What is Transcranial Magnetic Stimulation? Brain Center TMS

Learn how Transcranial Magnetic Stimulation (TMS) can help with mental health disorders and other ... What is TMS? ... Arch Neurol 2002; 59(3):413-417. FreeConsultation 619-419-0901 FreeConsultation 619-419-0901 TranscranialMagneticStimulation:AnEffectiveNoninvasiveTherapy TableofContents WhatisTMS?|Long-TermEffects|TMSasTherapy|TMSforDepression|TMSforCNSDisorders| TMSforOCD|SafetyofTMS|ADeeperLook|References|InfoVideo Forcenturies,cliniciansandneuroscientistshavedreamedofamethodtostimulatethebrainwithouttheneedforanesthesiaorsurgery.Severaldecadesago,PenfieldandPerotdemonstratedhowelectricalstimulationcouldimpactpatientsinanopencraniotomy,whichservedasafirststepinthinkingaboutvariousstimulationtechniques.1,2 TranscranialMagneticStimulation(TMS)maybetheanswertothedreamofthousandsofspecialistsbystimulating,noninvasively,thebrainandnervestructuresinawakeadults.Inaddition,itmaybethekeytounderstandingbrain-behaviorrelationships.However,wemustkeepinmindthatourknowledgeofTMSremainslimitedbecauseithasbeenonlyafewdecadessinceitsdiscoveryandapplication. MultiplestudiesarestillneededtounderstandtheexactmechanismsbehindTMS,sincetheparameters,suchasintensityandfrequency,varyforeachperson.Evenso,todaylargeorganizations,suchastheFDA,haveapproveditsuseforcertainpathologies,whichdefinitelysupportsthebeliefinthepotentialofTMS.ThisarticleisacompactoverviewoftheoperationandapplicationofTMS. WhatIsTranscranialMagneticStimulation? Inshort,itisanon-invasiveneurophysiologicaltechniquethatcanstimulatethehumanbrainthroughtheintactskull,withoutproducingsignificantdiscomfort.Inanotherera,wewouldcallitamiracle.However,thelackofknowledgeaboutitsexactmechanismstakesusabitfurtherawayfromthiseponymous. ItwasdiscoveredanddevelopedbyBarkerandcolleaguesin19853andhasbeenusedinhealthyandpsychiatricallydisturbedpatientstoexploretheircorticalfunctions.Somestudies(evenoldones)havetriedtodemonstrateanearlytherapeuticeffect.Mostofthesestudiesfocusedontheprimarymotorcortex,althoughmuchattentionwasalsodivertedtodepression,whereitappearstobequiteeffective.4 Simplyput,TMSusesmagneticstimulatorsthatconsistofsmallcapacitorsthatdischargecurrentsofextremelyshortdurationthroughaninductioncoilplacedonthescalp5.Theideaistocreateamagneticfieldfromthecurrentthatpassesthroughthebrainperpendicularlyandreachesvaluesupto3Tesla.Inthisprocess,partofthecurrentisdisplacedandcreatesasecondside(secondaryelectriccurrent/Eddy)inthebrain,whichalsohassomeeffect. Duetotheshortdurationoftheoriginalcurrent,theintensityofthemagneticfielddecreasesrapidlyanddoesnotallowittoreachlongdistances.Therefore,theeffectisthoughttobelimitedtothecortexandpartofthesubcorticalwhitematter.6 Thesecretisinvaryingtheintensityandfrequencyoftheimpulsesthroughthecoiltoachievediversestimulationsandreadingsofthebrain’sfunctioning.Thesearethepatternsthatarestillunderinvestigation,however,weknowenoughtoexerteffectsinvariousbrainsectorsandrecordthem. Forexample,stimulationintheprimarymotorcortexmayactasaninhibitorofthecorticospinalpathwayresponsibleformuscleactivationonthecontralateralsideofthebody.Thiscanberecordedasasmall“twitch”usingelectromyography.Thisisthepotentialevokedmotor(MEP). Ifwedonotuseasingleimpulse,butvarytheamount,anduseevenpulsesthroughthecoil,wecanrecordtheinhibitionandexcitationofthemusclefibers,thusrecordingthefunctioningofthecorrespondingcircuits.ThereisawholerangeofpossibilitieswiththeTMS.Wecancreateshortorlongrepetitivepulses(rTMS),evenregularorwithaspecificpatternincertainareasofthecortex. However,perhapsmostinterestingly,TMScancauselong-termchangesbycreatingspecificprotocols.Buthowisitmaintained?Well,TMSgenerateschangesinsynapticplasticity,whichensuresaprolongedeffect7.Ofcourse,thisrequiresprecisestimulationpatterns,appliedinspecificprotocolsthatcantriggerarealresponseontheplasticityoftheneurons. ThefirststepofrTMS(whichhasdemonstratedrealtherapeuticeffects)wastoovercometheeffectivenessofconventionaltreatmentsofrefractorypatients,suchaselectroconvulsivetherapy.rTMSwasfirstusedin1993asatreatmentformajordepressioninrefractorypatients8.Afterovercomingthatfirststep,morein-depthanddescriptiveresearchwasproposedonthevariouspatternsandprotocolsthatcouldbeusedinotherdiseases. NeuronalPlasticity–TheSecretofLong-termEffects ResearchthathasdemonstratedtheeffectsofrTMSonsynapticplasticityhasfocusedontheprimarymotorcortex,althoughtherearemanystudiesrelatedtodepressionandotherpsychiatricdisorderssuchasanxietyandOCD. Accordingtothesestudies,dependingontheintensityanddirectionofthecurrent,itispossibletoactivateanentirepathwayofneurons(suchasthecorticospinaltract)directlyortrans-synaptically.Weknowfrompreviousstudies,especiallyanimal-basedstudies,thatrepeatedimpulsesthroughneuronscanincreaseordecreasesynapticconductioninthelongterm,whichisknownaslong-term“depression”(LTD)or“potentiation”(LTP).9 Thisisthebasisfortheshort-termeffectofrTMS.ByincreasingtheintensityofrTMS,wecangeneratechangesinneurons,creatingnewsynapticinterconnectionsthatstimulatevariousreceptors.Themoreintenseandrepeatedtheimpulses,thelongerthechangeswilllast.However,inordertoobtaindefinitiveresults,changesattheproteinlevelarenecessary. ThisconclusionwassupportedbystudiesonrodentbrainswhereitwasrevealedthattherearechangesatthemolecularlevelwhichmaybethebasisofsynapticplasticityandthecrucialeffectofrTMSinhumans9.Accordingtotheavailabledata,therearenotonlychangesinsynapticstructure(andneuronalinterconnections),butalsodynamicchangesincalciumreceptors,whichmodulatetheexpressionofglutamatereceptors10.Somedataevenshowearlygenechangesthatregulatetheexpressionofpreviousgenes. Inaddition,thereseemstobeanothermethodthatcanalsoaffectsynapticplasticity,whichisknownas“spike-timing-dependentplasticity.”Itisakindofassociativestimulationthathasafixedimpulse(theconventionalSMT)andtheelectricalstimulationofaperipheralnervewhichcarriesitsimpulsetothecortex11. Othermechanismscanalsoaffectsynapticplasticity,however,theonesthathavebeenmoststudiedaretheoneswehavediscussedabove.Still,wecannotruleouttheimpactofrTMSthathasevenhadeffectsontheneuroendocrinesystembyloweringcortisollevelsinrats.Dataaresomewhatsparseonitseffectsbeyondsynapticplasticity;nonetheless,itisreallypromising. Approaches:rTMSasaTherapy TheeffectsofrTMSusuallylastabout30-60minutesinhumans,dependingonprotocolsandusagepatterns,suchaspulsenumber,rateandintensity12.Ofcourse,ifthisweretheonlyeffect,rTMSwouldnotmakerealsense.Permanentchanges(oratleastlongerduration)arecrucialforusingitasatherapy. Repeatedinductionofplasticityseemstofillthatgapbycreatingtemporarychangesforalongtime(LTP/LTD).Thisseemstodependonthenumberofsessions,soprotocolsof10ormoredaysofuse(onceaday)areoftenapplied.Sofar,depression(forexample)maywarranttherapiesofuptosixweeks,atleast20-30sessionsforbesteffects13.Theideaistocreatestructuralandfunctionalchangesgradually,to“regularize”theneuronalinterconnections. InordertoapplyrTMS,thepatientmustbeseatedorina“relaxed”position,inacomfortableenvironment.SomeevenconsiderusingrTMSpriortophysicalorpsychologicaltherapy,whichseemstocausedramaticchangesandincreasesitseffectivenessdramatically14.WewilldiscussthepathologieswhererTMShasproventobeeffective,goingdeeperintotheirtheoreticalbasesandthevariousstudiesthatcorroboratethesedata. MajorDepression Majordepressionisaworldwidehealthproblem.Muchattentionhasbeengiventomentaldisordersinrecentyears,yetthemanagementofthisillnessremainsachallenge,evenforexperiencedclinicians.TheideaofusingTMSasanantidepressanthasbeenaroundforaveryshorttime,yetithasmadegreatstrides. MostoftheavailablescientificstudiesthathavelookedatthepotentialforTMSinmajordepressionhaveyieldedpromisingresults,andtherearealwaysatleastmoderatechangesinsymptoms.Therehaveevenbeenstudieswithfollow-upsofuptooneyear,wheretheresultsremainpositive15. Still,manyparametersneedtobeadjustedtooptimizetheantidepressanteffectsofrTMS.Forexample,itisnecessarytomakeprecisecalculationsabouttheintensityusedbasedonthescalp-to-cortexdistance.Itisnecessarytofindamethodologythatprovidesaccuratemeasurements. AntidepressantMechanism Thepathophysiologyofdepressionisbasedonalterationsintheeffectofneurotransmittersonthevariouscircuitsofthebrain.Someclaimthatbothdopaminergicandserotonergicpathwaysareaffectedduringdepression.However,severalstudieshaveshownthatTMScanincreasedopaminergictransmissioninbothcorticalandsubcorticalareas15. DepolarizationcausedbyrepetitivetherapywithTMScausesphysiologicalandfunctionalalterationsoftheseaffectedbrainregions,includingtheprefrontalcortex,whichappearstoplayaninterestingroleindepression15.Moreover,letusrememberthattheeffectistwofold,bothdirectandindirect,sincethestimulusisalsotransmittedthroughtheneuronalcircuits. ItseemsthatwhenTMSisapplied,itispossibletoregulatetheneurocircuitsrelatedtomood.Iftheappropriateintensityandfrequencyareused,itispossibletoregainthelostbalanceofthebrainwaves.Also,althoughithasanactivatingeffectonthatmoodcircuitry,itmayhaveinhibitoryeffectsoncorticalandsubcorticalnetworksrelatedtotheamygdala,anareaofthebrainlinkedtoanxietyandfear,themainstaysofdepressiveepisodes. MovementDisorders Severalstructuresofourcentralnervoussystemarenecessarytomove;perhapsthemostimportantaretheprimarymotorcerebralcortex(M1)andthebasalganglia.Manymovementdisordershavesomeimpactonthebasalgangliasinceitistheinterconnectionpointofmanystructures(thalamus,cerebellum,cerebralcortex,etc.). However,asmentionedabove,thedirecteffectofTMSisquitesmall:itonlyreachesthecortexandpartofthesubcorticalregionofthebrain.Evenso,thesecretliesintheindirecteffectthroughtheneuronalinterconnection.Thesamestimulusreceivedbythecortexcansecondarilyinfluencethebasalgangliacircuitandproducedemonstrableclinicalbenefits. Thisideahasbeenconfirmedwiththousandsofobjective,theoretical,practical,descriptivestudies,etc.ManyusefunctionalMRItodemonstratehowTMScanincreasesignalingandregularizethefunctionofkeystructuresinmotorfunctioning,suchasthethalamusandthestriatednucleus.SomeevenusedPET(morespecificimagingstudies)andconfirmedthereleaseofdopamine,whichisoftenlackinginmanyneurodegenerativedisorders. Althoughtherearemanymovementdisorders,wewillexplainthefocusandeffectofTMSonthemostcommonones.Rememberthatalmostallofthemareduetoimportantgenomicalterations,sothetreatmentalwaysendsupbeingpalliative(symptomaticcontrol)andnotcurative. Amongthesewehave: Parkinson’sDisease ThebasisofthephysiopathologyofParkinsonisthealterationintheproductionofdopamineinthebasalganglia,thereforetheeffectofrTMSisuseful.Manystudieshavefocusedtheireffortsondeterminingthispremise,andtheresultshavebeenexcellent16,17. Unlikeotherdiseases,suchasDepression,rTMSprotocols(highorlowfrequency)varied,sotheyprovidedmixedresults.However,basedonspecificscalestodeterminethedegreeofmotorimpairment(suchastheUnifiedParkinson’sDiseaseRatingScale,UPDRS),therewasasignificantoverallimprovementinallmotorsymptoms,includingbradykinesia,temblor,stiffness,instability,etc. Thebeststudiesusedfrequencies1-5Hz,significantlyimprovingUPDRS.Theeffectwasmorepronouncedthanusingslowerfrequencies(0.2Hz),especiallywhenappliedtothepre-supplementarymotorarea(SMA),whichhasarelevantsideeffectonthethalamusandthestriatednucleus,whicharefundamentalinmotorcontrol. Stimulationhasbeentestedonothercorticalareas,suchasM1,whichhavealsohadapositiveoverallmotorUPDRSimpact,onstiffnessandbradykinesia,butnotonothermotorparameters.Inaddition,areassuchasM1benefitfromhigherfrequencies(10-25Hz).TheeffectevenexceedsthatofthemedicationusedforParkinson’s18. Huntington’sDisease AnalyzingthepopulationwithHuntington’sismoredifficultbecauseofthefewexistingcases(comparedtoParkinson’s).TheonlystudiesthathavetestedrTMSonpatientswithHuntington’sdiseaseanalyzedtheeffectonSMA,whichseemstoplayacrucialroleinmotorcontrolduringtheonsetofthedisease19. Hereagain,lowfrequencies(closeto1Hz)wereused,whichdecreasedinvoluntarymovements.However,higherfrequencies(5hz)werenotshowntohavethesameeffect,sofurtherandmoredirectstudiesareneeded. EssentialTremor Essentialtremorisapathologyofwhichweknowlittle.Thephysiopathologyremainsamystery,hencethename“essential,”althoughgeneticalterationsandcertainchangesatthelevelofthecerebellumandotherstructuresrelatedtofinemotorcontrol(thalamus–motorcortex)arelinked. Tocalmthetremor,rTMSwasattemptedonthecerebellum,yieldingvariousresults.Thebeststudiesshowedpositiveeffectsformorethanthreeweekswiththeapplicationoffivesessions(fivedays,onceaday).Thisencouragesfurtherprospectivestudieswithmorefollow-up20. Obsessive-CompulsiveDisorder Obsessive-CompulsiveDisorder(OCD)isacommonmentaldisorderaffectingmorethan2%oftheworld’spopulation.Thisconditionoftenoccursinconjunctionwithotherillnessessuchasanxietyanddepression.Moreover,likeallotherpsychiatricdisorders,itisstillveryunderdiagnosed. Aswiththeotherpathologiesmentioned,therearetwoeffectsofrTMSonOCD:direct(local)andindirect(secondary).ThelocaleffectsofrTMS,especiallyonthemotorsystem,arethemoststudiedsinceitisthemostaccessiblesystemforthistherapyandallowsobjectivemeasurements. WhensomeonehasOCD,itseemsthatthebraincircuitshavevariableactivity,whichplaysanimportantroleinrTMS.Itisdifficulttochoosethecorticalsiteofaction,aswellasthepatient’sstateduringtheintervention(doingsomementalactivityorresting).Infact,rTMShadprovenitseffectivenessandpositiveandpromisingresults,butitisnecessarytodeterminethepatternofbrainactivityoftheOCDpatientpriortointervention21. Apparently,neuroimaginginconjunctionwithcomputermodelsandrTMSitself(actingasadiagnosticmethod)mayhelpidentifythebraincircuitsthatshouldbetargeted.TheeffectivenessofrTMSisnotindoubt;itdependsonhowpersonalizedthetherapyis. ShouldWeBeConcernedAboutSafety? Aswementionedfromthebeginning,rTMSisafairlysafe,noninvasive,controlledtherapythatdoesnotcausedangerousadverseeffects.However,somepublishedsafetyguidelines,amongthemostcritical,havefoundcertaincomplicationstoberarebutworthnoting. Itappearsthat,insomecases,rTMSmayinadvertentlycauseseizuresinsomepeopleundergoingthistherapy.However,thisfindingwasmadeinpatientswhounderwentrTMSthroughasafetystudy,usingmotor-evokedpotentialsbeyondtheareaofstimulation.Therefore,thisstudyshouldnotbeconsidereddefinitive. Inaddition,thereweresomedisturbancesthatattractedattention.Forexample,oneoftheseizureswasinducedwithstimulationtrainsatexcessivelyshortintervals.Althoughthefrequencyandintensitywerewithinsafelimits,therewasnotenoughtime.Theruleofthumbisthatthereisatleastthesameamountofstimulationtimeasspacebetweensessions. Finally,only12caseswerereportedfrom1985to2003,averylownumberforthethousandsofstudiesconductedsincethattime.AllthisleadsustoconcludethatrTMSisafairlysafetherapythathasnorealadverseeffectsknownsofar,soitcanbefreelyused,aslongasitiswithinthesafetyparametersestablishedinthetherapeuticprotocols. LimitedEffectivenessandFutureDirections Althoughtheinformationwehaveisquitepromisingandpointstowardsdrasticpositivechanges,weneedmoredataandstudiesthatsupportandprovidenewperspectivesonrTMSasatherapeutictool.ThemajorlimitationishowlittleweknowaboutthemechanismofactionofrTMSandwhatarethemolecularstepsthatprovideitsbenefits. Forexample,thedatasupportingtheuseofrTMSinParkinson’spatientsareverypromising,butwhydoesitnotworkinthesamewayinpathologieswiththesamephysiopathologicalmechanism?Whydoesitnothavethesameeffectivenessinotherdiseaseswithdopaminedeficit,suchasdepression? Inthecaseofmovementdisorders,wecanassumethatwehavepreciseinformationaboutthespecificareawhererTMScanbeused,whetheritisM1orSPA,butwhataboutdepression?Aretherenoothermoreeffectiveregionswherewecanapplythistherapy?Thebottomlineisthatmoststudiesfocusonasingleareawhileinvestigatingdepression,andtherearestillthousandstoinvestigate. Itisevennecessarytoconsidertheanatomicaldifferenceofeachperson.Wearealldifferentandcorticalareasvaryslightlyinposition,thicknesschanges(bone,corticalandsubcorticalarea),amountoftissuevaries,etc.Therearemillionsofvariablesthatwestilldonotcontrol. Wearebarelyunderstandingwhatthevariouspatternsandprotocolsarethatwecanuse,butthepossibilitiesarealmostinfinitewithrTMS.Weneedlarge-scalestudies,whichallowustocombinepatternsandcreatecomparativegroupstofollowthemoverlongperiods.Theinformationisconciseandpromisingbutneedstobeexpandedanddeepened. Still,weknowwe’retakingtherightsteps.MajororganizationsliketheFDAhaveapprovedtheuseofrTMSfordepressionandevenobsessive-compulsivedisorder22,whichmeansthatthepositiveeffectandbenefitsofthistherapyareindisputable.Soon,newdiseaseswillbestudiedandtheacceptedtherapeuticrangeofrTMSwillsurelyincrease. Video:HowDoesTMSWork? References PenfieldW,PerotP.Thebrain’srecordofauditoryandvisualexperience:afinalsummaryanddiscussion.Brain1963;86:595.DOI:10.1093/brain/86.4.595 PenfieldW,JasperH.Epilepsyandthefunctionalanatomyofthehumanbrain.Boston:Little,BrownandCompany;1954. BarkerAT,JalinousR,FreestonIL.Non-invasivemagneticstimulationofhumanmotorcortex.Lancet1985;1(8437):1106-1107.DOI:10.1016/s0140-6736(85)92413-4 EdwardsMJ,TalelliP,RothwellJC.Clinicalapplicationsoftranscranialmagneticstimulationinpatientswithmovementdisorders.LancetNeurol2008;7(9):827-840.DOI:10.1016/S1474-4422(08)70190-X BarkerAT.Anintroductiontothebasicprinciplesofmagneticnervestimulation.JClinNeurophysiol1991;8(1):26-37.DOI:10.1097/00004691-199101000-00005 DayBL,DresslerD,MaertensdeNoordhoutA,etal.Electricandmagneticstimulationofhumanmotorcortex:surfaceEMGandsinglemotorunitresponses.JPhysiol1989;412:449-473.DOI:10.1113/jphysiol.1989.sp017626 RothwellJC.Techniquesandmechanismsofactionoftranscranialstimulationofthehumanmotorcortex.JNeurosciMethods1997;74(2):113-122.DOI:10.1016/s0165-0270(97)02242-5 HoflichG,KasperS,HufnagelA,RuhrmannS,MollerHJ.Applicationoftranscranialmagneticstimulationintreatmentofdrug-resistantmajordepression:areportoftwocases.HumPsychopharmacol1993;8:361-5. BlissTV,CookeSF.Long-termpotentiationandlong-termdepression:aclinicalperspective.Clinics(SaoPaulo)2011;66(suppl1):3-17.doi:10.1590/S1807-59322011001300002 MixA,BenaliA,FunkeK.StraindifferencesintheeffectofrTMSoncorticalexpressionofcalcium-bindingproteinsinrats.ExpBrainRes2014;232(2):435-442.DOI:10.1007/s00221-013-3751-6 StefanK,KuneschE,CohenLG,BeneckeR,ClassenJ.Inductionofplasticityinthehumanmotorcortexbypairedassociativestimulation.Brain2000;123Pt3:572-584.https://doi.org/10.1093/brain/123.3.572 CirilloG,DiPinoG,CaponeF,etal.Neurobiologicalafter-effectsofnon-invasivebrainstimulation.BrainStim2017;10(1):1-18.DOI:10.1016/j.brs.2016.11.009 MilevRV,GiacobbeP,KennedySH,etal.CanadianNetworkforMoodandAnxietyTreatments(CANMAT)2016clinicalguidelinesforthemanagementofadultswithmajordepressivedisorder:section4.neurostimulationtreatments.CanJPsychiatry2016;61(9):561-575.DOI:10.1177/0706743716660033 BologniniN,Pascual-LeoneA,FregniF.Usingnon-invasivebrainstimulationtoaugmentmotortraining-inducedplasticity.JNeuroengRehabil2009;6:8.DOI:10.1186/1743-0003-6-8 PhilipGJanicakandMehmetEDokucu.Transcranialmagneticstimulationforthetreatmentofmajordepression.NeuropsychiatrDisTreat.2015;11:1549–1560.doi:10.2147/NDT.S67477 KhedrEM,FarweezHM,IslamH.TherapeuticeffectofrepetitivetranscranialmagneticstimulationonmotorfunctioninParkinson’sdiseasepatients.EurJNeurol2003;10(5):567-572.DOI:10.1046/j.1468-1331.2003.00649.x IkeguchiM,TougeT,NishiyamaY,TakeuchiH,KuriyamaS,OhkawaM.EffectsofsuccessiverepetitivetranscranialmagneticstimulationonmotorperformancesandbrainperfusioninidiopathicParkinson’sdisease.JNeurolSci2003;209(1-2):41-46. BrysM,FoxMD,AgarwalS,etal.MultifocalrepetitiveTMSformotorandmoodsymptomsofParkinsondisease:arandomizedtrial.Neurology2016;87(18):1907-1915.DOI:10.1212/WNL.0000000000003279 GroissSJ,NetzJ,LangeHW,BuetefischCM.FrequencydependenteffectsofrTMSonmotorandcognitivefunctionsinHuntington’sdisease.BasalGanglia2012;2(1):41-48.DOI:10.1016/j.baga.2011.12.001 GironellA,KulisevskyJ,LorenzoJ,BarbanojM,Pascual-SedanoB,OterminP.Transcranialmagneticstimulationofthecerebelluminessentialtremor:acontrolledstudy.ArchNeurol2002;59(3):413-417.DOI:10.1001/archneur.59.3.413 LucaCocchi,AndrewZalesky,ZoieNott,GenevièveWhybird,PaulB.Fitzgerald,andMichaelBreakspear.Transcranialmagneticstimulationinobsessive-compulsivedisorder:Afocusonnetworkmechanismsandstatedependence.NeuroimageClin.2018;19:661–674.doi:10.1016/j.nicl.2018.05.029 U.S.Food&DrugAdministration.FDANewsRelease.FDApermitsmarketingoftranscranialmagneticstimulationfortreatmentofobsessivecompulsivedisorder.August17,2018.Retrievedfromhttps://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder  STOPTAKINGMEDICATIONS NoMoreIneffectiveDrugs NoMoreDebilitatingMedicationSideEffects HEALYOURBRAIN IncreasedBrainCellActivity IncreasedBrainCellConnectivity IncreasedBrainPlasticity  SIMPLETREATMENTPROCESS NonInvasive NoAnesthesiaOrMedication NoSideEffects ImmediatelyResumeNormalActivites ConditionsTreated WeutilizethemostadvancedTranscranialMagneticStimulationtechnologyavailabletoprovidehealingforanextensiverangeofmentalandneurologicalconditions,withoutmedication,discomfort,orsideeffects. TeenDepression LateLife/GeriatricDepression BipolarDisorder Postpartum/PregnancyDepression GeneralizedAnxietyDisorder PostTraumaticStressDisorder(PTSD) Panic /Phobias/SocialAnxiety ChildADHD TeenADHD AdultADHD Migraine Fibromyalgia AdultOCD Child/AdolescentOCD Asperger’sSyndrome Alzheimer’sDisease Parkinson’sDisease Concussion TraumaticBrainInjury TESTIMONIALS ReadabouttheexperiencesthatrecentpatientshavehadwithTMS DebilitatingDepression “AfterIdon’tknowhowmanydifferentmedicationprescriptions,noneofwhichworkedliketheyshould,ItriedTMSbecauseIcouldn’tcontinuetolivewithmydepression. Theresulthasbeenreallymiraculous. Ifeelsomuchbetter,now. Ifeelmorecapableofdoingthings. I’msomuchhappier. TMShasbeenasaviortome.” JonathanJ. AnxietyAttacks “IexperiencedanxietyattackssinceIwasateenager. I’vetriedanti-anxietymedications,alongwithalloftheothermedicationsthatIwastaking,buttheydidn’thelpwithmypanic. Ifoundmyselfunabletofunction–Iwouldcompletelyspiralinsidemyself,hangingonformylifewhentheattackswouldcome. IhadhearaboutTMSfromsomeone. Iwasdesperateanddidn’thaveanythingtolose,asnothingwasworking.Dr.SchneiderandArtarebothterrific. TheymademefeelsocomfortableandeducatedaboutTMS. ImustsaythatinitiallyIdidn’tfeelabigdifference. ButIknewthatitoftentakesmanysessionsfortheeffectstooccurforsomepeople. Iwasoneofthose. ButIcannotbemorepleasedwiththeimprovementinmyattacks. Ifeelsomuchmoreincontrolandcalm. Iambecoming,whoIusedtobe,whenpanicandanxietydidn’trulemylife. Iknowthatitwillonlycontinuetoimprove. IhighlyrecommendTMS.” SusanF. Daughter’sADHD “TMSchangedourdaughter’slife. ShewasdiagnosedwithADHDinsecondgrade. Wetookhertochildpsychiatristsandtriednumerousmedications,andtherapy,butnoneofithadanyrealpositiveeffect,ashersymptomsonlyincreasedovertime,tothepointwhereshewasfailinginschool,andhadconsiderabledifficultywithtasksoutsideofschool. WehadheardaboutTMSandwedecidedtotryit,althoughwedidnothavegreatfaithinit. Butwewereamazed. Afterjustafewsessions,wenotedimprovementinourdaughter. Shewasabletoconcentrateonschoolwork,specificallymath,forthefirsttime,ever. Shedoesn’tneedallofthestimuli,anymore,thatsheusedtoneed(phone,TV,music,computerallonatthesametime)justsothatshecouldfeel‘comfortable’. Weareseeingimprovementseveryweek,inherbehavior,herlevelofcalmness,herinteractions. Itistrulyamazing. Sofar,extremelygood. WearebelieversinTMS. AprilL. TMSInformationandConsultation 619-419-0901 SANDIEGOLOCATION ScheduleConsultation  ViewVideos FAQ PatientForms Contact Phone (619)419-0901 Email [email protected] Address 1321GarnetAve. SanDiego,CA92109 BrainCenterTMS 619-432-4495TheleaderinTMStreatment Wewillgladlyanswerallofyourquestions YourName(required) YourEmail(required) Subject YourMessage Δ