TMS - FAQ

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RTMS/TMS is the abbreviated from of Repetitive Transcranial Magnetic stimulation or Transcranial Magnetic Stimulator. The term refers to the fact that a magnetic field comprising multiple magnetic pulses per second passes non-invasively through the skull or cranium and no surgery is required. It is this magnetic field which is the basis for the therapeutic change within the brain cells.

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Brain Neurons and neuron transmitters play huge role in mind and mood related psychiatric conditions. For some people the neurons are excessively active and for some it is very less active. This chemical imbalance / neurotransmitter imbalance is believed to be the cause of depression and other mental / mood disorders. Researchers observed that stimulation of cortical neurons transmitters may significantly control a person’s mind and mood. Blood flow and glucose metabolism rise in the activated regions is thought to result in improved mood.

FDA APPROVALS FOR RTMS/ TMS

• In 2006 cleared for the use of depression
• 2009 approved for motor mapping
• 2012 approved for language mapping
• 2013 approved for MDD
• 2014 approved for migraine

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RTMS / TMS is currently being used as potential treatment for many Psychiatric & Neurological disorders. The psychiatric indications include Depression, Schizophrenia, Mania, Post –traumatic Stress Disorder, Obsessive- Compulsive Disorder, Phobias, Panic Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Eating Disorder, Addictions etc. the neurological condition where RTMS / TMS has proved to be useful are rehabilitation of Stroke, Parkinson’s disease, Migraine, Multiple Sclerosis, Autism, Epilepsy, Fibromyalgia and Chronic Pain. Details of the utility of RTMS / TMS in these conditions are given below. There are other disorders as well where RTMS / TMS is currently being tried.

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Yes. RTMS / TMS will not interfere adversely with medication. Rather, both will have a complimentary effect on the underlying disease process.

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No, it is not. RTMS / TMS is a treatment option and like all other treatments for any other illness, it too has its limitations. It will not help everyone who receives it. There will be some who benefit less than the others. But it is a very effective and extremely safe treatment alternative, both in treatment resistant cases and also as first line treatment. The studies indicate the success rate of TMS at 65-80%. But the major advantage being, it is safer than other methods available to treat depression.

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The efficacy of RTMS / TMS in treating Depression has been clearly established. It is useful both in treatment resistant Depression and also as a first line treatment modality. There are studies which have shown that its benefits equal those seen with the use of anti-depressants. When given in combination with medication. Relief from symptoms and recovery can be anticipated quicker, the dose requirement of medication goes down and the adverse effects associated with continued intake of higher doses of medicine would also decrease. Overall, RTMS / TMS has been considered a ‘life saver’ in Depression.

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Many patients with schizophrenia experience auditory hallucinations. Following RTMS / TMS, a majority of patients experience a significant reduction in these voices. Patients of chronic Schizophrenia often exhibit negative symptoms such as lack of motivation, lack of interest or pleasure, lack of energy, social withdrawal, decreased speech etc. Use of RTMS / TMS has enabled patients to experience a significant decrease in the severity of the negative symptoms.

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Yes. RTMS / TMS has been shown to not only bring about significant improvement in the Obsessive thoughts and Compulsive urges but it also helps to improve the mood of the individual.

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Yes. Where anxiety is present as a part of a Depressive illness, the treatment for the depression will help to decrease the symptoms of anxiety. However, RTMS / TMS will also treat Anxiety disorders such as Panic Disorder, Post Traumatic Stress Disorder & Phobias, in addition to OCD (discussed above).

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Yes, RTMS / TMS is useful in treating the Manic phase in Bipolar Disorder, in addition to its antidepressant effects.

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Yes. When used in the inhibitory mode. RTMS / TMS can bring down the Hyperactivity in a child who has ADHD. This could result a significantly low dose of medication being required to manage the problem in addition to improving the results with other interventions.

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Yes. There is reduction in tics following a course of RTMS / TMS.

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Studies have shown that RTMS / TMS can help some people with Eating Disorders such as Anorexia Nervosa & Bulimia Nervosa. We are recommending that a trial of RTMS / TMS should be given in these conditions.

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Craving is seen to go down following application of RTMS / TMS. So, it would be a worthwhile modality to try as a part of overall treatment for Chemical Dependence.

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Following a course of RTMS / TMS, there is a decrease in rigidity & slowing (Bradykinesia), improvement in the abnormal movements (Dyskinesia) and an improvement in walking as well, improvement in speech is also noted.

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Yes. A course of RTMS / TMS has been shown to improve spasticity, decrease weakness or paresis and induce movements in paralyzed limbs. These improvements have induced even several years after the Stroke happened.

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The use of RTMS / TMS in MS has been associated with decreased spasticity in the limbs, improved hand dexterity & improvement in urinary tract related problems.

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Yes. It has been used for its role in preventing the Migraine attacks from taking place and can reduce the frequency & severity of the Migraine headache. RTMS / TMS is now FDA approved to treat migraine.

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After a course of RTMS / TMS, children with Autism showed fewer symptoms of hyperactivity, sensory overload and repetitive behaviours. The results show a great deal of promise in reducing the severity of the distressing symptoms of Autism and, as a result, helping in better communication & social interaction. The treatment does not adversely affect areas of “giftedness” in the treated children.

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Patients report a measurable reduction in pain after RTMS / TMS. It has a selective effect by increasing pain tolerance & altering pain processing, thereby providing long-lasting pain relief.

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Yes. Amblyopia is the most prevalent cause of visual impairment in a single eye, affecting millions of people in India. If not detected early enough-before seven to twelve years of age-the condition has been considered untreatable. Recent studies show that RTMS / TMS therapy improved contrast sensitivity in patients amblyopic eyes.

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Yes. RTMS / TMS is very safe treatment modality. It is generally considered to be free from side effects when proper procedures are followed. Over the years since its introduction, safety guidelines have been developed which minimize risks. The main complaint from a small percentage of patients is discomfort in the scalp or a headache during and immediately following the stimulation session. The can be prevented or treated with usual pain medications such as aspirin or ibuprofen.

Another problem may be ringing the ears caused by the noise of the stimulating coil, so earplugs are typically worn during the procedure which cut the sound by up to 30 Decibels. Seizures are the major possible risk associated with RTMS/ TMS, although they have only been reported in less than 1% patients thus for out of the tens of thousands of sessions that have been given worldwide. RTMS / TMS safety guidelines were established in 1993 and revised in 1996 and when these have been followed no seizures have been reported. These guidelines are strictly followed at out clinic.

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Patients can hear a loud clicking noise when the magnetic pulse is applied, so earplugs are normally worn to avoid discomfort. There is also a tingling sensation which can be felt in the scalp to a greater or lesser degree by patients. It is rarely uncomfortable and usually stops being a disturbance after the first 3 -4 sessions. Some patients even report that they become so accustomed to the feeling that they can tell when the physician is stimulating the correct spot. .

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Medicines will always remain the mainstay for treatment of various disorders. However, there are studies available now which report that the therapeutic effects RTMS / TMS in Depression match those produced by medicines. Currently, our understanding & experience show that if RTMS / TMS is started in a patient on medication and is effective, there would be a quicker onset of recovery, a decrease in the dose of the required medicine, a decrease in the adverse effects produced by medicines and better compliance. Where medicines have not helped in recovery or remission, RTMS / TMS has the potential to become the #1 alternative treatment in such drug-resistant cases.

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ECT is a highly effective but invasive but invasive treatment for Major Depression which stimulates the entire brain with a large amount of electricity in an non-focussed way, thereby causing brief unconsciousness, a lot of cognitive side effects & memory disturbances. RTMS / TMS is a non-invasive method of stimulating the brain through the use of focused magnetic fields in a variety of Psychiatric & Neurological disorders. RTMS / TMS has not been shown to cause memory loss or loss of consciousness. It does not require anesthesia, unlike ECT.ECT is undoubtedly more effective as an anti-depressant in Major Depression but RTMS / TMS has a superior side effect profile to ECT, apart from the much larger spectrum of disorders where it is effective.

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Currently available data from repeated application of high intensity, time-varying magnetic fields to humans, as in magnetic resonance imaging, do not suggest that the long-term risks of RTMS. TMS are significant.

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Before treatment starts, an MTI of the head is advisable. This helps in an accurate determination of different sites of stimulation during the course of treatment. The MRI has to be done at a centre recommended by us so that correct localization of areas of brain can be done

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Different disorders require different protocols for RTMS / TMS. Usually, 20 to 30 sessions, each lasting 20 to 30 minutes, are required. These are done at a frequency of either once or twice a day. When 2 sessions are done in a day, there is a gap of 45 to 60 minutes between sessions.

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Typically, results are achieved within one or two weeks of beginning treatment. Most patients tend to be aware of therapeutic benefit only in the second week of treatment. Late-responders may require sessions going into the third week to achieve significant reduction in symptoms.

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All chronic illnesses may need maintenance therapy. Usually, this would be done with medication. However, in certain cases, it may be advisable or even desirable to have follow – up RTMS / TMS sessions 6 to 12 months after the initial phase of treatment is over. This can be discussed with your treating doctor.

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Different disorders have different protocols for RTMS / TMS. Costs ofdifferent packages are available upon request.

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