Transcranial Magnetic Stimulation (TMS)

What is Transcranial Magnetic Stimulation or TMS?

Transcranial Magnetic Stimulation, or TMS, is an FDA-approved, non-invasive brain stimulation treatment to help patients struggling with mental health disorders including:

Depression
Obsessive compulsive disorder (OCD)
Smoking cessation

TMS is the safest and least invasive brain stimulation therapy currently available. This treatment works through neuromodulation – the stimulation and alteration of nerves that research has shown are involved in mood and behavior.

What Types of TMS Does MUSC Health Offer?

MUSC Health offers three unique options for transcranial magnetic stimulation:

Repetitive TMS (rTMS)

Repetitive TMS, or rTMS, is the traditional approach to TMS. This treatment typically includes six weeks of daily treatments. rTMS takes 20 minutes a session and is done once a day. The MUSC Brain Stimulation Clinic is the first in South Carolina to provide this treatment to people with OCD and those wanting to stop smoking or using tobacco/nicotine.

Accelerated TMS

Accelerated TMS involves 10 minutes a session with multiple daily doses of TMS, aiming to expedite positive outcomes for patients with depression.

SNT, or SAINT, TMS

If you suffer from major depressive disorder (MDD), you may benefit from SNT TMS (formerly known as SAINT TMS). MUSC Health is the first on the East Coast to commercially launch this innovative, and FDA approved, approach in delivering TMS for depression. SNT TMS has nearly an 80% remission rate.

SNT therapy uses MRI scans to target the best part of your brain to treat depression with neurostimulation. This involves getting functional MRI (like movies of the brain, not still images).The targeting process helps not only identify the location for stimulation, but also for correct dosing. A process known as theta burst stimulation involves a pattern of magnetic pulses delivered to cause neurons to fire and rebuild connectivity. The MRI scan, which takes approximately 45 minutes, will occur prior to your treatment. Once the personal target from the scan is analyzed and delivered, treatment can begin. SNT treatment consists of 10 sessions per day for five consecutive days. Each session includes 10 minutes of stimulation followed by a 50-minute rest period.

Dr. Short uses the TMS machine wtih his patient

SAINT TMS

Increased remission rate for depression with new method of TMS.

How Does MUSC Health Use TMS?

MUSC Health uses the all variations of TMS to treat depression, OCD and for smoking cessation. Patients can relax, read, or listen to music while a small curved device, about the size of a cupped hand, delivers 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.

TMS for Depression

Approximately 30% of patients with severe depression fail to respond to treatment with antidepressants. Before TMS was available, "treatment-resistant" patients often received Electroconvulsive Therapy (ECT). While ECT can be highly effective, some patients experience unwanted side effects, including short-term memory loss or headaches. ECT requires a patient to take some time off work and not drive, which is not feasible for many people.

TMS offers more convenience and provides good outcomes for patients who have treatment-resistant depression. Accelerated TMS can be especially beneficial for individuals who have not found relief from depression through conventional treatments. It offers new hope and a chance for a better quality of life.

TMS for Obsessive Compulsive Disorder (OCD)

Obsessive compulsive disorder (OCD) is a chronic, often disabling disorder defined by distressing and intrusive 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 resolved.

TMS was FDA-approved in 2018 for the treatment of OCD, and it is thought TMS modifies the brain networks involving Obsessive Compulsive Disorder. By activating the neurocircuitry of OCD and then stimulating those regions, TMS can reduce symptoms in people with treatment resistance to medications and OCD therapy. The FDA noted that 38% of patients receiving TMS had at least a 30% reduction in symptoms, compared with 11% of patients who received sham TMS. Recent real-world data has proven TMS to be even more successful for OCD treatment than originally thought, with over half (nearly 58%) of patients receiving a clinically significant response to treating OCD symptoms. 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.

MUSC Health was 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 the uncontrollable desire to smoke. 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 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 stimulating brain regions associated with craving. In a prospective, double-blind, randomized, sham-controlled, multi-center trial, 262 people were 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 (18 sessions over six weeks). Of people completing the treatment, 28% quit smoking for more than four weeks, compared to 11% of people who received a placebo. Of people who didn't quit, those who received TMS smoked less per day than those who received a placebo.

MUSC Health was the first service in South Carolina to have TMS treatment for smoking cessation.

Billing and Insurance for TMS

As a patient at the MUSC Health Department of Psychiatry, Brain Stimulation Division, you will receive bills from the physicians and from the hospital. MUSC Physicians (MUSCP) submits bills for the professional fees charged by its physicians. The Medical University Hospital Authority (MUHA) bills for hospital facility charges for the use of equipment, space, and supplies. Both MUSC entities participate with Medicare, BlueCross BlueShield, and various other payers and managed care organizations. They do not, however, participate with all payers. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate. Co-payments will be required before or at the time of service.

MUHA may participate with a health plan, but MUSCP may not. In this instance, you would be responsible for paying for the portion of your physician's bill that your insurance plan does not cover. Depending upon your insurance, you may not receive a bill at all, but instead receive an explanation of benefits, which will outline what your insurance was charged and what was paid on your behalf.

In some instances, your insurance requires a prior authorization before you begin treatment. Without the prior authorization, you will be required to pay for all bills. Some insurers do not require a prior authorization, but whether an authorization is required, it's still not a guarantee of payment. All payments are based on medical necessity and cannot be determined until the claim is processed. The medical documentation will be reviewed in order for the insurance company to determine payment. Thus there is no guarantee how much is covered and if the insurance company does not cover, then the patient is responsible for payment.

Although the FDA approved TMS for the treatment of major depressive disorder in 2008, currently not all insurers are willing to cover TMS for treatment-resistant depression. TMS has evidence to treat depression after 1 medication treatment failure, but some insurers will not cover TMS unless a patient has failed to respond to 4 antidepressant medications of adequate duration and dose during this depressive episode and a trial of psychotherapy. Generally, insurers will not cover TMS for depression in patients with a diagnosis of bipolar disorder.

Disclaimer

Rates and discounts do change, be sure to confirm with the Brain Stimulation Service for any changes in charges that may not have been updated on this website.

TMS Patient Forms and Resources

Forms

Additional Resources

Martha Rhodes: My TMS Journey website
The Clinical TMS Society website