Repetitive Transcranial Magnetic Stimulation rTMS

RTMS is a non-invasive procedure that eases symptoms of aggressive mental health disorders. This electromagnetic treatment is becoming a popular treatment.

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Article Contents

What is TMS?

According to the Mayo Clinic, “Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” 1 This procedure has a few different parts to it. Normally, it is seen as one of the last options a doctor might use after multiple antidepressants or other treatment methods have failed to produce results. 

EEG Evaluation

An electroencephalogram, otherwise known as an EEG, is an evaluative test used to find issues that are related to electrical activity in the brain. 2 It is normally the first step once TMS is decided to be the best treatment option. The EEG will track and record the different brain wave patterns by using metal discs and electrodes that are placed on the scalp.

Doctors will look for abnormal patterns that might show seizures, less brain activity in a specific area, or overstimulation. The EEG will help the doctor to see where the brain is having issues and what areas that they need to specifically target. Once an EEG evaluation is done, the doctor will set up the first TMS appointment. 2  

Magnetic Pulses

During the TMS sessions, patients will have an electromagnetic coil placed against their scalp targeted towards the abnormal area. The doctor will then send magnetic pulses towards the area to stimulate it. The goal of this is for the patient’s mood to improve or their symptoms to lessen. These pulses are completely painless, and it is not something that a patient should worry about. It is no more powerful than an MRI machine. 

rTMS

Repetitive transcranial magnetic stimulation is a form of TMS that uses “magnetic pulses to target specific areas of the brain.” 3 During these rTMS sessions, doctors will send magnetic pulses to the brain to stimulate it. It is an FDA-approved treatment for severe depression once other treatment options have not worked. One important thing though to know is the difference between TMS and rTMS. 

Difference between TMS and rTMS

There are a few different kinds of TMS. Many times, rTMS and TMS will be used interchangeably because of the repetitive nature of the therapy. The main differences are standard rTMS and deep TMS. The goal of rTMS is to regulate specific brain structure’s activity through repeated pulses, while deep TMS does the same thing, but it attempts to stimulate deeper, reducing more adverse symptoms of specific mental health conditions. 4   

Range of Activity

RTMS can only go to a depth of .7 cm using a figure-8 coil. However, deep TMS can reach 3.2 cm using an H-coil. Deep TMS uses a wider field of stimulation than rTMS. RTMS tends to send pulses towards a specific spot within the brain, while TMS focuses on broader stimulation. 

Level of Treatment Efficacy

A 2019 study showed that deep TMS had a higher treatment efficacy than rTMS when used alongside medication. RTMS is still a very effective procedure, but we are still learning more about deep TMS. Both options are very effective. RTMS seems to be more available than deep TMS due to the power of the magnetic pulses and the patented rights of the equipment. 

FDA Clearance Status

RTMS has received FDA clearance to treat severe cases of depression and migraines. Deep TMS recently received clearance to treat OCD. It is also being used in Europe for a variety of different conditions. 

What to Expect in TMS therapy?

When going in for your appointment, you can expect to go through a few different tests to make sure that TMS therapy is the best option for you. The first appointment will be filled with testing that might involve the TMS process. It is normal for doctors to see where your thresholds are to make sure that they do not exceed them during the process. You can expect some minor side effects, but overall, it should be a painless procedure. 5  

How Long Is the Therapy?

TMS therapy normally lasts anywhere between twenty to fifty minutes five days a week for four to six weeks. It can be a time-consuming process since you have to make a daily commitment to it, but it is well worth it once the treatment has been completed. The repetitive nature of rTMS helps to activate different parts of the brain that maybe became less active due to specific mental health conditions. 

How to Prepare for TMS?

There are several things you can do before an appointment to make sure that you are prepared for TMS therapy. For one, make sure there is no metal within your body or on your body when seeking treatment, which can cause major damage. Talk to your doctor thoroughly about any medications that you are taking or the side effects you may be facing. 6  

Physical Exam
The doctor might perform a physical exam before treatment to ensure everything will be safe and effective. When going through the physical exam, make sure to be completely honest and provide as much information as possible, so your healthcare physician can make an informed decision about your treatment plan.

Psychiatric Evaluation
They might also do a psychiatric evaluation to make sure that you can mentally handle the treatment. It can also be a great time for them to check for other mental health disorders that you might be struggling with, so they can attempt to treat those, too.

Who Administers TMS?
Finally, a technician certified in TMS therapy, or your physician will administer the treatment. They will monitor you closely during the procedure to make sure that everything is going okay, and you are not being overstimulated. 6  

Who Cannot Receive TMS Therapy?

Normally, people are disqualified from TMS therapy when they have a non-removable piece of metal within their head or sometimes this body. This fact is because the magnetic pulse can cause the object to move or malfunction, which might lead to a serious injury or death. You must give full disclosure of anything that might cause issues during the process, so your doctor can keep you safe during the treatment.

Metal Implants or Plates

People that have metal implants or plates in or near their head cannot participate in TMS therapy, since it could move or malfunction, leading to serious injury or death. There are several reasons why a metal implant might be placed in, but they cannot be removed, which disqualifies the person from TMS treatment. 

Patients with Known Risk of Seizure

In rare instances, TMS can trigger seizures within a person. If someone has a higher risk of seizures, it is best that they do not participate in TMS therapy. If the brain is overstimulated, the patient might have a life-altering or fatal seizure. If you have struggled with seizures in the past or are diagnosed with epilepsy, please make sure to let your healthcare physician know. 

Tattoo with Magnetic-sensitive Ink

Tattoos with metallic ink or magnetic-sensitive ink can also cause a lot of damage during TMS. Normally, this treatment causes the ink to heat up, which could cause a lot of damage. Sometimes, it is difficult to know what kind of ink was used for your tattoo. If you have any questions, make sure to reach out to the tattoo artist to find out more specifics. This issue mainly relates to facial tattoos. 

Stents in Neck or Brain

Stents are used to open up pathways for blood to flow better. During TMS, the stent could cut the artery or shift positions, leading to fatal outcomes. You must disclose this information to your healthcare provider before treatment. 

Aneurysm Clips

Whenever someone has a growing aneurysm, a doctor might put in a clip to stop blood from flowing into it. The magnetic pulses could cause the clip to shift, either leading to the aneurysm exploding or growing once again, which could be fatal or lead to serious injury. 

Shrapnel or Bullet Fragments Near Head

Finally, if a person has any shrapnel or bullet fragments near their head, the strong magnet can cause them to move through the body, causing a lot of destruction as it rips through. If you have ever been shot or hit with shrapnel, make sure to discuss it with your doctor before exploring TMS therapy. 

Benefits of rTMS Therapy

This electromagnetic treatment plan has helped several people by easing symptoms of mental health disorders and other neuro disorders they were struggling with. Although rTMS is used as a last resort option, it can help people with the most aggressive forms of different mental health disorders. Here are a few of the benefits. 

Structural

One of the best things about repetitive transcranial magnetic stimulation is that it is tailor-made to fit the person receiving the treatment. The doctor will see what parts of the brain need treatment and to what extent the patient should receive stimulation. By going through this process, it makes the plan unique to each individual and what they are struggling with. 

Physiological

Additionally, rTMS therapy tends to see pretty immediate results such as an easing of symptoms of depression. Because of this fact, TMS therapy helps to improve the daily life of a person by restimulating parts of their brain that might have been abnormal previously or less active. 

High Success Rate

Around 40-60% of people report having success after going through rTMS therapy. This number is even better when we consider that most people who seek this treatment have exhausted all other platforms. RTMS therapy helps a lot of people, and it has a great track record. 

Non-Invasive

It is a non-invasive procedure, and it requires no surgery. This factor is one of the main benefits of TMS treatment. 

No Side Effects

There are little to no side effects with rTMS therapy. Some people experience headaches, and some other people in rare instances might have a seizure. Overall, however, it is a very safe procedure with limited side effects. 

Non-Drug

Although many doctors will use rTMS therapy alongside medication, it is also a non-drug treatment that does not require medication. Because of this fact, it can be seen as a healthy alternative for someone that maybe has struggled with prescription use disorder in the past.

FDA Cleared

TMS is an FDA-approved treatment method, which shows that it is safe and effective. 

Covered by Most Insurance

Most insurance companies now cover rTMS once other options have been exhausted. Make sure to check with your insurance company to see what their specific requirements are in regards to TMS therapy. 

Zero Downtime

Finally, there is zero downtime. Since you do not need anesthesia and it is non-invasive, you can leave without a recovery time once your appointment is completed. 

Outlook

In conclusion, rTMS is a very beneficial, FDA-approved medical procedure that lasts for multiple weeks on a daily basis. It can help with the most aggressive forms of many mental health disorders, and there have been several breakthroughs. If you want to learn more about rTMS, please contact your health care physician to see if it is an option for you. 

  1. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
  2. https://kidshealth.org/en/parents/eeg.html
  3. https://www.healthline.com/health/depression/repetitive-transcranial-magnetic-stimulation
  4. https://www.brainsway.com/professionals-faqs/how-does-deep-tms-compare-to-standard-rtms/
  5. https://www.mytransformations.com/post/what-to-expect-during-tms-therapy
  6. https://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/faq_tms.html

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