Neurostimulation
Treatment

Transcranial magnetic stimulation (TMS) is a proven treatment for various mental health conditions. The Australian government now reimburses for TMS therapy. Deep TMS is the medical advancement of regular TMS. The technology allows for deeper and broader brain areas to be activated in a single treatment session. The brain gets more stimulation with deep TMS than with normal TMS. Studies show better outcomes with deep TMS.

Deep Transcranial Magnetic Stimulation (Deep TMS) is an innovative treatment currently TGA registered for treatment-resistant major depressive disorder (MDD) and obsessive-compulsive disorder (OCD).

Transcranial magnetic stimulation (TMS) is applied by resting a coil on the patient’s head. An electrical current flows through the coil, generating a magnetic field that penetrates through the skull and induces a second electrical flow of current in the brain. When finding the patient’s motor threshold (MT), as the current flows through the coil the patient will experience involuntary activation of different muscle groups depending on the positioning of the coil over the motor cortex.

A course of treatment for depression typically consists of 36-44 treatments, with treatments occurring 3-5 days per week for 4 weeks, then decreasing to 2-3 days per week. A course of treatment for OCD typically consists of 29 treatments, with treatments occurring 5 days per week for 5 weeks, then 4 days per week in the final week.

Additionally, you may require maintenance sessions or retreatment for a recurrence of depression or OCD.

Before starting TMS, we will discuss with you the available treatment options, including different medications, combinations of medications, psychotherapy, and Electroconvulsive Therapy (ECT). We will make sure you understand the relative success rates and prevalence of side effects.

TMS is prescribed and directly supervised by our team who are trained in TMS.

TMS is administered by trained technicians who are familiar with different TMS protocols, but may only administer exactly what is prescribed. They are trained to handle an adverse event, such as a seizure.

TMS has been used since 1985.

Several adverse effects may occur from TMS treatment:

1. Patients may experience headaches, face pain, jaw pain, tooth pain, or neck pain. In most cases, over-the-counter medication (e.g., ibuprofen, acetaminophen, aspirin) will relieve the pain. The vast majority of patients find TMS to be tolerable. Please check with your doctor prior to taking any new medications.

2. TMS produces a loud clicking noise during stimulation, which can result in tinnitus or hearing loss if ear protection is not used. To prevent risk, earplugs are provided. The risk of hearing loss when wearing earplugs is most likely less than 0.01%, or 1 in 10,000 patients.

3. TMS can induce a seizure, even in the absence of brain lesions, epilepsy, or other risk factors. The overall risk for seizures during Deep TMS has been extensively studied, and is approximately 0.06% or 6 in 10,000 patients. TMS does not cause epilepsy.

4. TMS could potentially cause inadvertent teeth clenching, biting of the tongue, and chipping teeth. The overall risk for this is very low.

5. TMS could theoretically induce transient changes in cognition or movement. However, safety studies across numerous clinical trials have found no such side effects to-date.

6. Risks of exposure to a magnetic field during pregnancy are not fully understood, however TMS is deemed as a safe and viable treatment for women who are pregnant and post-partum.

7. There is only one absolute contraindication for Deep TMS – the presence of a ferromagnetic (highly susceptible to magnetization) substance in the head.

8. TMS effectiveness and safety has been studied for years and no adverse effects have been associated with long-term TMS treatment.

In addition to multiple placebo-controlled studies, real clinical usage has demonstrated that nearly 3 in 4 patients achieve clinical response and nearly 1 in 2 achieve remission from depression. Patients also experience significant reduction in anxiety symptoms.

The treatments are given in our clinic. You do not need to be admitted to hospital.

Treatments consist of 35 sessions across a 7-week period followed by periodic maintenance sessions. Each session takes 20 minutes. Medicare rebates can apply.

Yes, deep TMS is safe and has been proven to be well tolerated throughout many clinical trials.

Traditional TMS uses a figure 8 coil, whereas deep TMS and in particular the BrainWay’s unique coil design enables deeper and broader stimulation of the brain than the traditional figure 8 TMS coils. This deeper and broader stimulation of the brain from the deep DMS coils results in greater activation of neurons and less likelihood of targeting errors resulting in higher efficacy rates.

Some people report some mild discomfort during the procedure but this usually subside once the procedure finishes.

Some people have reported a mild discomfort and a tapping sensation in the targeted area during the procedure.

The most common side effect during treatment is a mild headache which can easily be treated with over the counter medications such as paracetamol. These symptoms tend to only occur in the first one or two sessions and most users report a reduction in side effects after receiving more treatments.

Other infrequent side effects may include muscle or twitches, uncomfortable scalp sensations, and jaw pain. These also tend to diminish over the course of treatment and adjustments can be made during treatments to help ease discomfort for the user.

A specially designed helmet is fitted to the patient’s head and begins to send the targeted magnetic pulses to the brain. Patients feel a light tapping on their head during the procedure but can read or catch up on social media whilst receiving the treatment. Each session lasts roughly 20 minutes and patients can go back to normal daily activity including driving after their session.

Each session of deep TMS usually lasts for 20 minutes. The usual course of treatment is 5 sessions a week for 4-6 weeks.