Frequently Asked Questions About TMS - Johns Hopkins ...

Transcranial Magnetic Stimulation (TMS) is a non-invasive method of brain stimulation used to treat major depression in the Johns Hopkins Brain Stimulation ... SkipNavigation COVID-19Updates Masksarerequiredinsideallofourcarefacilities.Wearevaccinatingalleligiblepatients.Learnmore: Vaccines,Boosters&AdditionalDoses|Testing|PatientCare|VisitorGuidelines|Coronavirus|EmailAlerts FindmoreCOVID-19testinglocationsonMaryland.gov. WhydoesrTMSwork?rTMS (repetitivetranscranialmagneticstimulation)hasbeenshowntoproducechangesinneuronalactivityinregionsofthebrainimplicatedinmoodregulation,suchastheprefrontalcortex.Aseachmagneticpulsepassesthroughtheskullandintothebrain,thisinducesbriefactivityofbraincellsunderlyingthetreatmentcoil.ThefrequencyofpulsedeliveryalsoinfluenceswhetherbrainactivityisincreasedordecreasedbyasessionofrTMS.Recentstudiesalsosuggestthatstimulationovertheleftandrightsidesofthebraincanhaveoppositeeffectsonmoodregulation.WhenisrTMSused?Antidepressantmedicationsandpsychotherapyarethefirstlinetreatmentsformajordepression.Thesetreatments,however,donotworkforallpatients.Intheseinstances,rTMSmightbeusedasanalternativetreatment,ortoaugmentantidepressantmedicationsorpsychotherapy.Patientswhohavefailedtoachieveanadequateresponsefromantidepressants,orwhoareunabletotoleratemedications,mightconsiderrTMStherapy.WhathappensduringanrTMSprocedure?BecauserTMSusesmagneticpulses,beforebeginningatreatment,patientsareaskedtoremoveanymagnetic-sensitiveobjects(suchasjewelry,creditcards).Patientsarerequiredtowearearplugsduringtreatmentfortheircomfortandhearingprotection,asrTMSproducesaloudclickingsoundwitheachpulse,muchlikeanMRImachine.PatientsareseatedduringeachsessionofrTMS. DuringthefirstrTMSsession,severalmeasurementsaremadetoensurethattheTMScoilwillbeproperlypositionedoverthepatient’shead.Oncethisisdone,theTMScoilissuspendedoverthepatient’sscalp.TheTMSphysicianthenmeasuresthepatient’smotorthreshold,byadministeringseveralbriefpulses.Themotorthresholdistheminimumamountofpowernecessarytomakethepatient’sthumbtwitch,andvariesfromindividualtoindividual.Measuringthemotorthresholdhelpsthephysicianpersonalizethetreatmentsettingsanddeterminetheamountofenergyrequiredtostimulatebraincells.Oncethemotorthresholdisdetermined,thecoilisthenbroughtforwardsothatitrestsabovethefrontregionofthepatient’sbrain.Treatmentisthencommenced. Duringthetreatment,patientswillhearaseriesofclickingsoundsandwillfeelatappingsensationunderthetreatmentcoil.Motorthresholdisnotcheckedateverytreatmentbutmaybereassessedifthereisconcernitmayhavechanged,forexample,becauseofachangeinmedication.WhoadministersrTMS?rTMSisalwaysprescribedbyaTMSphysician.AtJohnsHopkins,allTMSphysiciansarespecificallyTMScredentialedbytheHospital.TheinitialmotorthresholdisalwaysdeterminedbyaTMSphysician.ThetreatmentitselfisadministeredbyanexperiencedTMStechnicianunderthesupervisionoftheTMSphysicianorbytheTMSphysician.TheTMStechnicianorphysicianwillalwaysbepresenttomonitorthepatientduringthetreatment.Thepatientcanstopatreatmentatanytimebyaskingthestaffmemberpresent.HowlongisanrTMSprocedure?rTMStherapyinvolvesaseriesoftreatmentsessions.TreatmentsessionsvaryinlengthdependingontheTMScoilusedandthenumberofpulsesdeliveredbuttypicallylastaround30–40minutes.PatientsreceiveTMS5daysaweek.AtypicalcourseofrTMSis4to6weeks.However,thiscanvarydependingonanindividual’sresponsetotreatment.DoIneedtobehospitalizedforacourseofrTMS?UnlikeECT,rTMSdoesnotrequireanysedationorgeneralanesthesia,sopatientsarefullyawakeandawareduringthetreatment.Thereisno“recoverytime”,sopatientscandrivehomeafterwardsandreturntotheirusualactivities.Whataretheside-effectsofrTMS?rTMSiswell-toleratedandassociatedwithfewside-effectsandonlyasmallpercentageofpatientsdiscontinuetreatmentbecauseofthese.Themostcommonside-effect,whichisreportedinabouthalfofpatientstreatedwithrTMS,isheadaches.Thesearemildandgenerallydiminishoverthecourseofthetreatment. Over-the-counterpainmedicationcanbeusedtotreattheseheadaches.AboutonethirdofpatientsmayexperiencepainfulscalpsensationsorfacialtwitchingwithrTMSpulses.Thesetootendtodiminishoverthecourseoftreatmentalthoughadjustmentscanbemadeimmediatelyincoilpositioningandstimulationsettingstoreducediscomfort.TherTMSmachineproducesaloudnoiseandbecauseofthisearplugsaregiventothepatienttouseduringthetreatment.However,somepatientsmaystillcomplainofhearingproblemsimmediatelyfollowingtreatment.Noevidencesuggeststheseeffectsarepermanentifearplugsarewornduringthetreatment.rTMShasnotbeenassociatedwithmanyoftheside-effectscausedbyantidepressantmedications,suchasgastrointestinalupset,drymouth,sexualdysfunction,weightgain,orsedation.ThemostseriousriskofrTMSisseizures.However,theriskofaseizureisexceedinglylow.AtJohnsHopkins,wefollowup-to-datesafetyguidelinesthataredesignedtominimizetheriskofseizures.WhilerTMSisasafeprocedure,itisimportanttopointoutthatbecauseitisanewtreatment,theremaybeunforeseeablerisksthatarenotcurrentlyrecognized.WhocannotgetrTMStherapy?Patientswithanytypeofnon-removablemetalintheirheads(withtheexceptionofbracesordentalfillings),shouldnotreceiverTMS.Failuretofollowthisrulecouldcausetheobjecttoheatup,move,ormalfunction,andresultinseriousinjuryordeath.ThefollowingisalistofmetalimplantsthatcanpreventapatientfromreceivingrTMS:AneurysmclipsorcoilsStentsintheneckorbrainDeepbrainstimulatorsElectrodestomonitorbrainactivityMetallicimplantsinyourearsandeyesShrapnelorbulletfragmentsinorneartheheadFacialtattooswithmetallicormagnetic-sensitiveinkOthermetaldevicesorobjectimplantedinorneartheheadDownloadPatientScreeningFormforMetalWhowillbenefitthemost?Existingevidencetodatesuggeststhatpatientswhoarelesstreatment-resistantrespondbettertorTMSthanthosewhoarehighlytreatment-resistant.However,thereismuchyettobelearnedaboutparticularvariablesthatmayimpactresponsetorTMS.ResearchersarepresentlyconductingclinicalstudiestoevaluatewhowillbenefitmostfromrTMStherapy.Forexample,thereisalotofinterestinevaluatingwhetherrTMSwithantidepressantmedicationsismoreeffectivethanrTMSalone.HowcanIgetrTMStreatment?rTMSisoneofthebrainstimulationtreatmentsfordepressionofferedatJohnsHopkins.Beforeschedulingyoufortreatment,youmustfirstbeevaluatedbyoneofourTMSpsychiatriststodetermineifrTMSwouldbesafeandappropriateforyou.IfyouresidelocallyandareinterestedinbeingevaluatedforoutpatientrTMStreatment,ortolearnmoreaboutourprogram,pleasecontact MichaelTibbs. 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