What is TMS?

TMS or transcranial magnetic stimulation is a type of neuromodulation. Sometimes you will see “r” before the TMS which stands for “repetitive.” The stimuli are given in a train of impulses.TMS may be confused with transcranial direct current stimulation which involves the placement of electrodes typically over the forehead. This is a type of neuromodulation involves a very small direct current stimulation rather than a magnet. The use of a magnet allows greater power to be distributed in a deeper portion of the brain which would not be feasible using direct electric stimulation due to the pain and tissue destruction.


The modality began with Dr. AnthonyParker, a British scientist, who began using the technology on humans in 1985. Since that time the technology rapidly developed and was ultimately cleared for use by the FDA.

 

Understand this is not an online purchased “fix everything machine.” The effect of this modern medical technology is real and quite powerful. Stimulation of the scalp can cause immediate contraction of essentially any muscle in your body.  If an area is stimulated long enough, the region stimulated will fail temporary causing a transitory neurologic deficit. Not a toy this one!


Currently, the FDA has approved the use of transcranial magnetic stimulation for drug-resistant major depression disorder (MDD) and obsessive-compulsive disorder (OCD). The treatments are often provided in the psychiatrist office but many neurologists are stepping up to the plate. 

 

A dramatic example of a success story using TMS was recorded in a popular book called Switched On: A memoir of brain change and emotional awakening. The story describes the wonderful experience of John Elder Robinson who was diagnosed with autism and treated by Dr. Alvaro Pasqual-Leone of Harvard. Great book, heartily recommended. There will be more to come.

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The procedure itself is painless and rarely associated with side effects. Occasionally clients may complain of a mild headache, lightheadedness, tingling, facial muscle twitching and irritation of scalp at site of stimulation. The mechanism of action is related to increasing neuroplasticity by inducing electric currents in the brain.


The treatment process can be supplemented with medication such as conventional antidepressants or intravenous ketamine or intranasal esketamine. Cognitive-behavioral therapy is also valuable in this context. Often the treatment will be repeated five days a week for several weeks. Newer your protocols allow more than one treatment per day and are often associated with rapid response. The patient is placed in a comfortable chair with a headrest and the coil is placed over the appropriate scalp location. A rapid sequence of popping sounds begins which can be somewhat annoying. Earplugs provided!

The treatments may last up to 30 minutes but protocols are rapidly changing and typically getting shorter. The patient will be able to resume usual activities including driving almost immediately.


Your decision to participate in a TMS program is a major commitment. Usually, the procedure will be paid by the insurance provider. As described above, the treatment can be combined with other modalities. When embarking on a program of this nature it is often advisable to make certain lifestyle changes that will give the treatment the best possibility of success. Adhering to an intelligent diet, exercising, maintenance of healthy sleeping hygiene and participating in gratifying social activities are all important for brain health. Make changes. Einstein helps us here. "Problems cannot be solved by the same level of thinking that created them." 


While most TMS therapy is related to depression and obsessive-compulsive disorder, the procedure is often used in an off label context. Providers are using the therapy for post-traumatic stress disorder (PTSD), various types of pain including headache, phantom limb disorder, anxiety, autism, and attention deficit disorder just to name a few. The implications of this therapy on plasticity, learning and maintaining a healthy brain tumor out the lifespan are enormous.

If you are interested in pursuing transcranial magnetic stimulation you might have to do your own research. Most physicians are not familiar with this type of therapy.

Getting help means you’re getting serious.

 

David B. Sudderth, MD

Adult Neurologist

Author
Dr. David Sudderth

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