Transcranial Magnetic Stimulation (TMS)


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The idea of a “miracle machine” that allows us to alter the function of our brain without surgery or medications is exciting, but can also be scary. Transcranial Magnetic Stimulation (TMS) has been used as a non-invasive procedure for treating depression and other psychiatric disorders, with promising results.

The FDA approved TMS in 2008 for treatment resistant depression, and its efficacy is being studied across an array of conditions from schizophrenia to autism spectrum disorder. In this post we’ll review how it works and what studies have shown so far about its safety and effectiveness. 

transcranial magnetic stimulation (tms)
@tmstherapynow

Transcranial Magnetic Stimulation, or “TMS” for short, is a newer treatment designed to look at how the brain reacts to electric impulses. The main goal of the treatment is to observe how it affects moods, depression and chronic pain. Doctors use this because it might be able to show us something about the brain that’s otherwise impossible with traditional methods.

Much progress has been made in understanding what TMS does inside the human brain due to high-resolution anatomical imaging software combined with experienced clinicians who are familiar with comprehensively evaluating clinical outcomes including patient complaints of pain or improved mood before and after TMS treatments are performed.

Technological advances in the last 15 years have led to the development of some devices for measuring and modifying cellular electrical current in the brain. One of these devices is the Transcranial Magnetic Excitation (TME) system.

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) therapy is a system that creates a magnetic field and activates the brain’s natural electricity without direct electricity to the brain. This article contains many details and processes of TMS.

Is TMS a safe procedure?

It’s been found that TMS is a safe procedure, and does not cause any major adverse reactions.

Details About Transcranial Magnetic Stimulation

In the Transcranial Magnetic Stimulation application, brain activity is changed by creating a strong but short magnetic field from the outside and the treatment effect occurs. Transcranial Magnetic Stimulation (TMS) is a non-invasive method that stimulates neurons in the brain. Through rapidly changing magnetic fields (electromagnetic induction), weak electric currents induced in tissues lead to excitation. In this way, brain activity can be triggered or modulated without the need for surgery or external electrodes. TMS method, which maps the functioning of the brain, is a powerful tool for diagnosis and research in orology.

Repetitive, Transcranial Magnetic Stimulation (rTMS) shows promise in the treatment of a number of disorders such as depression and anxiety disorder. As a result, it is a good alternative to ECT with its current situation.

In which diseases is Transcranial Magnetic Stimulation effective?

Transcranial Magnetic Stimulation is not recommended as a first-line treatment. The application of Transcranial Magnetic Stimulation (TMS) is recommended as an option in the treatment of depression that has not responded to a drug application in the 2010 ‘guideline’ approved by the FDA in 2008 and published by the APA. Typically, it is used only in patients with depression who did not improve with standard therapies, or in patients who may consider electroconvulsive therapy but want to try another alternative.

Patients with prolonged depression or those who do not improve with standard treatments may be candidates for this procedure. rTMS is an important option in treatment-resistant psychiatric cases.

For patients who do not achieve sufficient improvement with standard treatment, it deserves some attention as a promising treatment for negatively manifested schizophrenia, hallucinatory conditions, addiction, OCD, and other refractory psychiatric disorders. The important thing is that by listening to the voice of the clinician in the physician, the patient can make a decision to move one more step towards remission.

It’s not simply about the therapy you give; it also covers any possible therapies that might be used as alternatives. On the other hand, determining the rTMS protocol and considering the security screen are important issues that the physician should pay attention to.

In the 2010 ‘guideline’ approved by the FDA in 2008 and published by the APA, TMS application is recommended as an option in the treatment of depression that has not responded to a drug administration. Typically, it is used only in patients with depression who did not improve with standard therapies, or in patients who may consider electroconvulsive therapy but want to try another alternative.

Transcranial Magnetic Stimulation can also be used in cases where drug use is restricted, for example; It can be used easily in pregnancy, breastfeeding mothers and heart patients and in this respect, it provides great convenience to the patient and the physician.

Deep TMS: What Is It?

Deep TMS method used in addiction treatment stimulates the deepst regions of the brain that cannot be stimulated with classical TMS.

Deep TMS is a therapeutic technique that uses magnetic fields to stimulate brain tissue. It’s been shown in studies to be an effective treatment for depression and other mental disorders. The procedure typically lasts 20 minutes, with treatments occurring once or twice a week depending on the severity of symptoms. In some cases, patients will need 10 sessions before they start feeling relief from their symptoms.

Are magnetic fields dangerous to the brain?

The human body is vulnerable to magnetic fields, but for most people, this vulnerability does not lead to an immediate risk of adverse health effects. However, if high levels of the magnetic field are experienced there can be detrimental consequences. The severity of any detrimental consequences may depend on the magnitude of the exposure and some personal susceptibility factors.
Any interaction with a magnetic field over some threshold depending on personal susceptibility will have some effect on the person. Not all external fields are dangerous so prevention is important since scientists do not yet know for certain what kind or how much time is needed before harmful long-term affects occur due to exposures at low levels which cannot be detected by current methods.

Method That Affects Which Area of ​​The Brain?

Deep TMU device is a method that stimulates areas of the brain such as the Insula and Anterior Cingulate Cortex, which play a role in addiction by acting on a deep region.

Deep TMS Is Used in The Treatment of Which Diseases?

Deep TMS is used in addiction, schizophrenia, Obsessive-Compulsive Disorder (OCD), Adult Attention Deficit Hyperactivity Disorder, and some other psychiatric diseases.

This article may be of interest to you: Validation Addiction and BDP

Thanks to the features of the head used in the device, stimulation can be given to different brain regions in different diseases. The use of Deep TMS application in depression and bipolar disorder is FDA and CE approved. It is especially used in the treatment of depression in America, Canada, Australia, Germany, Belgium, Italy, and other European and South American countries.

Why Is Deep TMS Important in Addiction Treatment?

Since addiction treatment is a difficult disease, it is important to regulate the brain regions that are impaired in treatment. Today, addiction is known to be a chronic and recurrent brain disease like schizophrenia or a chronic disease with a long-term treatment such as diabetes.

Addiction is not caused by a willpower disorder, lack of personality, or moral weakness. It occurs due to changes in hormones called neurotransmitters such as dopamine in the areas we call the reward center located in the depths of the brain. Powerful treatments such as deep brain stimulation can be effective in reversing these changes.

A New Method for Drug and Alcohol Addiction: EMDR Psychotherapy

Deep TMS Applications in Addiction Treatment:

The goal in addiction treatment is first to remove the alcohol/substance used from the body and then to reduce the desire/desire (craving) felt for this substance. Almost half of the addiction patients have difficulty in coping with alcohol/substance abuse despite the treatment methods such as drug therapy, psychotherapy, and family therapy, which are still applied in the treatment protocol. 

The purpose of deep TMS application is to stimulate the deep brain regions with the TMU method. Studies conducted in recent years reveal that Deep TMS treatment reduces the craving of addictive patients to smoke/alcohol/substance use.

In addition to reducing craving with deep TMS application, it also helps to reduce impulsive behaviors that cause substance use in the individual and by improving the person’s healthy decision-making ability. As a result of the stimulation of these areas, interest in the addictive substance decreases, and the self-control ability of the person increases. It becomes more resistant to addictive substances. Session durations vary according to the type, amount and frequency of the substance used by the patient.

In Which Cases Is Deep TMS Required?

The Deep TMS method should be used in addiction patients, especially in cases of relapse after treatment, if the patient seeks the addictive substance despite known treatments.

Noting that 60-70% of addictive patients are accompanied by other psychiatric diseases such as depression, anxiety disorder and psychosis.

Deep TMS applications are effective in treating the accompanying psychiatric disease together with addiction.

Does Deep TMS Pose a Health Risk?

Deep TMS is considered to be a very low-risk application since no invasive procedure is applied to the patient when compared to other brain stimulation methods as in classical TMS. This method does not cause any damage to the brain.

What Is the Use of Deep TMS In The Treatment of Obsessive Compulsive Disorder (OCD)?

Many patients with this disorder may be resistant to drug treatment. So much so that many patients have to live with this disorder because treatment is unsuccessful. Control over thoughts and behaviors can be increased by stimulating brain regions such as the anterior cingulate area with Deep TMS.

In which diseases is it applied?

• Alcohol addiction,
• Smoking addiction,
• Cocaine addiction,
• To overcome Multiple Sclerosis-Fatigue,Neuropathic pain,
• Obsessive compulsive disorder,
• Increasing autism-communication skills, Parkinson’s disease,
• Alzheimer’s Disease,
• CE approval is available for resistant neuro/psychiatric disorders such as negative symptoms (withdrawal, apathy) in schizophrenia.

What is Deep Transcranial Magnetic Stimulation?

transcranial magnetic stimulation (tms) 3
Source: @russ_nikov

Deep Transcranial Magnetic Stimulation is the TMS application that can affect the deep structures of the brain. Thanks to the features of the headgear used, stimulation can be given to different brain regions in different diseases. There are studies showing that it is effective in Obsessive-Compulsive Disorder, Adult Attention Deficit Hyperactivity Disorder, and some other psychiatric diseases, and its use is increasingly common.

In Which Situations is Deep Transcranial Magnetic Stimulation Applied?

The use of Deep Transcranial Magnetic Stimulation application in Depression and Bipolar disorder is FDA and CE approved, and it is widely used in the treatment of depression in America, Canada, Australia, Germany, Belgium, Italy and other European and South American countries.

Deep Transcranial Magnetic Stimulation application also suggested for:

  • Alcoholism
  • Alzheimer’s Disease
  • Cocaine addiction
  • Multiple sclerosis-relieving fatigue,
  • Neuropathic pain,
  • Obsessive compulsive disorder,
  • Increasing autism-communication skills,
  • Parkinson’s disease,
  • Smoking addiction
  • CE approval is also available for resistant neuro/psychiatric disorders such as schizophrenia-negative symptoms, and the results of clinical studies are positive, and its use in treatment is increasing.

What is Neuronavigation Transcranial Magnetic Stimulation?

Neuronavigation is an application that enables the treatment to be applied exactly to the desired point in the brain and thus increases the effectiveness of the treatment.

  • Brain MRIs of the patients are taken first and the images taken are transferred to the navigation device.
  • The point in the patient’s brain to be treated is determined by a specialist.
  • The neuronavigation device ensures that brain stimulation (transcranial magnetic stimulation) is given to this exact point.

Does Transcranial Magnetic Stimulation / rTMS Have an Effect on the Brain?

 rtms

With TMS, the electrical conduction of the cells in the brain is intervened. Considering that the brain works with electrical and chemical messages, this intervention has the effect of activating the natural processes of the brain that are not functioning adequately. The treatment effect is created by creating a strong but short magnetic field, without giving any electrical current from outside. Thus, a change called “neuronal depolarization” occurs in the targeted area of ​​the brain.

What Is the Difference Between Transcranial Magnetic Stimulation / rTMS and Electroconvulsive Therapy (ECT)?

ECT is applied by a direct electrical current to the brain. It should be done in a hospital environment and under general anesthesia. TMS treatment can be applied on an outpatient basis and does not require anesthesia or analgesic. In most cases, the patient does not feel any negative effects other than a mild headache and a slight discomfort at the stimulation site.

How Long Is the Transcranial Magnetic Stimulation / rTMS Session?

Session duration is determined according to the individual needs of the patient. Thermal application of the specified frequency and intensity is performed for 5 to 30 minutes.

In Which Diseases Is Transcranial Magnetic Stimulation / rTMS Effective?

Currently primarily recommended treatment areas are Treatment Resistant Depression, Schizophrenia and Obsessive Compulsive Disorder and Schizophrenia which are all mental disorders. It is noted that it can be used in pregnancy, breastfeeding mothers, and cardiac patients and has superiority over drug therapy. (Arch. Gec – Psychiatry. 1999; 56: 300-311)

In Which Situations Is Transcranial Magnetic Stimulation Used In Neurology?

It is currently used for experimental purposes in speech disorders, epilepsy, Parkinson’s and some strokes. Research is ongoing.

How Is Transcranial Magnetic Stimulation / rTMS Used In Children?

Scientific studies on its effects on autism and hyperactivity are still in progress.

How Is Transcranial Magnetic Stimulation / rTMS Applied?

After psychiatric evaluation and then imaging of the brain with functional MRI or Quantitative EEG, it is recommended to determine the appropriate area according to the diagnosis considered and apply it to that region. In depression, a coil is usually placed in the left anterior forehead area. Rhythmic warnings are given. It is applied in sessions of 10 to 30 minutes, not less than 20 sessions. There is no need for any preliminary preparation other than clean hair.

What Are the Benefits of (TMS / rTMS)?

• Based on highly effective clinical research results, the success rate of tTMS treatment is higher than pharmacotherapy and less than electroconvulsive therapy.

• It has few or no side effects. The most severe side effect is a mild headache.

• Quick onset therapeutic effect (typically within 1 week).

• There is no direct intervention on the body. So it does not require an invasive procedure.

• It does not require anesthesia.

• The patient is treated on an outpatient basis.

• It has superior targeting power for specific neuron circuits.

• It only requires 2 to 4 weeks of treatment.

• Provides a therapeutic benefit for people resistant to treatment.

• Patients do not need to stop using medication for rTMS application.

• A reduction in depression symptoms is typically achieved for those who do not respond to treatment.

• Equally effective in treating patients with major depressive disorder and bipolar disorder.

• Treatment parameters are determined individually for each patient.

• Protocols are based on the specific diagnosis of each individual patient and allow the most effective course of treatment.

• Patients are informed of the progress made on the depression and anxiety rating scales throughout the treatment course.

• The treatment parameters applied in our hospital and the results obtained from all rTMS procedures were followed using a specially developed software program. This allows the medical staff to track each patient’s progress in treatment and provide feedback on results on an individual basis.

 • As with an effective treatment modality, the degree of improvement varies from person to person. Pre-procedure initial consultation with a medical doctor at our hospital helps determine the possible outcome range based on the individual’s depression intensity, medical history, and expectations.

When Does Transcranial Magnetic Stimulation Treatment Respond?

  • Typically, improvement is seen within one to two weeks of starting treatment.
  • Most patients tend to notice a therapeutic benefit within the second week of treatment.
  • Late responders may need additional sessions on the third week to achieve significant reductions in depression symptoms.
  • On average, patients enter maintenance therapy after about 8-12 months. This time frame varies for each patient.
  • On average, maintenance therapy involves half the number of rTMS sessions completed initially.

We strongly request that patients who feel their depression symptoms reoccur should contact us immediately. You will be contacted as soon as possible.

What Are the Immediate and Short-term Risks of TMS?

Seizures

The primary safety problem experienced in TMS is the risk of causing a seizure. Although this risk is primarily associated with rTMS, single-pulse stimulation has been reported to cause seizures in patients with large cerebral infarctions, contusions, or other structural brain lesions. It can be said that the occurrence of seizure activity is highly improbable if the conditions are in accordance with established safety guidelines (Wassermann 1998).

Cardiovascular Effects

No significant changes in blood pressure and heart rate were reported during and after rtTMS administration. (Foerster et al. 1997).

Auditory Function

In a study involving 12 depressed subjects who received tTMS for four weeks, no significant change in hearing threshold was observed for four weeks after the study (Loo et al. 2001).

Headache

TMS application can cause local pain caused by direct stimulation of the muscles under the coil and the stimulation of the nerves in the face and scalp. The procedure is usually more painful with higher intensity and frequency. Approximately 5% to 20% of subjects experience tension headaches after rTMS sessions (George et al. 1999).

What Are the Side Effects of TMU / tTMS (TMS / rTMS)

Compared with other brain stimulation methods, it can be considered that rTMS is relatively safe because it is non-invasive. Major problems are involuntary induced seizures that gives local pain during the application, changes in auditory performance due to the noise generated by the coil due to the passage of electrical current, ligament pain, and potential changes in cognitive function.

Most of these side effects are sudden and short-lived. Results of animal studies did not reveal any long-term neuron damage findings attributable to tTMS. In a safety study, it was revealed that rTMS has no significant effect on sleep EEG in therapeutic parameters (Graf et al. 2001).

Can TMS Be Used In the Treatment of Depression In the Elderly?

Late-life depression is an important issue in treatment resistance. Treatment-refractory depression is more common in the elderly, and combination or augmentation treatments carry greater risks of drug interactions. There are a limited number of TMS studies in this patient group.

In the only study conducted on the use of TMS in the treatment of depression in the elderly in our country, an average of 18 sessions of TMS in the left DLPFC area was administered simultaneously with antidepressant therapy in 65 elderly patients with treatment-resistant depression with an average age of 66.6. As a result of the treatment, 38 of 65 patients had partial recovery and 19 had full recovery. In this study, no cases with worsening depression symptoms were found, and no serious side effects or cognitive worsening were reported. (Hız Sayar et al. 2013).

rTMS Procedure Description

  • TMS treatment is applied to brain regions that are thought to be affected by depression and other mood disorders.
  • Thanks to rTMS, it is possible to selectively modulate or change the activity in some parts of the brain.
  • RTMS produces a number of positive effects on the brain that have been shown to be effective in the treatment of various conditions and diseases as well as depression (e.g. stimulant or suppressive effects).
  • The treatment affects the electrical activity in the brain through the pulsed magnetic field. A magnetic field is created by giving short pulses of current through an eight-shaped metal coil
  • The metal coil covered with plastic is kept close to the scalp so that the magnetic field is focused on specific areas of the cortex or brain surface.
  • The magnetic field generated in rTMS penetrates the skull and scalp painlessly and safely and induces a current in specific neurons (brain cells).
  • Because magnetic stimulation is transmitted at regular intervals, it is called repeating TMS or rTMS.
  • Stimulation parameters, such as the number of alerts, alert strength and duration, and the length of the alert interval, can vary completely. Its ability to change parameters while directly targeting specific brain cells suggests that rTMS has a very valuable therapeutic potential. It is also possible to adapt the treatment to the needs of each patient.
  • The validity of rTMS treatment has been tested in multiple ways in clinical trials and medical research studies. It has been approved for use in Canada since 2002.
  • In peer-reviewed articles in various medical journals, it has been stated that rTMS treatment shows promise in the treatment of Parkinson’s Disease, Auditory Hallucination, Schizophrenia, Obsessive Compulsive Disorder, Tinnitus, Eating Disorders, Migraine-type headaches, Pain Management and other mood disorders.
  • In peer-reviewed articles in various medical journals, it has been stated that rTMS treatment shows promise in the treatment of Parkinson’s disease, Auditory Hallucination, Schizophrenia, Obsessive Compulsive Disorder, Tinnitus, Eating Disorders, Migraine-type headaches, Pain Management and other mood disorders.

Benefit Period

  • Typically, improvement is seen within one to two weeks of starting treatment.
  • Most patients tend to notice a therapeutic benefit within the second week of treatment.
  • Late responders may need additional sessions on the third week to achieve significant reductions in depression symptoms.
  • On average, patients enter maintenance therapy after about 8-12 months. This time frame varies for each patient.
  • On average, maintenance therapy involves half the number of rTMS sessions completed initially.
History of cbt

Aaron Beck

Types of Homework in CBT

About Author

I was born in Sweden but came to America to study. I'm doing my master's degree on Emdr here. I love to explore different psychotherapy methods and share this information. For your questions, you can contact me at my e-mail address.

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