Transcranial Magnetic Stimulation Procedure
Overview
Mechanism of Action
Transcranial magnetic stimulation (TMS) therapy is a non-surgical technique that uses focused magnetic fields to activate specific areas of the brain. A provider places a device, often called a coil, on the patient’s scalp. This coil sends quick, controlled magnetic pulses, which pass through the skull to stimulate nerve cells.
Most commonly, the treatment targets regions linked to mood, such as those involved in depression, but providers also use it for obsessive-compulsive disorder (OCD), migraines, and to support quitting smoking. This brain stimulation changes how neurons fire and communicate, which eases symptoms when other methods have not worked.
Types of Stimulation
Providers deliver TMS using different methods and tools. The key types include:
- Repetitive TMS (rTMS): Delivers repeated magnetic pulses to shallow brain areas.
- Deep TMS: Uses a special coil to reach deeper brain regions and cover a broader area.
- Theta Burst Stimulation: A rapid pattern of pulses to mimic the brain’s natural rhythms.
All of these methods aim to change cortical activity and improve brain function.
Targeted Brain Regions
Providers can target specific brain regions using navigated TMS systems. These systems ensure precise placement, especially in procedures like language mapping and pre-operative planning for neurosurgery.
| Brain Region | Clinical Use |
|---|---|
| Prefrontal cortex | Depression, OCD |
| Motor cortex | Pre-surgical mapping, research |
| Broca’s/Wernicke’s area | Language mapping |
Clinical Settings and Research
Clinicians widely use TMS in psychiatry and neurology for patients who do not respond to standard care. Researchers also rely on TMS in neurophysiology studies. As experience grows, experts continue to develop new protocols and adapt stimulation parameters for different conditions and brain functions.
Reasons for Use
Providers often use TMS when standard depression treatments, like antidepressants or talk therapy, have not helped. Providers consider TMS for people seeking new options when other therapies have failed. TMS may also help with other mental health issues and conditions, such as:
- Major depressive disorder and treatment-resistant depression
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Chronic pain, migraines, and headaches
- Addiction and nicotine dependence
Potential Risks
Frequent Reactions
Most people experience mild effects after repetitive TMS sessions. Common complaints include scalp discomfort, mild pain, and headaches. Some also notice slight muscle movements, tingling, or twitching in the face, along with feeling dizzy or lightheaded. These reactions usually fade soon after treatment and often decrease as sessions continue.
Table: Examples of Frequent Reactions
| Symptom | How Common | Usually Lasts |
|---|---|---|
| Scalp Discomfort | Often | Short-term |
| Headache | Often | Short-term |
| Facial Twitching | Sometimes | Short-term |
| Dizziness | Sometimes | Short-term |
If people are sensitive to pain or headaches, doctors can lower the strength of the magnetic pulse or suggest over-the-counter pain relievers before starting. In rare cases, those already prone to migraines could experience a worsening of headaches, which may require stopping or adjusting their treatments.
Rare or Serious Reactions
Though repetitive TMS is FDA cleared for some mental health needs and does not require hospitalization or surgery, a few serious risks exist. Rarely, a person may have a seizure.
There is also a low chance of short-term hearing problems if ears are not well protected from the sound during therapy. People with bipolar disorder may show signs of mania, especially if they have had it before. Researchers continue to study whether any long-term issues are associated with this therapy.
Getting Ready for Treatment
Preparing for repetitive transcranial magnetic stimulation (rTMS) involves several key steps to make sure the treatment is safe and suitable. Below is a checklist and information to help guide the process:
| Preparation Step | What To Do |
|---|---|
| Physical and mental health | See healthcare provider and psychiatrist. |
| Medical history | Share details about implants, medications, and health. |
| Insurance | Call insurer for rTMS coverage details. |
| Support for first visit | Arrange transportation if desired. |
1. Medical Checkups and Tests
- Schedule a physical exam with a healthcare provider to review overall health.
- Lab tests or additional checks may be needed, depending on personal medical history.
- A mental health evaluation from a psychiatrist or other mental health professional is also important, especially if depression or related conditions are being discussed.
2. Share All Medical History
- Inform the healthcare provider of any implanted metal or electronic devices in the body, such as:
- Aneurysm clips or coils
- Stents
- Pacemakers
- Cochlear implants
- Deep brain stimulators
- Bullet fragments
- Not every device means rTMS is unsafe, but some implants do carry risks because of the strong magnetic fields used in treatment.
- List any medications, supplements, or vitamins you are currently taking.
- Discuss any history of seizures, epilepsy, frequent headaches, or brain injuries (such as stroke or tumor).
3. Pregnancy and Family History
- Let your provider know if you are pregnant, planning to become pregnant, or have a family history of certain neurological conditions.
4. Previous Treatments
- Mention if rTMS or similar treatments have been tried before and whether they were effective.
5. Insurance Considerations
- Check with the health insurance provider to find out if rTMS sessions are covered, especially for mental health concerns like depression.
- Some insurance plans may require a history of failed responses to other medications before approving rTMS.
6. Preparing for the First Session
- Providers conduct treatment on an outpatient basis, with no need for anesthesia.
- Most people do not need someone to drive them, but having a friend or family member available after the first visit is sometimes helpful if side effects are a concern.
What You Can Expect
Your Initial Session
During the first repetitive TMS session, the healthcare provider spends extra time preparing. This visit usually takes about one hour. The person gets comfortable in a reclining chair and wears earplugs throughout the process.
A provider uses an electromagnetic coil, placing it against the person’s scalp. The person may feel a tapping on their head and hear clicking sounds. The provider shifts the coil to find the best spot and looks for a reaction in the person’s hands or fingers, such as a slight twitch.
This mapping step guides future sessions and is important for movement and stroke rehabilitation. The provider determines the best strength of magnetic energy by watching when the fingers or thumb move during several tries.
| Step | Description |
|---|---|
| Getting Ready | Sit in a chair, wear earplugs, and relax. |
| Coil Placement | The coil is moved on the scalp to find the exact spot. |
| Energy Tuning | Strength is checked by looking for hand movement. |
| Mapping Complete | Setup is saved for future appointments. |
What Happens in Follow-Up Visits
Providers use the mapping from the first visit for regular treatments. At each session, the person sits in the same type of comfortable chair and wears earplugs. The provider returns the coil to the mapped location, chosen for treatment rather than to trigger finger or hand movement.
During the session, most people remain awake, with the magnetic coil producing quick tapping on their scalp. There is usually a pattern of tapping for a few seconds, then a break. Treatment times can vary. Some recent methods, like intermittent theta burst stimulation, last just a few minutes.
Others can take 20 minutes, depending on the type. People may notice mild scalp discomfort or brief pain while the tapping is happening, but there is typically no discomfort during pauses.
Neuronavigation tools and careful planning keep the treatment focused on the right spot, which may help certain movement disorders or people recovering from a stroke.
Key Points for Each Session
- Stay alert and comfortable.
- Expect tapping, clicking sounds, and possible mild pain.
- Sessions are brief, from about 3.5 to 20 minutes.
What to Know After Each Session
After each office visit, most people return to their usual routine right away. Activities like driving, working, or studying can continue as normal. Sometimes, a person might get a mild headache for a short while after treatment, but this typically goes away on its own.
People generally do not need to recover or rest for a long time after each session. The day can continue as planned, with no need for help from others. Those involved in stroke rehabilitation or managing movement disorders often keep up with their therapies and routines without pause.
Findings
After a series of rTMS sessions, people often continue using other standard treatments like medication or counseling. These steps help manage depression over time. Ongoing or maintenance rTMS aims to keep symptoms from coming back, but its role is not fully clear yet.
Some individuals find that repeating rTMS after several months can help if depression returns, and many insurance plans will pay for this. Newer approaches, like accelerated TMS, are also under review for their potential to help people who do not improve with standard options.
