What is Rtms?
- The application of Repetitive magnetic pulses over the scalp to produce electrical activity in specific regions of the brain
- rTMS uses magnetic pulses to stimulate the neurons in the brain related to mood and anxiety, where communication between neurons is either over-active or under-active. The magnetic field produced by the rTMS equipment induces or reduces electrical activity in the neurons
- Relatively new for psychiatric disorders
- Since 1990, more than 20 randomized, controlled trials studying TMS as a treatment for depression have been published by researchers throughout the world
- Well established in: Neuroscience research experiments, Clinical application for neurological conditions and Neuronal diseases as an investigative tool
How does TMS produce relief from depression?
- Exact mechanism is still unknown
- Research studies show large scale brain networks altered in patients with depression – degree of the change in their connectivity predicts the severity of depression
- Effects similar to long-term potentiation (LTP) or long-term depression (LTD) of stimulated neurons – implicates changes in synaptic plasticity (ability of synapses to strengthen or weaken over time in response to increases or decreases in their activity
- Research suggests applying rTMS at the left dorsolateral prefrontal cortex (DLPFC) can enhance this region’s connectivity with other regions that are crucial for regulating emotional processing
- TMS known to have molecular effects that are similar to changes observed in ECT, including increased monoamine turnover, increased brain derived neurotropic factor and normalisation of hypothalamic pituitary adrenal axis
Clinical guidance and approvals of rTMS
Endorsed for clinical use in USA, North America, Australia, New Zealand and other European countries. It has been FDA approved in America for depression since 2008 and has been approved in Europe.
- NICE approved since 2015- IPG 542
- NICE has opened a consultation to recommend rTMS in routine practice with appropriate clinical governance
- “Recent NICE guidance (IPG 542) concluded that evidence on rTMS for depression showed no major safety concerns.” -The Royal College of Psychiatrists
Overview of TMS administration
- Outpatient procedure
- NICE approved
- Non-invasive, minimal side effects, safe
- Does not require sedation or general anaesthesia
- Requires patient to be comfortably seated
- Ear plugs used to mask the noise from discharging coil
- A small insulated electromagnetic coil is placed on the scalp
- Intensity of rTMS set as percentage of motor threshold
- Most widely used treatment protocol is FDA based standard parameters:
- total of 3000 pulse for each session
- lasting 37.5 minutes (4 seconds of treatment, wait 26 seconds off, therefore cycle equals 30 seconds) number of trains is 75- in total less than 45 mins
- Usually daily sessions 5 days a week for 4-6 weeks
- Can drive straight after and resume normal activities
- History of epilepsy or organic brain pathology
- acute alcohol dependence syndrome
- Taking drugs which cause a significant reduction in seizure threshold
- Severe or recent heart disease
- Presence of surgically placed ferromagnetic material (e.g. cochlear implant or cardiac pacemaker)
All patients should be screened using a standard questionnaire before accepting them for rTMS treatment
How many sessions will I need?
TMS treatment is generally given 5 days a week for up to 4-6 weeks. The number of sessions needed for positive results is different for each person. This will be decided by the consultant/nurse and will be discussed at initial appointment.
What does a rTMS treatment feel like?
You may feel a tapping sensation on the area of your scalp underneath the plate, in rhythm with the magnetic pulses. Other than this, however, there are no physical sensations. Patients often choose to read, listen to music or rest during the sessions.
What are the Side Effects of rTMS?
One of the main benefits of rTMS is its minimal side effects. The potential side effects of rTMS include discomfort at the site of stimulation, scalp discomfort, transient headache, neck pain and facial twitching during treatment. In very rare cases, a seizure may occur.
Is there a recovery period after rTMS session?
There is no recovery period after a rTMS session, and you can resume your daily activities immediately. Some patients may feel mild scalp irritation or tingling after their first session, but this usually goes away on subsequent visits.
Difference between TMS and ECT
While both TMS and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability.
Both are designed to treat depression through the application of energy into the brain, but the similarities end there.
ECT is a more intensive and invasive procedure than TMS: ECT requires an anaesthetic and is designed to cause a controlled seizure. One of the main side effects from ECT is memory loss which does not occur with TMS.
By contrast, TMS is an outpatient procedure with few side-effects. The patient can go about their day to day life as normal immediately after leaving the TMS clinic.
How will I know if I would respond to TM
75% of patients get a significant improvement in their symptoms from TMS. It is not possible to know which patients will respond so we break the treatment into two courses of 15 sessions. If a patient is not showing any benefit from the first course of TMS, we discuss the chances of further improvement with the patient. At this point, we may recommend alternative treatment options rather than continuing TMS treatment.
Relapse after TMS
Current statistics suggest that up to 2 in 3 patients will relapse within the first year following their TMS treatment. To counteract this, Expert TMS offer various maintenance options to help our patients optimise the improvements they have experienced.
Maintenance treatment- after care
An ongoing support plan to ensure you maintain the benefits of your treatment can be done and individually tailored for your needs .Costs can be discussed based on the number of sessions
- Suitable for patients who have successfully completed a full course of TMS for anyof the conditions
- Two Theta-Burst sessions within one 30 minute appointment per month
- Top up treatments as and when you need them. Patient to book in if and when they feel as though they need a TMS boost
For more information or to get in touch today, please use the details below:
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Fearnhead, Warrington, Cheshire, WA2 0XP
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