Non-invasive Brain Stimulation
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate brain cells to improve symptoms of depression, OCD and other disorders. TMS uses magnetic pulses to induce small electrical currents in the brain cortex. These magnetic pulses are at a specific frequency that either stimulates or inhibits the brain region they target. TMS has been typically used when other treatments haven’t been effective. TMS Therapy is FDA approved for treatment-resistant depression and Obsessive Compulsive Disorder and may also aid in the treatment of anxiety, PTSD, ADHD, Tourette’s, Autism Spectrum Disorders and chronic pain, among other uses.
What is TMS Therapy?
TMS stands for transcranial magnetic stimulation. TMS uses non-invasive electromagnetic fields, similar to those produced by an MRI machine, to stimulate or inhibit the brain. During TMS therapy, a magnetic field is administered in very short pulses to a specific part of the head to activate or inhibit those underlying brain cells. The course of treatment may vary depending on target symptoms; it may be about 19-37 minutes per session, 3-5 times a week, over 4-6 weeks.
How does it work?
An electromagnetic coil is held against the head near an area of the brain that is thought to be involved in the regulation of mood, anxiety or other symptoms. Then, short electromagnetic pulses at a particular frequency are administered through the coil. The magnetic pulses easily pass through the skull and cause small electrical currents to stimulate or inhibit nerve cells in the targeted brain region. In turn, the stimulated cells have an impact on the brain circuits involved in certain symptoms. Because this type of pulse generally does not reach further than two inches into the brain, we can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan.
Is TMS painful?
No. It may cause some discomfort, depending on the individual. In the large majority of patients, TMS is well tolerated with only minor discomfort on the scalp where TMS is applied. Most people describe TMS as a light to moderate tapping sensation where the coil is placed.
Are there any contraindications for TMS?
TMS Therapy is contraindicated for use in patients who have active or inactive implants (including device leads, pacemakers, etc), including deep brain stimulators, cochlear implants, and vagus nerve stimulators. People with a history of epilepsy or seizure activity or who are currently pregnant, breastfeeding, or trying to conceive should discuss options with their provider.
TMS coil placement
on the head
What do TMS effects feel like?
Most patients report increased energy, focus, and motivation to perform activities in as little as 5-10 sessions. Many patients have described TMS therapy as life changing. Oftentimes, family members will notice effects before the patient does.
How soon will I start feeling the effects of TMS?
Most patients start experiencing relief after 5-10 sessions, but this can vary greatly depending on the severity of the symptoms and the individual’s unique genetic makeup. Some may not feel the effects of TMS until as many as 40 sessions, while some may feel the effect almost immediately after their first.
What are the most common side effects?
The most commonly reported side effects during clinical trials were headache and scalp discomfort. These potential side effects were typically mild to moderate, and were less common after the first week of treatment. During clinical trials, less than 5% of patients treated with TMS discontinued treatment due to side effects. If necessary, headaches from TMS can be treated with over-the-counter pain medications, as indicated by your physician. If the side effects persist, the strength of the TMS pulses can be temporarily reduced to ensure the comfort of the patient. Let your treatment provider know about any side effects your experience.
Will I be able to drive home after a TMS session?
Yes, patients are able to resume normal activities immediately after the treatment.
Is there anything I should avoid during the treatment duration?
Patients may be asked to stop the use of Bupropion before beginning TMS and to abstain from alcohol during the course of their TMS treatment
What you can expect
Repetitive TMS or rTMS is usually done in a doctor’s office or clinic and requires a series of treatment sessions to be effective. 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 by examining what is called “motor threshold,” which is a reference point that helps determine the right dose. The amount of stimulation can be changed during the course of your treatment as needed, depending on symptoms and side effects. At each session, you will be seated in a chair and asked to wear earplugs. At your first session, you will be asked to wear a cap and your head measurement will be taken to determine where the brain region/s to be treated are mapped on your head. This process is known as mapping. Then an electromagnetic coil will be placed against your head while your provider switches the pulses on and off. You will hear a tapping or clicking sound and feel a tapping sensation on your head. From there, the next session will likely be shorter and very similar. You will sit in a comfortable chair with earplugs and the magnetic coil placed against your head. Once the machine is turned on, you will hear clicking sounds and feel a tapping sensation on your head. You will remain awake and alert for the duration of the session. After each treatment, you can return to your normal activities and work and drive as normal. After completing a treatment series, you and your clinician will determine which next-steps to take, these may include additional TMS sessions, maintenance TMS or to just continue with your medication and/or therapy treatment.
For more information, download the TMS consent form here
Monarch eTNS (external Trigeminal Nerve Stimulation)
The Monarch eTNS (external Trigeminal Nerve Stimulation) device is indicated for the treatment of pediatric ADHD as a standalone therapy (monotherapy) in patients ages 7 through 12 years old. The device is used at home under the supervision of a caregiver during periods of sleep. Here’s a link to a 9 minute video that explains how to use it.
- Cannot tolerate/use stimulants due to side effects or medical contraindications.
- Parents/caregivers who do not want to use medication
- Patients who despite being on stimulants have a partial response or side effects that prevent dose increases.
Additional indications and age groups are being studied including teens and adults with ADHD.