Transcranial Magnetic Stimulation (TMS) - Cleveland Clinic

Transcranial magnetic stimulation, or TMS, is a treatment for people with severe depression whose illness has not been helped by at least one ... ThinkyoumayhaveCOVID-19? Findoutwhereyoucangettested Needavaccineorbooster? Scheduletoday ComingtoaClevelandCliniclocation? Visitationandmaskrequirements Home / HealthLibrary / Treatments&Procedures TranscranialMagneticStimulation(TMS) Transcranialmagneticstimulation(TMS)isanon-invasivebrainstimulationprocedurethatmayhelppatientswithseveredepression. Appointments866.588.2264 Appointments&Locations RequestanAppointment Overview ProcedureDetails Risks/Benefits RecoveryandOutlook AdditionalDetails TranscranialMagneticStimulation(TMS) Overview ProcedureDetails Risks/Benefits RecoveryandOutlook AdditionalDetails BackToTop Overview Whatistranscranialmagneticstimulation(TMS)? Transcranialmagneticstimulation,orTMS,isatreatmentforpeoplewithseveredepressionwhoseillnesshasnotbeenhelpedbyatleastoneantidepressantmedication.Itisatypeofbrainstimulationtherapy.TMSelicitsmagneticenergy,whichturnsintoelectricalcurrentunderneaththepatient’sskull,tohelpregulatethepatient’semotions. TMSisanadjuncttreatmentthatworksalongwithmedicationandisnon-invasive(doesnotrequiresurgery). Whatisdepression? Depressionisacommonandseriousmedicalillness.Oneaspectofdepressionisalackofactivityintheprefrontalcortexofthebrain,orthearearightabovetheeyes,thathelpscontrolemotions.Itaffectshowthepatientfeels,thinksandacts. Symptomsofdepressionmayinclude: Feelingsad Lossofinterestorpleasureinactivitiesonceenjoyed Changesinappetite—weightlossorgainwithoutdieting Lackofenergyorfeelingtired Troublesleepingorsleepingtoomuch Thoughtsofdeathorsuicide Ifthesesymptomslastatleasttwoweeksorlonger,thepatientshouldseeahealthprofessionalfordiagnosisofpossibledepression.Theillnesscanbetreated. Whatotherconditionscantranscranialmagneticstimulation(TMS)beusedtotreat? TMShasshowngreatpromisetreatingthedepressedpatient,butisalsobeingstudiedforpossibletreatmentofotherconditions,suchasvasculardepressionfollowingastroke.Also,researchersarelookingatTMSasapossibletreatmentforschizophrenia,attentiondeficit-hyperactivitydisorder(ADHD)andpost-traumaticstressdisorder(PTSD). ProcedureDetails Whatcanthepatientexpectduringthetranscranialmagneticstimulation(TMS)procedure? Theprocedureisusuallyperformedbyadoctorwhilethepatientisawakeandseatedinachair.Adevicewithanelectromagneticcoilisplacednearthepatient’sleftprefrontalcortex,orthefrontsideofthescalp,anareawherealackoffunctionalandmetabolicactivityisfoundinthedepressedpatient. Thedeviceisheldinplaceforabout40minutes.Asteadyelectriccurrentispassedthroughthispartofthebraincausingneurons,ornervecells,inthebraintosendelectricalimpulses.Theseimpulseswillthentriggerachemicalreactionthat,overtime,willhelpliftthepatient’smood. Doctorstypicallyrecommend30sessionsofTMStherapy,usuallygivenfivetimesperweekforfourtosixweeks. Becausethistypeofpulsegenerallydoesnotreachfurtherthan2inchesintothebrain,thedoctorcanspecificallytargettheportionofthebraintotreat.Thisprecisionalsolessensthechanceforsideeffectsthatmayoccurwithotherprocedures. Whatdifferenttypesoftranscranialmagneticstimulation(TMS)treatmentareavailable? Repetitivetranscranialmagneticstimulation(rTMS)usesmoreintenseelectricpulses. rTMSisusedtotreatpatientswithunipolardepression. InrTMSanelectromagneticcoilisheldagainstthepatient’sleftsideofthescalpwhileshortelectromagneticpulsesareadministeredthroughthecoil.Themagneticandrepeatingpulsescausesmallelectricalcurrentsthatstimulatenervecellsinthetargetedregionofthebrain.EachrTMSsessionusuallylasts30to60minutesanddoesnotrequiresedationoranesthesia. Thestrengthofthesecurrentsisaboutthesameasamagneticresonanceimaging(MRI)scan. ResearchisstillbeingconductedonthebesttreatmentoptionsforrTMS,suchaswhethertheprocedureworksbestasasingletreatmentorwhentheprocedureiscombinedwithmedicationand/orpsychotherapy. SideeffectsofrTMS,suchasheadaches,scalpdiscomfort,orbrieflightheadedness,aremildormoderate.Somepatientsmayfeelatingleofthemusclesofthescalp,jaworfaceduringtheprocedure.Althoughrare,itispossiblethattheprocedurecouldcauseaseizure. Deeptranscranialmagneticstimulation(dTMS)isarelativelynewmethodofstimulatinglarger,deeperbrainregions. Theprocedureusesspecializedcoils,calledHcoils,whichreachabout2inchesbeneaththesurfaceoftheskullandaredesignedtotargetdifferentbrainareas. DuringadTMSsession,apersonwearsacushionedhelmet,whichgeneratesbriefmagneticfields,similartothoseinMRIscans.Thisisanoutpatientprocedurethatdoesnotrequireanesthesia. Theproceduretakesplacedailywith20-minutesessionsoverfourtosixweeks.Thepatientcanresumenormalactivitiesimmediatelyaftertheprocedure.ThedTMSprocedurehasfewsideeffectsanddoesnotresultinseizuresormemoryloss. Risks/Benefits Whatarepossiblesideeffectsoftranscranialmagneticstimulation(TMS)treatment? DoctorsreportminimalsideeffectsforthepatientbeingtreatedwithTMS.Somemayfeelatwitchingorvibratingsensationaroundtheface,cheekorscalp,orcomplainofaheadacheormusclesoreness.Thereisalowriskofseizure. Whowouldbenefitfromtranscranialmagneticstimulation(TMS)? Beforebeginninganytreatmentfordepression,thepatientshouldtalkwithhisorhertherapist,doctor,orothermentalhealthtreatmentprovider.Eachpatientisdifferentandwhatworksforonemaynotworkforanother. TMSisusedonthepatientwhohasnotrespondedtomedicationwhentreatedfordepression.Manymentalhealthprofessionalsreportpromisingresultsfromthistreatment.However,theprocedureisstillundergoingresearchonitseffectivenessandlong-termresults. Whoshouldnotbeconsideredfortranscranialmagneticstimulation(TMS)? TheTMSprocedureisnotrecommendedforpatientswhohaveahistoryofseizures.Thosewhohaveametalplateintheirhead,oranyothermetalinandaroundtheirheadshouldnothavetheproceduredone.Bracesandfillingswillnotinterferewiththetreatment. RecoveryandOutlook Howlongafterthe(TMS)treatmentcanthepatientexpecttoseeresults? DoctorssaythatthepatientoftenexperiencesrelieffromTMSwithintwotofourweeks. Whatfollow-upisnecessaryafterthetranscranialmagneticstimulation(TMS)procedure? Dependingonthepatient’soutcome,follow-upsessionsmayberecommendedeveryfewweeksormonthstohelpmaintainthepositiveresults. AdditionalDetails Howdoestranscranialmagneticstimulation(TMS)differfromelectroconvulsivetherapy(ECT)? BothTMSandelectroconvulsivetherapy(ECT)areusedtotreatseveredepression. ECThasbeenusedintheUnitedStatesformorethan70yearsandcreatesamoregeneralizedbrainstimulation.Itsendsasmallelectricalcurrentthatissentthroughthebraintotriggerashortseizure.Thecurrentcausesashortseizurewithinthebrain,whichproduceschangesinthebrain’sfunctioningandchemistry.Thepatientneedsanesthesiaduringtheprocedure.ECTisusuallyrecommendedseveraltimesperweekoverthreetofourweeks. ThepatientmayexperienceconfusionandsomememorylossaftertheECTprocedure.Becauseanesthesiaisused,additionalrisksmustbeconsidered,andmeanslongerpreparationandrecoverytimeforeachsession. ThedoctormayrecommendECTifapatienthastriedmultiplemedicationsortherapiesthathavenotworked,orifheorsheissuicidal,psychoticorcatatonic. Incontrast,TMSisamorerecentformoftreatment.Itisamuchmoretargetedprocedure.Thepatientisawakeandalerttheentiretime.SideeffectsofTMSareminimalandthepatientdoesnotsufferanymemoryloss. 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