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Transcranial Magnetic Stimulation (TMS)

What is TMS?

Transcranial magnetic stimulation (TMS) is a non invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression and other psychiatric and neurological disorders. It is a technique for gently stimulating the brain. It utilizes a specialized electromagnet placed on the patient’s scalp that generates short magnetic pulses, roughly the strength of an MRI scanner’s magnetic field but much more focused. The magnetic pulses pass easily through the skull just like the MRI scanner fields do, but because they are short pulses and not a static field, they can stimulate the underlying cerebral cortex (brain). Low frequency (once per second) TMS has been shown to induce reductions in brain activation while stimulation at higher frequencies (> 5 pulses per second) has been shown to increase brain activation. It has also been shown that these changes can last for periods of time after stimulation is stopped. TMS was first developed in 1985, and has been studied significantly since 1995.

TMS is typically used when other depression treatments have not been effective, when the patient cannot tolerate the side effects of medication, or simply choose to have an effective treatment without the risks of medication. It is approved as an effective treatment for depression and OCD by the Food and Drug Administration (FDA) in the U.S. and our equipment is approved by the FDA and Medsafe here in New Zealand. It is widely used in Australia, the US and Europe. We are the only providers of TMS in New Zealand.

It is an effective the treatment of anxiety as well as in patients who experience auditory hallucinations. There is good evidence that it has potential benefits in the treatment of autistic disorders and we had success in treating patients with this disorder. Other medical uses for TMS include the treatment of tinnitus and complex pain syndrome.

TMS improves neurological functioning by stimulating activity in underactive regions of the brain that are contributing to a particular brain condition. It is different from other brain-stimulation therapies, like electroconvulsive therapy. It is a nonconvulsive procedure; patients don’t have a seizure, and they are awake and alert the entire time.

How it works

1. Before having rTMS, you may need a:

•  Psychiatric evaluation to discuss your depression

These evaluations help make sure that rTMS is safe and a good option for you. You will attend an initial assessment to determine whether TMS is the recommended treatment for you. You will have the opportunity to clarify your questions in this initial interview.

Before considering treatment, check with your health insurance company to see whether rTMS is covered. Your policy may not cover it.

2. What you can expect

Repetitive TMS is usually done in a doctor's office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks. TMS isn't invasive, doesn't require anesthesia and can be performed on an outpatient basis. You don't need to arrange for someone to drive you home after treatment — unless, for the first treatment, you prefer a driver until you get a sense of how you'll feel afterward.

3. Your first treatment

Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes.

Most likely, during your first appointment:

•  You'll be taken to a treatment room,asked to sit in a reclining chair and given earplugs to wear during the procedure.

•   An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a tapping sensation on your forehead. This part of the process is called mapping.

Your doctor will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.

During each treatment

Once the coil placement and dose are identified, you're ready to begin. Here's what to expect during each treatment:

•  You'll sit in a comfortable chair,wearing ear plugs, with the magnetic coil placed against your head.

•  When the machine is turned on,you'll hear clicking sounds and feel tapping on your forehead.

The procedure will last between 15 and 45 minutes,and you'll remain awake and alert. You may feel some scalp discomfort during the treatment and for a short time afterward.

After each treatment

You can return to your normal daily activities after your treatment. Typically, between treatments, you can expect to work and drive.

WHAT DOES IT FEEL LIKE TO RECEIVE TMS?

Generally TMS produces a slight knocking or tapping sensation on the head. This is also associated with a tapping sound produced by the TMS device. When administered at some stimulation sites it can cause contraction of the muscles of the scalp and occasionally the jaw. Mild headache and transient lightheadedness may sometimes result from TMS. These symptoms usually resolve by themselves shortly after the treatment is over.

Approved and promising uses for TMS

In the U.S., TMS is FDA approved to treat major depressive disorder in adults. In many European countries it is approved for a multitude of other common brain conditions including:

  • Anxiety
  • Post-Traumatic Stress Disorder
  • Stroke after-effects
  • Bipolar depression
  • Schizophrenia
  • Parkinson’s Disease
  • Alzheimer’s Disease
  • Chronic pain
  • Nicotine addiction

TMS has even shown promise in treating more conditions such as, tinnitus, fibromyalgia, Tourette syndrome, autism spectrum disorder, multiple sclerosis and more. Currently in the U.S. TMS is being used off-label to treat many more conditions than it is FDA approved for and the studies are showing promising results.

Who cannot get rTMS therapy?

Patients with any type of non-removable metal in their heads (with the exception of titanium, braces or dental fillings), or within twelve inches of the coil should not receive rTMS. Failure to follow this rule could cause the object to heat up, move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving rTMS:

  • Aneurysm clips or coils

  • Stents in the neck or brain

  • Implanted stimulators

  • Cardiac pacemakers or implantable cardioverter defibrillator (ICD) - not an absolute contraindication

  • Electrodes to monitor brain activity

  • Metallic implants in your ears and fragments in your eyes (eg.welders)

  • Shrapnel or bullet fragments in or near the head

  • Facial tattoos with metallic or magnetic-sensitive ink in your head

  • Other metal devices or object implanted in or near the head (except for titanium, crowns and fillings, which are safe).

What Will TMS Treatment Cost Me?

Costs vary with the type of treatment and protocol for your specific diagnosis and needs. The first consultation where your diagnosis and treatment is evaluated to determine if TMS is appropriate costs $475.00. The weekly cost (five sessions) varies between $1,200.00 to $1,475.00. The number of sessions needed vary between 10 (two weeks) and 30 (six weeks), depending on the specific protocol for your condition.

A successful treatment will reduce the number of follow up visits to a specialist, improve the quality of your life, reduce time off work, avoid long term side effects of medication like weight gain and of ongoing medication costs. Therefore, the long-term cost of TMS might be cheaper then long-term treatment with medication by reducing doctors visits and the costs involved with the potential long-term negative effects of medication on the your health.

Phone (09) 486 0182 to make an appointment