapy can be paid from healthcare flexible spending account.

Advantages of TMS.

  • No systemic side effects, such as weight gain, sexual dysfunction, sedation, nausea, or dry mouth.
  • No adverse effects on concentration or memory.
  • No seizures.
  • No device-drug interactions.
  • The most common adverse event related to treatment was scalp pain or discomfort at the treatment area during active treatments, which was transient and mild to moderate in severity. The incidence of this side effect declined markedly after the first week of treatment.
  • There was a less than 5% discontinuation rate due to adverse events.
  • During a 6-month follow-up period, there were no new safety observations compared to those seen during acute treatment



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