Repetitive Transcranial Magnetic Stimulation (rTMS)

What is rTMS?

30% of patients fail to respond to antidepressants for depression. Some patients who have been treated with multiple antidepressants are still severely depressed. After ten years of testing, in 2008, the FDA approved a new technique for assisting previously treatment-resistant patients.

Repetitive Transcranial Magnetic Stimulation, or rTMS, is a non-invasive procedure in a doctor's office.

During the 20-minute procedure, the patient can relax, read, or listen to music without anesthesia. A small curved device, about the size of a cupped hand, rests lightly on the patient's head, delivering focused magnetic stimulation directly to the area of the brain thought to be involved with regulating mood. The magnetic field pulses are the same strength as those used in magnetic resonance imaging (MRI) machines. Typically patients receive six weeks of daily treatment, and some receive regular intermittent treatments to alleviate their low mood.

rTMS for Depression

"Treatment-resistant" patients often receive Electroconvulsive Therapy, or ECT. While ECT can be highly effective, some patients experience unwanted side effects, including short-term memory loss or headaches. Some patients can't take off work or from driving a car as required during an ECT treatment course. rTMS results are similar to those of ECT but with fewer side effects. It offers more convenience as the patient tends to be more mobile and productive.

TMS for OCD

Obsessive-compulsive disorder (OCD) is a chronic, often disabling disorder defined by unwanted and distressing thoughts and repetitive behaviors that the person feels driven to do. About 40% of people with OCD do not respond to medications or OCD therapy and few people find their symptoms resolve.

TMS was FDA approved in 2018 for the treatment of obsessive compulsive disorder (OCD) and it is thought TMS modifies the brain networks involving OCD. TMS for OCD involves 29 treatments done once daily for five days a week. Each session involves the patient be provoked by the things they have obsessions or compulsions for about five minutes before the TMS starts. By activating the neurocircuitry of OCD and then stimulating those regions with TMS can reduce OCD symptoms in people with treatment resistance to medications and OCD therapy.

The FDA noted 38% of patients receiving dTMS had at least a 30% reduction in OCD symptoms, compared with 11% of patients who received sham TMS. Post marketing analysis of 219 patients from 22 community sites demonstrated a response rate of 57.9% after 29 sessions, with improving response rates and response magnitudes with longer treatment durations, 50% at 31 days and 78% after 60 days.

Studies suggest that the mechanism of action of TMS for OCD is different from medications and OCD therapy, and non-response to either is not a predictor of response to TMS. We are the first service in South Carolina to have TMS treatment for OCD.

TMS for Smoking

Smoking is one of the leading causes of death in developed countries. The addiction to nicotine, similar to the addiction to drugs and alcohol, involves modulation of the brain reward system and causes uncontrollable desire to smoke. Approximately 38 million U.S. adults smoke cigarettes, and 480,000 die from smoking each year. Cigarette smoking has been found to harm nearly every organ system in the body and is the leading cause of preventable death in the U.S. and of disease burden worldwide (Brian L et al., JAMA Intern Med 2014). Many people can't quit alone and fail to respond to nicotine replacement therapies.

TMS was FDA approved for smoking cessation in 2020. The TMS reduces craving by stimulation brain regions associated with craving. In a prospective, double blind, randomized, sham controlled, multi-center trial which enrolled 262 people randomized into two groups: an active treatment group treated with Brainsway's H4 Deep TMS coil, and a sham (placebo) control group. The treatments were performed daily, five days a week for three weeks, followed by an additional three sessions once a week for three weeks (for a total of 18 sessions over the course of 6 weeks). Of people completing the treatment, 28% quit smoking for greater than four weeks compared to 11% of people that received placebo. Of people that didn't quit, those that received TMS smoked less per day than those who received placebo.

We are the first service in South to have TMS treatment for smoking cessation.