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Transcranial Magnetic Stimulation (TMS) - How Does It Work, Indications, and the Procedure

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Transcranial magnetic stimulation is a type of treatment where magnets are used to generate electrical currents to stimulate certain pathways in one’s brain

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Abhishek Juneja

Published At December 6, 2022
Reviewed AtFebruary 9, 2024

What Is Transcranial Magnetic Stimulation Therapy?

Transcranial magnetic stimulation (TMS) is a non-invasive approach to treating certain neurological and psychiatric conditions. With the help of a magnetic stimulator device, a coil is positioned on the head, from which magnetic pulses are emitted to influence brain activity. Doctors often advise transcranial magnetic stimulation when all other treatments are ineffective and one suffers from side effects from the drugs. TMS has minimal side effects compared to treatment with drugs.

Which Conditions Are Treated With Transcranial Magnetic Stimulation Therapy?

It is mainly used to treat conditions like:

  • Depression - When standard antidepressant drug therapies, psychotherapy, counseling, etc., do not work, repeated transcranial magnetic stimulation is a good option.

  • Degenerative conditions like Parkinson's disease, Alzheimer’s disease, and more.

  • Psychosis.

  • Anxiety disorders.

  • Post-traumatic stress disorder (PTSD).

  • Obsessive-compulsive disorder (OCD).

  • Substance abuse disorders.

  • Pervasive developmental disorders such as Asperger’s or autism.

How Does Transcranial Magnetic Stimulation Therapy Help Individuals?

The brain helps manage thoughts by creating different electrical and chemical messenger pathways. Each type of thought or feeling coincides with a particular pathway or route these signals travel along. When an individual’s brain practices a certain pathway, the better it gets at doing it, and it becomes a habitual memory for the nerve cells and vice versa.

For instance, in the brain of somebody with depression, the activity in certain regions remains quite low. With repeated sessions of transcranial magnetic stimulation, the pathway involved in mood alteration is fired up multiple times, breaking the depression cycle.

When a magnetic field generator or coil is placed near the head of the person receiving the treatment and connected to a pulse generator or stimulator, it produces small electric currents in the brain through electromagnetic induction. This electric current energizes the tissues and stimulates the thought pathways a thousand times in a single transcranial magnetic stimulation session.

The same pathway gets stimulated countless times with multiple sessions, and the practice keeps that particular pathway energized all the time. It effectively changes the firing pattern of the nerve cells, thereby altering the underlying brain dysfunction. Thus, the repetitive application of transcranial magnetic stimulation can produce potentially beneficial effects in curing neurological and psychiatric diseases.

How Does a Transcranial Magnetic Stimulator Work?

It works on a very interesting technology based on Faraday’s law (every magnetic field generates an electric current, and by source, every electric current generates a magnetic field). Here, very powerful magnets are arranged in a special configuration to generate an electrical field from a distance.

This electrical field is pointed in a certain position, to or near the surface of the head, and it will generate an electrical current. These electrical currents stimulate certain brain areas where a group of nerve cells (neurons) is involved. This triggers certain previously inactive pathways to become active. Activating these brain circuits repeatedly, daily, and permanently alters brain functions for the better.

What Benefits Does Transcranial Magnetic Stimulation (TMS) Offer?

Transcranial magnetic stimulation offers noninvasive neuromodulation with several advantages:

  • Targeted Treatment: TMS precisely targets specific brain regions.

  • Minimal Side Effects: Compared to some medications, TMS typically has fewer systemic side effects.

  • Effective for Depression: TMS treats major depressive disorder.

  • Well-Tolerated: This procedure is generally well-tolerated, making it a viable option for individuals who may not tolerate other treatments.

What Is the Procedure Involved in Undergoing Transcranial Magnetic Stimulation Therapy?

  • Step 1 - Consulting the Psychiatrist

The first step of transcranial magnetic stimulation treatment is to schedule a consultation with a psychiatrist. The doctor will explain the procedure and determine whether or not one is suitable for transcranial magnetic stimulation treatment. If the doctor thinks it is required, one may undergo a physical examination and do certain lab tests. One should inform the doctor if the participant is pregnant, under treatment for some other medical condition, or possesses metallic implants or devices attached to the body. Those with a history of seizures, severe headaches, or traumatic head injury should also communicate relevant details with the doctor.

  • Step 2 - Signing the Consent Sheet.

If the doctor determines that the patient can be treated with transcranial magnetic stimulation and the patient is willing to receive the treatment, they will be signing a consent sheet.

  • Step 3- Preparatory Session.

The patient’s brain excitability during the first session is measured by determining a motor threshold. Everybody reacts differently to transcranial magnetic stimulation pulses. For instance, a person with a thicker skull might need stronger pulses. Determining the motor threshold is a two-step process. First, the spot that controls one’s hand muscle is found, and stimulating this part will result in hand cramps. Secondly, the minimal stimulation dosage will be determined at this spot. This dosage is fixed as the motor threshold. The actual treatment location is further to the front of the head, so the ideal spot will also be determined in the initial session.

  • Step 4 - Ongoing Sessions as Per the Doctor's Prescription.

A transcranial magnetic stimulation session lasts thirty to sixty minutes and is performed with a fully conscious participant. After the treatment, the participant is allowed to resume their day-to-day activities normally. One may resume psychotherapy and medications after a series of TMS treatments.

What Are the Side Effects Encountered With Transcranial Magnetic Stimulation?

This treatment is quite safe and well-tolerated by the majority of individuals. One may feel mild pain and discomfort in the scalp at the stimulation site. Rarely may one get contractions and muscle twitches in the face. There might be a headache, a lightheaded feeling, and a tingling sensation for a short while. Very rarely have some encountered seizure attacks or hearing loss. For some individuals suffering from depression associated with bipolar disorder, transcranial magnetic stimulation was found to trigger maniac responses.

What Occurs Following TMS?

After transcranial magnetic stimulation, individuals may experience several effects, including reducing certain neurologic symptoms and improving mood.

Conclusion:

Transcranial magnetic stimulation can be truly beneficial in common psychiatric conditions such as depression, where the fault lies in a brain circuit not getting actively triggered. Undergoing this therapy repeatedly forces the brain to trigger that circuit and permanently alter one’s mood for the better. Many depressed individuals feel happy, more relaxed, and content after therapy. It is tremendously helpful for individuals suffering from treatment-resistant depression. One should discuss the possibility of undergoing transcranial magnetic stimulation with a psychiatrist if they feel it will benefit them.

Frequently Asked Questions

1.

What Is the Function of Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation is a treatment modality that uses a magnetic field to influence brain functioning. Transcranial magnetic stimulation works on two basic principles: electricity and magnetism. In this treatment, an electromagnetic coil is placed on the scalp near the forehead. The electromagnet delivers a magnetic pulse that regulates the nerve cells in the brain involved in mood control and depression.

2.

What Are the Risk Factors Associated With Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation is considered to be well tolerated by patients. The following are the associated risk factors with a transcranial magnetic solution.
 - Headache.
 - Pain in the scalp.
 - Pain in the neck.
 - Dizziness.
 - Lightheadedness.
 - Tingling in the muscles of the face or scalp.
 - Temporary tinnitus.
 - High sensitivity to sound.

3.

What Is the Success Rate of Transcranial Magnetic Stimulation?

Transcranial magnetic stimulation has a success rate of between 70% to 80%, which means that the majority of individuals have got significant relief after treatment.

4.

Does Transcranial Magnetic Stimulation Repair the Brain?

Transcranial magnetic stimulation is recommended to repair damaged neurons in the prefrontal cortex of the brain. It also increases the production of serotonin and repairs the brain’s condition.

5.

Is Transcranial Magnetic Stimulation Therapy Painful?

Transcranial stimulation therapy can be uncomfortable and painful as it stimulates the superficial tissue, scalp muscles, and peripheral nerves. This can cause irritation, pain, and muscle twitches or discomfort.

6.

What Is the Difference Between Transcranial Magnetic Stimulation Therapy and Antidepressants?

Transcranial magnetic stimulation therapy and antidepressants are both treatments that are indicated for depression. Transcranial magnetic therapy stimulation uses magnetic rays to stimulate areas in the brain for regulating mood and emotion. Meanwhile, antidepressants use chemical messengers called neurotransmitters that allow the brain to receive signals from the nervous system. Antidepressants generally increase the levels of neurotransmitters that affect mood and emotion.  Transcranial magnetic stimulation therapy can relieve people who underwent antidepressant treatment and did not get success or cannot tolerate them.

7.

How Can Transcranial Magnetic Stimulation Change the Affected Person’s Personality?

No, transcranial magnetic stimulation cannot change the personality of the affected person. Still, it can relieve depressive symptoms and improve the ability to think and function, which helps the affected patient a lot.

8.

How Can Transcranial Magnetic Stimulation Worsen Anxiety?

Transcranial magnetic stimulation is indicated to treat depression, and anxiety symptoms can increase. However, anxiety is not mentioned as a side effect of transcranial magnetic stimulation therapy, and there is no evidence that transcranial magnetic stimulation worsens anxiety. Most people report feeling calmer and more able to cope with stressors. But a trial in 2011 stated that patients with panic disorder indicated that repetitive transcranial magnetic stimulation therapy suffered from anxiety.

9.

How Many Sessions of Transcranial Magnetic Stimulation Are Needed for Depression?

During the therapy, a patient will receive around 36 treatments over nine weeks. The patient will undergo five weekly treatment sessions for the first six weeks. And then the remaining six sessions over the following three weeks. However, the health care provider may recommend a shorter or longer transcranial magnetic stimulation course, depending on the unique clinical conditions.

10.

Does Transcranial Magnetic Stimulation Therapy Make the Patient Angry?

 
It is observed that in the patients undergoing transcranial magnetic stimulation therapy, 5 out of 30 patients have experienced anger issues.

11.

Can a Patient Drive After Transcranial Magnetic Stimulation Therapy?

Transcranial magnetic stimulation does not require any sedation or anesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time,” so patients can drive home afterward and return to their general activities.

12.

How does Transcranial magnetic stimulation therapy help to get a sound sleep?

Transcranial magnetic stimulation therapy assessed the trait of insomnia in patients with insomnia due to disturbed intracortical excitability. Reduction of an overexcited state in patients with insomnia can effectively improve sleep patterns.

13.

Can a Patient Be Allowed to Drink While Doing Transcranial Magnetic Stimulation?

During transcranial magnetic stimulation, the patient is asked to avoid the consumption of alcohol for better results.
Dr. Abhishek Juneja
Dr. Abhishek Juneja

Neurology

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