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Studies Concerning Transcranial Magnetic Stimulation

How TMS Started
Electromagnetic Treatment
Safer Treatments

Over the past few years, there are several studies indicating the efficacy of Transcranial Magnetic Stimulation or TMS as an alternative depression treatment.

Researchers at Butler Hospital along with the collaboration of different clinics in the US confirmed the efficacy of TMS treatment for patients with depression who were unsuccessful on their antidepressant medications. Their finding is one of many first studies who delved into the use of TMS treatment. It was published on June 11, 2012 edition of Depression and Anxiety in the Wiley Online Library.

 

How did TMS Start?

Anthony Baker introduced TMS in 1985 at the University of Sheffield in England. It was intended as a neurodiagnostic tool used to produce an evoked potential in muscle tissue by activating neurons in the motor cortex. The whole concept of TMS was based on the two basic principles of physics; Faraday’s principle of electromagnetic induction and Ampere’s law.

Faraday’s principle involves the use of electromagnetic induction and that voltage can be measured and changed when generated across a length of wire – if the wire was left exposed to a perpendicular magnetic field flux of alternating intensity. Also, Ampere’s law state that the magnetic field can be managed around an electric current is proportional to the electric current.

TMS principle revolves around this principle. The stimulation coil consists of several wire loops encased in an insulating material. According to Kobayashi M, Pascual-Leone A. in Transcranial magnetic stimulation in neurology, “If a pulse of current is passed through this coil and placed over a person’s head, it produces rapidly changing magnetic pulses that penetrate the scalp and skull and reach the brain with minimal attenuation.”

Because of this, TMS can emit rapid and powerful but painless magnetic field that stimulates brain nerve cells. In doing so, it activates inactive region in the brain associated with depression.

Since its introduction in 1985, TMS had been studied as an alternative treatment for various mental disorders. Several studies show that TMS can be an effective treatment for major depression, Tourette syndrome, reducing auditory hallucinations in patients with schizophrenia, and obsessive-compulsive disorder. There a lot of evidence showing the efficacy of TMS in psychiatry.

 

Another Form of Electromagnetic Treatment

However, TMS was not the first treatment introduced that uses electromagnetic pulses. It was Electroconvulsive therapy (ECT) that was first used in 1938 which also show the significant result in treating major depression. Unfortunately, ECT uses an invasive method like anesthesia which resulted in severe side effects. It soon loses its popularity amongst patients with depressive disorders.

ECT remains one of the most controversial forms of treatment in the entire field medical science. It’s a love and hate relationships. But one film stands out in providing a wide range of people about the use ECT. The film “One Flew over Cuckoo’s Nest”, shows how crude treatment method ECT can get. Even though ECT can also effectively treat depressive symptoms, there has been a steady decline of its use in clinical psychiatry clinics.

 

A Safer Treatment Method

About 16.1 million people suffer from depressive disorders across the US. Depression is a serious illness affecting 350 million people worldwide; it’s becoming the largest health problem in the world. The medical community had developed medications and treatment plan to help manage its symptoms but there are patients who do not respond positively to these. Using medications often entails adverse side effects like tolerance and drug addiction.

The approval of FDA for TMS had cleared the TMS brain-stimulating device for treating depressive disorder to patients where antidepressant has failed to work. TMS brings new hope and vitality to patients and their families wherein it shows better results than the conventional treatment plan. It has far lesser and fewer side effects, some does not even experience and adverse reaction to TMS procedure.

TMS procedure shows its efficacy to over 24,000 people suffering from depressive disorder. About 1 out of 3 people have experienced complete remission from depression. While 50% of patients reported having significant reductions in their symptoms. The American Psychiatric Association also supports the use of TMS for patients who develop tolerance over their antidepressant medications. They suggest that medical professionals should consider TMS as a form of treatment rather than changing from one antidepressant to the other. Using antidepressant medications often lead to drug addiction.

One study conducted by Garcia-Toro M, Mayol A, Arnillas H, et al in their book entitled “Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression” shows that TMS can treat depression symptoms as effectively as any antidepressant medications.

 

How it Works
Why is TMS Effective?
When to get TMS
Who Benefits?
How Long for TMS to Work

Transcranial Magnetic Stimulation or simply known as TMS is a non-invasive, non-systemic procedure that stimulates brain nerve cells to treat Major Depressive Disorders. Generating magnetic waves similar to an MRI, TMS therapy is safe to use for everyone. This painless electromagnetic pulsed emits magnetic fields in specific parts of the brain associated with mood and behaviors.

Magnetic waves can reach into deeper parts of the brain without the use of pharmaceuticals or surgeries. TMS therapy is usually done inside the doctor’s office for about 30 to 45 minutes over a period of 4 to 6 weeks of treatment sessions. Since it does not require any surgeries, anesthesia, and hospitalization, patients can immediately go back to their daily lives following each treatment sessions.

The US Food and Drug Administration approved the use of TMS as a safe and effective treatment for depressive disorders in 2008. This painless procedure was given a nod to treat patients with resistant depression symptoms when all antidepressant treatments have failed.

 

How Does TMS Work?

Majority of people suffering from depression failed to respond with the conventional medications and psychotherapies. Experts believed the region in the brain near the dorsolateral prefrontal cortex tends to be underactive while some parts of the brain remain overactive. This creates chemical imbalances within the brain structures causing some of the most common depressive symptoms. The electromagnetic pulses that TMS machine produce can penetrate deep into the brain that activates inactive brain cells while suppressing other brain regions without the use of medications and surgeries. TMS therapy is a safe and effective treatment option to stimulate the dorsolateral prefrontal cortex and treat depressive symptoms.

During a TMS procedure, health care providers placed an insulated magnetic coil over the head of the patient. It then emits magnetic pulses that stimulate brain neurons; it’s painless yet effective method of treating depression. As a non-invasive and non-systemic method, patients can immediately go on with their daily activities following the treatment session.

 

Why is TMS so effective?

TMS consistently produce positive changes in neuronal activity in regions of the brain often linked in mood regulation. As the magnetic waves pass through the skull painlessly and into the brain, this triggers the brief activity of brain cells directly underneath the treatment coil. Health care providers monitor the frequency and the threshold of magnetic waves as it directly influences brain activity during TMS treatment sessions. Some recent studies suggest that stimulating the left or the right sides of the brain can have opposite effects on mood regulation. That is why all patients needing TMS treatment undergoes strict and thorough medical assessment to fully identify their particular need.

 

When is TMS therapy recommended?

Antidepressant medications and psychotherapy remain as the first line of treatments for Major Depressive Disorders. Unfortunately, the majority of patients failed to respond accordingly to these conventional treatment methods. If patients failed several times using pharmaceuticals, then doctors may recommend TMS therapy or to combine antidepressant medications and psychotherapy. Also, patients to who cannot tolerate medications might also consider undergoing TMS therapy.

But not everyone can undergo TMS therapy, as the machine functions like an MRI, patients with metallic implants, pacemakers, bullet fragments and the likes are prohibited from using TMS. This can interfere with such metals and may cause adverse side effects.

 

Who will benefit the most from TMS therapy?

Numerous research and clinical data show that patients with resistant to conventional medications respond better to TMS than others. Since TMS is a simple procedure, it does not involve the use of any pharmaceuticals that are known to have severe side effects like weight gain, irritability, sleep problems, digestive problems, and sexual dysfunctions. Patients undergo TMS therapy in a very comfortable clinical setup without the stress of having these problems.

 

How long does it take to see results from TMS?

Each person has their own genetic make-up, the response time from TMS therapy varies from one patient to another. Some patients reported to feel a lot better than the others; they claim to experience relief within the first week of a therapy session. In some instances, patients will notice a big difference in their symptoms within the 4th week of treatment. This huge improvement has a lasting effect on the patient, the majority of patients claim that they can function better without worrying about relapses.

 

However, if TMS works slowly for others it does not mean it’s not effective, some people just take a little more time to readjust the brain and create new neural pathways. But the effects are the same; it relieves depression even for patients with treatment-resistant disorders.

 

How was TMS First Done?
Brain Stimulation Research
Uses of TMS

The first known brain stimulation attempts using electromagnetic stimulation goes as early as 1896 when Jacques-Arsene d”Arsonval of Paris and Silvanus P. Thompson showed the first ever prototype in London. However, it was not until 1985 when Anthony Barker and his team showed the first successful demonstration of Transcranial Magnetic Stimulation at the Royal Hallamshire Hospital in Sheffield, England.

 

How Was it Done?

Barker and his team essentially took a leaf out of Michael Faraday’s book. They made a single Faraday coil and place it above the left prefrontal cortex using a motor strip and saw the right hand moved. Barker’s team first did the experiment on themselves. This single yet monumental experiment created ripples within the medical community. The result created excitement and interest in the international research community about using TMS for various medical usages. Because of such feat producing concrete proof that electromagnetic stimulation of the brain showed a direct tissue response, the medical community credited Anthony Barker as the inventor of TMS.

 

Brain Stimulation Research Studies

Since its discovery, there was an exponential growth of different international studies on brain stimulation. Majority of these studies focuses on the use of TMS in treating different mental disorders, side effects, and most importantly – its efficacy. Today the field has garnered enough topics to have its own called Brain Stimulation.

 

TMS Uses

Health Canada was the first government body to approve the use of TMS in 1997. Soon after, it got its first official use in treating resistant depression in 2002. The US Food and Drug Administration approved TMS therapy in 2008 after taking into consideration its risk and efficacy.  

Today, TMS machine uses electromagnetic wave pulses similar to an MRI machine; it’s generally safe for everyone. Medical providers placed the coil near the prefrontal cortex of the brain associated with depression symptoms. The electromagnetic waves suppress overacting brain regions while activating inactive brain cells. This creates a new chemical balance within the brain structures thus relieving the patients with the depressive symptoms. It’s a simple procedure that does not require any hospitalization, anesthesia, or surgeries. Patients undergoing TMS therapy are kept fully awake and can immediately resume their daily routine following the session.

Some studies even show that lasting effect of TMS without relapse and even without taking antidepressant medications. Numerous research studies have been published since its approval and TMS therapy consistently show great promise of treating resistant major depressive disorder and other mental health diseases.

Just recently, the 2nd International Conference on Brain Stimulation Conference in Barcelona, Spain held on March 6, 2017, awarded Anthony Barker, Ph.D. the International Brain Stimulation award. About a thousand or more people from across the globe attended the conference with professionals from a myriad of disciplines such as neurosurgeons, neurologists, biomedical engineers, psychiatrists, and researchers.

The conference was a great platform for speakers from the international community to present their data and research about the different types of brain stimulation topics. For several days, topics like TMS, deep TMS, ECT, vagus nerve stimulation, effects of ultrasound on brain tissue, and other invasive brain stimulation were presented to the public.

But the highlights of the studies include topics of the potential uses and indications for TMS therapy. Some experts showed different types of research about the future use of TMS for treating addictions such as cocaine, opiates, alcohol, nicotine and even obsessive-compulsive disorder. There was even a research that shows great promise for the potential benefits of TMS in treating pain sufferers and for stroke rehabilitation.

With its success of treating major depressive disorders with no or minimal side effects, TMS therapy is the focus of widespread research studies. TMS providers continue to seek and explore its uses in treating various disorders.

 

Alternative Depression Treatment
Highly Effective
How TMS Works 
No Substantial Side Effects

Many experts now consider depression as a major health issue. It affects more than 14 million American adults every year. Medical experts believed that it will be the second leading cause of disability in the world by 2020. About two-thirds who suffered an episode will at least have another episode during their lifetime. Depression is an incapacitating illness and treatments methods are often ineffective or intolerable because of its adverse side effects.

Current antidepressant medications and therapies failed to at least a third of people suffering from depressive disorders leaving them with inadequate treatment options.

 

TMS as an Alternative Depression Treatment

TMS therapy is a relatively new non-invasive procedure that delivers highly focused magnetic pulses to a specific brain region called the left prefrontal cortex. It stimulates the inactive areas of the brain associated with depression. These electromagnetic pulses are similar to the magnetic field of an MRI procedure. The rapid bursts of magnetic energy passed through a coil and directly to the brain excite neurons which rewire the brain to improve mood behaviors.

As a non-invasive procedure, TMS does not involve any major surgeries, insertion of intravenous lines or any kind of medications that may harm the body. There is no sedation or anesthesia involved during TMS session treatment.

 

An Effective Treatment

Over recent years, experts have discovered newer treatment parameters and more precise targeting locations for TMS. Several studies show that TMS can be an effective treatment not only during the course of 4 to 8 weeks sessions but also having these improvements persist beyond that time.

 

How TMS Works

TMS uses a computer program connected to a small electromagnetic coil which delivers short but rapid bursts of magnetic pulses directly on the left prefrontal cortex of the brain. However powerful these electromagnetic pulses, it does not affect the entire brain. The electromagnetic pulses of TMS can reach about 2 to 3 centimeters into the brain right underneath the treatment coil.

This treatment coil is placed on top of the patient’s head that believed to be linked with mood regulation.

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As electromagnetic pulses reach deeper into the brain, they produce tiny small electrical currents. These electromagnetic currents activate neuron within the brain which believed to release important neurotransmitters.

 

In October 2008, the US Food and Drug Administration approved the use of TMS treatment for the major depressive disorder. This revolutionary treatment option received approval for its safe and effective therapy, particularly for treatment-resistant patients.

 

One of the studies about TMS shows that the procedure was a significant alternative method to preclude impending relapse in 32 of 38 patients or about 84%. This strongly suggests that the efficacy of TMS is seen in the majority of acute treatment-resistant patients. The reintroduction of TMS later in the medical management of depression can safely and effectively prevent relapse.

 

No Major Side Effects

TMS does not have any major side effects unlike its counterparts of conventional depression treatments. This new innovation does not produce common side effects like memory loss, sleepiness, sexual problems, or weight gain. It serves as an ideal major depression treatment because it does not elicit side effects of conventional medications like drug abuse.

As a non-systemic procedure, it does not require any sedation or implantation of other depression treatments like those of deep brain stimulation.

Today, TMS is widely acclaimed for its treatment of major depressive disorder but other studies are underway to prove its efficacy to other mental disorders. Different types of research are being conducted each year to explore possibilities of TMS as a treatment for a wide range of different brain disorders like Generalized Anxiety, Obsessive Compulsive Disorder, Cognitive Impairments, and Tinnitus.

 

What is TMS?
How does it work?
What to expect with TMS
Safety precautions
After treatment 

 

What is TMS?

Transcranial magnetic stimulation or TMS is a non-invasive medical treatment that uses a magnetic field to stimulate nerve cells in the brain mainly for depression. However, recent studies show that TMS can cure a variety of mental disorders including addiction.

 

How does it work?

In this procedure, the electromagnetic coil is placed on the scalp of the patient near the forehead. The electromagnet delivers a magnetic pulse to stimulate nerve cells in the brain that involves regularization of the mood control and depression. TMS activates this region of the brain to reduce the activity associated with depression. It sends stimulation effects in the part of the brain linked with treating depression and mood improvement.

Treatment of depression is through repetitive magnetic pulse called r TMS or TMS. Depression is well treatable but a lot of people failed to achieve success using conventional medical treatments and therapies. TMS, on the other hand, is an effective alternative treatment for depression with fewer or no relapse at all.  Unlike the other procedures including nerve stimulation or deep brain stimulation, TMS is a non-invasive and non-systemic treatment. As a non-systemic procedure, it does not cause any side effects of seizures or any sedation with anesthesia.

Patients with melancholic depression can also benefit from TMS.  There are several studies suggesting on how to use TMS on specific disorders.  Multicenter studies on efficacy for 6 weeks will test whether a longer period of stimulation is more effective in a controlled setting. While another research shows that a right-sided stimulation is more effective.

 

What to expect in a TMS session?

This medical procedure uses an electromagnetic coil extends with a high-intensity current that turned on and off in the coil through the discharge of a capacitor. This is a time-varying a magnetic field which lasts for about 100 – 200 microseconds. The strength is about 1.5 to 2 Tesla at the surface of the coil.

Healthcare professional conducts TMS as an outpatient basis in a clinic and it requires a series of treatment sessions to become more effective and preferably within five times a week for about four to six weeks. The attending doctor will conduct the procedure in the best place. Pacing the magnet on the head and best dose of magnetic energy will be given. Upon the first session of appointment, the patient will be placed in a treatment area where there is a wearing of earplugs, an electronic coil will also be placed in the forehead and switches off and repeated to produce stimulating pulses.

The tapping of the sounds will last in a few seconds and then pause for a while, the feeling sensation on the forehead called mapping. Doctors will then determine the right amount of magnetic energy that patients needed.  

During the actual treatment, once a coil is placed on the forehead and dose is identified, now ready to start the procedure. Once settled in a comfortable chair wearing earplugs and the magnetic coil placed, health care professionals will turn the machine on. The patients will then hear a clicking sound or feel a light tapping on their forehead. The procedure will last about 40 minutes, patients will remain wide awake and alert the entire session. Patients may feel some mild discomfort during the treatment within the first week but will ultimately subside afterward.

 

Safety Precautions

The preparation of TMS should always be observed before applying to patients. TMS treatment is not for everyone, although relatively safe, there are pre-medical evaluation and tests. These include the following:

 

  • Physical examination and doing laboratory tests or any other tests required to make sure that the r TMS is safe and in normal,
  • have a psychiatric assessment to evaluate the mood of depression,
  • any metal or implanted medical device in the body in some patients or people with metal implant device can have the procedure and due to strong magnetic field

 

Furthermore, it is recommended for the following persons who have aneurysm clip or coil, stents, implanted stimulators, implanted vagus nerve or deep brain stimulators, electrodes for brain monitoring, implanted electrode device such as a pacemaker, medication pump, and bullet fragments to undergo TMS. 

 

After TMS treatment

After treatment, normal activities or daily works are normal once the patient was treated, such as driving and working in the offices and others. May different ways to perform its techniques may vary according to the studies for more effectiveness.

 

TMS effectiveness in depressed patients takes about several weeks of treatment depending upon the cooperation of each patient. Symptoms will drastically improve during and even after treatments. There are no significant signs of relapse. When undergoing the procedure, it involves continuing treatment until patients are symptom-free with the hope that will prevent relapses.

 

Depression improves clinically proven with TMS and if there is an episode or return of symptom it can be repeated again called re-induction. All the procedures and management will become helpful for the intervention to prevent and detect the depression or any other mood disorders.

 

Humans are the only species on Earth capable of looking into ourselves. Not just in the soul-searching kind of way, but literally opening our heads and studying the brain. Our brain is what makes us tick, what makes us who we are, and nearly all of our body parts are used to either protect or keep our brain running.

 

Our Brains and Depression

What’s interesting is that our brains are powered by electricity. Our body consumes calories to create energy, which the brain uses to activate its cells and produce the needed signals to keep us alive and make us who we are. Sometimes, the brain fails to function the right way, often caused by infections, abnormalities, or injuries. One such example is depression, a condition where the brain’s altered chemistry causes a person’s thoughts and perception, causing feelings of sadness and disinterest. Sometimes it can be managed using drugs, but medications don’t always work for everyone. Some people are resistant to drugs, others cannot tolerate the drugs itself, and some have persistent or severe depression that won’t fully go away with meds alone.

Through the use of electromagnetism, however, medical researchers and physicians found ways to affect our brain and help treat conditions such as depression. Since several regions of the brain regulate our mood, stimulating these areas could activate neurons in an attempt to awake or realign the circuitry in your brain.

 

How it Works and What to Expect

Before you start a TMS procedure, you’ll need to do two tests: a physical exam and lab tests to ensure TMS is safe for you. TMS is a safe and harmless procedure, but in the realms of medicine, we always need to be as safe as possible. You could have metal plates in your body from surgery, a pacemaker or similar devices, or foreign objects that could be affected by the magnet.

Then, you’ll undergo a psychiatric evaluation, which is especially important if you are suffering from depression. When all is said and done, you’re ready for TMS therapy.

 

Starting Treatment

You’re going to be seated on a chair and the operator will attach sensors to your hand and your head that will monitor your body’s electrical activity. The procedure starts with the physician placing the “coil” over your head activate the machine.

The first step is to activate the coil on certain parts of your brain. When the machine is activated, it will produce a somewhat loud clicking sound and one of your arms or legs may twitch. This procedure is called mapping. Once they are finished with mapping and they have found the area to be stimulated, they will begin the procedure.

The coil will stay on a certain part of your head and the machine will turn the coil on at fixed intervals. The entire procedure may last around 30 to 40 minutes. Afterward, you may feel slight hearing impairment from the loud clicks, and a bit of scalp pain or discomfort. In some cases, you might feel some motion sickness, but all the symptoms will disappear after a few minutes.

The entire therapy may last somewhere between 25 to 40 sessions and is usually done about 5 or 6 days a week.

For more questions about TMS or to schedule a consultation, contact us today.

 

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