TMS is a focal brain stimulation treatment that passes small electromagnetic currents through parts of the brain. Different regions of the brain can be targeted by holding a specially designed coil near the patient’s scalp. Energy is then applied which stimulates nerve cells in that particular brain region.
TMS therapy doesn’t use a drug; it directly stimulates relevant areas of the brain. As a result, there are no foreign compounds introduced to the body in TMS, and it does not have the side effects typically associated with drug therapy.
TMS therapy usually involves several repetitive sessions; this is referred to as repetitive Transcranial Magnetic Stimulation (rTMS)
rTMS has been established since 1985 as an effective alternative to some antidepressants. It has been increasingly used to treat depression, obsessive-compulsive disorders (OCD), some symptoms of psychoses (auditory hallucinations) and PTSD, among other conditions.
Research also suggests that targeting the stimulation more precisely within the area of the dorsal prefrontal cortex can improve symptoms of depression. This region of the brain is responsible for “executive functions”, such as selecting appropriate memories and inhibiting inappropriate responses.
Other psychiatric symptoms, such as OCD, require specific modification to the stimulation regions. To this end, Modalis follows well researched and published protocols.
If you suffer from depression and have not seen significant improvement from traditional antidepressant medications like SSRIs, SNRIs, TCAs, and MAOIs, our TMS therapy may be an excellent solution for you.
rTMS is effective via several complex pathways. One mechanism, in particular, appears to involve opioids, which are the body’s natural pain-relieving chemicals. When rTMS stimulates the brain area involved in pain, there is a significant release of opioids. In conjunction with several other brain chemical systems, this provides substantial pain relief beyond the time of stimulation.
To manage pain, an area of the brain called the primary motor cortex (M1) is typically targeted. A range of other, different regions of the brain could be stimulated for other forms of pain such as neuropathic pain, fibromyalgia, and migraines. rTMS can also be used to treat tinnitus (ringing in the ears).
rTMS is a well-tolerated treatment. It has been used to treat thousands of people, and only a small percentage discontinue treatment because of its side effects:
Headache: this is the most common side effect and occurs in about half of patients treated with rTMS. These headaches are usually minor and generally resolve throughout the treatment. Simple over the counter pain medication (e.g. paracetamol) is typically enough to address these headaches, but they are often self-resolving.
Scalp discomfort: this is usually minor and occurs in about a third of patients. This happens where the coil is placed over the scalp and often resolves by the third treatment.
Adjustments can be made to the coil position and stimulation settings to reduce discomfort.
Seizures: This is an infrequent side effect and typically occurs in people at an independent risk of seizures. These seizures tend to be short and self-limiting. Patients are screened before treatment to ensure they do not fall into this at-risk category. Importantly, the chance of having a seizure during an rTMS treatment is lower than that while taking an antidepressant or analgesic drug.
It is important to note that all patients are monitored during each treatment session by specially trained medical and nursing staff. Any side effects will be managed and are
reversible once the rTMS treatment stops. As rTMS is a relatively new treatment, there may be unforeseeable risks that are not currently recognized
A medical practitioner who has expertise in rTMS treatment will complete a thorough assessment before treatment to ensure its safety and suitability for the patient. In general, patients who have a history of epileptic seizures or those who have metal in their heads should not receive rTMS. Below is a list of examples, which is not exhaustive:
- Metal stents in the neck or brain
- Deep brain stimulators
- Aneurysm clips or coils
- Metallic implants in your head, ears, eyes or neck
- Facial tattoos with metallic ink
- Other metal objects around your head
TMS treatment is generally safe for patients with non-epileptic seizures.
Positive treatment responses to rTMS vary between patients. A bettering of symptoms is just one measure of success. Others include improvements in productivity, increased psychological and emotional wellbeing, improvement in sleep and in quality of life, and a reduction in the need for pharmacological treatment.
The duration of benefits can also vary between patients and conditions. For example:
- In chronic pain, benefits can last up to 2 months, but usually require “top-up” sessions to maintain the improvement. How often a patient receives a top-up session can also vary. Patients can expect to receive one treatment every month to consider rTMS a worthwhile treatment.
For depression and other psychiatric conditions, the response rates and remissions also vary from patient to patient. TMS treatment should be a part of broader clinical interventions and should not be seen in isolation to other forms of treatment, including counselling and practical support.