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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. TMS is typically used when other depression treatments have not been effective, or when the patient cannot tolerate the side effects of medication. It is approved as an effective treatment of depression 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 also effective in the treatment of anxiety and OCD as well as in patients who experience auditory hallucinations. There is good evidence that it has potential benefits in the treatment of autistic disorders.

Other medical uses for TMS include the treatment of tinnitus and complex pain syndrome.

How it works

During a TMS session, an electromagnetic coil is placed on your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It aims at restoring normal brain function.

TMS 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. There are also no cognitive side effects or memory loss in TMS, which are common in patients who undergo ECT. In fact there is evidence that TMS might improve cognitive function. TMS has been available overseas for over twenty years with great advances over the past ten.

What happens during an rTMS procedure?

For each rTMS session, the patient sits in a comfortable reclining chair and is made to feel relaxed. Patients might wear earplugs during treatment for their comfort and hearing protection, as rTMS produces a clicking sound with each pulse, much like an MRI machine. 

During the first rTMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS physician then measures the patient’s resting motor threshold, by administering several brief, totally painless pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch even if ever so slightly, and varies from individual to individual. Measuring the motor threshold helps the physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.

Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced.  During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.

Who administers rTMS?

rTMS is always prescribed by a psychiatrist. Resting Motor Threshold (RMT) is determined by the psychiatrist. The treatment itself is administered by an experienced TMS technician under the supervision of the psychiatrist or by the psychiatrist. The rTMS technician or psychiatrist will be present to monitor the patient during the treatment. The patient can stop treatment at any time by asking the staff member present. There is no need for sedation.

What are the side-effects of rTMS?

rTMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about half of patients treated with rTMS, is headaches. These are mild and generally diminish over the course of the treatment.  Over-the-counter pain medication like paracetamol can be used to treat these headaches. On even rarer occasions some patients may still complain of hearing problems immediately following treatment. The evidence indicates these effects are very short-lived and resolve completely.

rTMS does not cause the side-effects caused by antidepressant medications, such as weight gain, gastrointestinal upset, dry mouth, sexual dysfunction, or sedation. The most serious risk of rTMS is seizures. However, the risk of a seizure is exceedingly low. We follow up-to-date safety guidelines that are designed to minimize the risk of seizures and no seizures have been reported when treatment protocol is followed.

Who cannot get rTMS therapy?

Patients with any type of non-removable metal in their heads (with the exception of 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, which is safe).

What Will TMS Treatment Cost Me?

TMS is relatively cheap in comparison with other equivalent medical procedures. For example, while a minor surgical procedure of 30 minutes or less might cost up to NZ$4,000.00 or more, the full course of rTMS for depression will cost between $5,900.00 for 20 sessions of about 30 minutes each over a period of four weeks (or NZ$8,850.00 for a six weeks treatment). Furthermore, it will not cause the side-effects commonly experienced with medications, or long-term effects like weight gain. In some cases, it might save the costs associated with the use of long-term medications. TMS will not impact in your ability to drive, or to go back to work straight after each session. The treatment consists of a daily session every day, except for the weekends.

The first consultation where your diagnosis and treatment is evaluated to determine if TMS is appropriate costs $475.00. As we expect you to have 20 treatment sessions over four weeks (occasionally another 10 sessions might be required if recovery is significant but not complete).

All payments can be made in a progressive way, typically a week at a time. If you should stop treatment before the end of your treatment course, any payments for sessions not completed will be reimbursed to you.

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 costs of ongoing medication costs. Therefore, the long-term cost of TMS might be substantially cheaper then long-term treatment with medication by reducing doctors visits and medication costs, the costs involved with the treatment of the potential long-term negative effects of medication on the patients' health

The types of payment we accept include MasterCard, Visa (a 3% surcharge on credit cards apply), Eftpost and Cash. Unfortunately, unlike Australia, North and South America, Europe and Israel, the health insurers in New Zealand do not cover the costs of TMS yet.

How can I get TMS treatment?

TMS is one of the treatments for depression offered at our clinic. Before scheduling you for treatment, you will be evaluated by our psychiatrist to determine if TMS would be safe and appropriate for you. Alternatively, if you already see a psychiatrist, you can ask him or her to refer you directly, in which case treatment can be scheduled quicker.

 

Phone (09) 486 0182 to make an appointment