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

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 All 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.

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• 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 pathways that communicate through electrical and chemical messengers. 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 the coil is connected to a pulse generator or stimulator, it produces small electric currents in the brain through electromagnetic induction. This electric current is used to energize 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 end up stimulating certain areas of the brain where a group of nerve cells (neurons) is involved. This triggers certain previously inactive pathways to become active. Activating these brain circuits repeatedly, on a daily basis, permanently alters brain functions for the better.

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

1. 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. One may have to undergo a physical examination and do certain lab tests if the doctor thinks it is required. 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, and traumatic head injury should also communicate relevant details with the doctor.

2. 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.

3. Step 3 - Preparatory session.

During the first session, the patient’s brain excitability is measured by determining what is called 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 which controls one’s hand muscle is found, and stimulating this part will result in hand twitches. 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 in the initial session, the ideal spot will also be determined.

4. Step 4 - Ongoing sessions as per the doctor's prescription.

A typical transcranial magnetic stimulation session lasts for 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.

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 one feels it will benefit them.