Transcranial Magnetic Stimulation (TMS)

A NEW HOPE ARISES

WHAT IS TRANSCRANIAL MAGNETIC STIMULATION?^[1]

Transcranial magnetic stimulation, or TMS for short, is a non-invasive medical procedure that utilises magnetic fields to stimulate neurons (nerve cells) in your brain to lessen the symptoms of depression and other conditions of the brain. It’s considered a non-invasive treatment because it’s accomplished without cutting the skin. It’s used when standard forms of treatment have failed to work as expected.

HOW DOES IT WORK?^[1]

Here’s the gist. The neurons in your brain use minute amounts of electricity to send messages and information between them and the rest of your body. Neuroscientists and researchers have discovered that special magnets may positively affect or stimulate the neurons to be more active and send signals or messages.

For example, people who suffer from depression and other brain-related conditions have decreased brain activity in certain areas of the brain. The magnets in TMS have an electromagnetic coil that conveys magnetic pulses, which influence neurons in the part of the brain concerned with depression. The electromagnetic coil is placed beside the scalp (of the head) nearest the brain area of concern to increase activity. The magnets used in TMS are special and not your typical refrigerator magnets, okay? So, stop wondering if the refrigerator magnets will work the same for you. Please note that how TMS works hasn’t been completely understood and explained. But it demonstrates much potential in treating several medical conditions.

WHICH MEDICAL CONDITIONS MAY BENEFIT FROM TMS?^[1]

The following medical conditions may benefit from treatment with TMS:

Depression

Up to 60% of people suffering from stubborn depression admit that their symptoms improve after undergoing TMS. Moreover, this long-term positive effect can be appreciated up to a year after treatment.^[2]

Migraines

Research studies have stated that treatment with TMS may decrease the number of migraine episodes, including the severity of pain.^[3]

OCD or obsessive-compulsive disorder

Studies reveal that up to 45% of people undergoing TMS therapy for OCD report a decrease in the severity of their symptoms.

Smoking cessation

A study published in 2021 revealed that TMS could affect brain areas responsible for cravings, including smoking. Another study showed that the success rate (quit rate) could be as high as 28% even after four months.^[5]

TMS is usually a second-line or alternative treatment for the abovementioned medical conditions. It’s reserved for conditions that don’t respond to standard forms of treatment. The medical conditions TMS has approval for use as treatment will vary in different countries. Medical authorities in the UK, US, Canada, Australia, New Zealand, Israel, Germany, and Finland approve using TMS primarily for depression and other brain-related conditions that aren’t responding as expected to treatment. Please note that different types of TMS exist for different medical conditions.^[6]

Research studies are ongoing to see if TMS could be useful for the following conditions:

SOME THINGS TO EXPECT BEFORE, DURING, AND AFTER TMS^[1]

1. TMS is generally regarded as safe with a low risk of side effects, but it’s not suitable for everyone. It’s contraindicated if you have any piece of metal permanently situated in your head, like metal plates, cochlear implants, aneurysm clips, etc. Dental fillings and braces are exempt. TMS is also not advisable for people diagnosed with epilepsy or those who have suffered a severe head injury in the past. Pregnancy is also a contraindication of TMS. If you have a pacemaker, schedule a consultation with your cardiologist if you want to undergo TMS.
2. You may feel anxious before the procedure. That’s understandable. Talk to your healthcare provider about the procedure to ease your mind.
3. TMS treatment can last from 30 minutes to one hour, five times a week. It can last for one to one and a half months. This frequency and duration is the usual schedule for the treatment of depression. Scheduling for other medical conditions can vary depending on prevailing protocols and response to treatment.
4. Before the procedure, remove anything on your body that has metal, like eyeglasses with metal frames, jewellery or cell phone.
5. During the procedure, you’ll be seated on a comfortable chair, and a technician will place the magnetic coil on your head. The coil may be housed in a helmet or at the end of an extension arm. The coil’s position relative to your head will depend upon the condition being treated. The technician will also give you earplugs to protect your ears. The first session will usually take longer than the succeeding ones because the technician will take some baseline measurements. The technician will then gradually increase the strength of the magnetic pulse. You can feel this as a gentle tapping-like sensation on your head.
6. Don’t be surprised that your fingers, thumbs, or hands may experience slight movement or twitching during the treatment. The technician trained in the procedure will tell you it’s normal. The twitching will also inform the technician that the strength of the magnetic pulse is sufficient. You’ll also hear clicking sounds as the magnet turns on and off during the procedure.
7. You can go about your normal routine right after the treatment.
8. The table below summarises the side effects of TMS:
   
   

   Extremely Rare Side Effect	Common Side Effects
   Seizures (<1% of treatments)[7]	Ringing sensation in your ears. Headaches Dizziness Neck pain Scalp pain (mild) Increased sensitivity to sound Discomfort or mild pain in the face, eye, skin, or toothache.

   
   

   *Common side effects are mostly mild and transient, happening after your therapy for a few minutes.

   
   

ADVANTAGES AND DISADVANTAGES OF TMS^[1][8]

Advantages

Current available clinical data shows convincing evidence that TMS works for a variety of brain-related conditions, especially for depression. It’s even safe and effective for treating depression among children and adolescents. It doesn’t require sedation or anaesthesia, is well-tolerated, and is non-invasive. It can improve the quality of life and even save a life. Depression is the leading cause of suicide worldwide. It’s present in at least 50% of people who commit suicide. Just imagine the impact that TMS can have on these worrying statistics. Let’s not forget the numerous systemic side effects associated with antidepressant drugs. The most serious side effect is a seizure, and it’s extremely rare. Other usual side effects are mild and transient. Lastly, it’s an outpatient procedure in which you can resume whatever you plan to do after the treatment.

Disadvantages

TMS isn’t a one-time treatment. Therapy can last several weeks, depending on your medical condition and response to treatment. In addition, the process for insurance coverage can be burdensome or may not cover it at all. Furthermore, the availability of TMS might be limited in the area you’re residing in.

Up to the time of this writing, TMS has been substantially studied as a treatment for depression. More research is being done to substantiate its efficacy for other medical conditions. Initial results from research on these conditions show great promise and hope. If you have a medical condition that is not responding to standard treatment, you may benefit from TMS. If you want to know more about TMS, schedule an appointment with your primary healthcare provider and ask about it.