WHAT IS DEEP TMS?

Deep TMS was developed by Prof. Abraham Zengen in 2001. It was patented by the American National Institute of Mental Health and the company Brainsway. It was approved by the U.S. Food and Drug Administration in 2003. Although reported to be applicable on children, it is advised to be implemented on people over 16 years of age.

Deep TMS is a drug-free and non-surgical treatment that does not require anesthetics. The patient is awake and conscious during the implementation. The target area of the brain is physically stimulated by sending magnetic pulses under the skull through a mechanism placed onto the skull. Therefore, the neurons functioning over electrical activity become active via magnetic stimulation.

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FREQUENTLY ASKED QUESTIONS

What are the disorders treated by Deep TMS?

In psychiatry, Deep TMS is being implemented at high success rates in the following disorders in many countries around the world:

H1

  • Major Depression
  • Bipolar Disorder (Manic Depression)
  • Post-Traumatic Stress Disorder (PTSD)
  • Schizophrenia (Negative Symptoms)
  • Schizophrenia (Auditory Hallucinations)

H7

  • Obsessive Compulsive Disorder (OCD)
  • Cocaine Addiction
  • Panic Disorder
  • Tourette’s Syndrome (Tics)
  • Asperger’s Syndrome

Does Deep TMS have side effects?

No side effects have been spotted excluding the temporary situations such as temporary headaches, temporary ringing in the ears, etc. during the application. It is safe and tolerable. In the case that the ache continues following the first couple of sessions, it is not harmful to take painkillers. Following the application, the patients may continue their daily routines, such as driving cars. It does not cause temporary memory loss, weight gain, xerostomia or sexual problems.

Why is Deep TMS important in terms of addiction treatment?

It is extremely significant to regulate the impaired brain parts during the treatment, due to the fact that addiction is a disease that is quite challenging to treat. Today, addiction is known to be a chronic and recurrent brain disorder like schizophrenia, or a chronic disease with a long-term treatment like diabetes. Addiction does not stem from a defective intention, lack of personality or moral weakness. It is caused by the changes in hormones named “neurotransmitters”, such as dopamine, in the areas called “nucleus accumbens” located deep in the brain. Strong treatments like brain stimulation can be effective in reversing such changes.

In which cases is Deep TMS required?

It is required for a fast and effective solution, if it is suitable for the patient to take a Deep TMS treatment. Furthermore, it is required in terms of preventing recurrence in treatment-resistant depression, in cases entailing drug-free treatment, and in addiction. In addiction patients, particularly in cases where post-treatment recurrence comes into question, it is required to use the Deep TMS method if the patient seeks the substance that causes addiction despite the known treatments.

Is Deep TMS risky in terms of health?

Deep TMS is a low-risk practice just like regular TMS. Both Deep TMS and regular TMS are quite low-risk methods of application as no interventional procedures are applied on the patient, when compared to other methods of brain stimulation. This method does not cause any damage on the brain.

DEEP TMS AND DISORDERS

Deep TMS and Major Depression

Major depression is a serious brain disorder that complicates the individual’s life. In addition to drugs and psycho-social intervention, TMS is also a method administered particularly for patients who are treatment-resistant, complain about the side effects of drugs, have liver-kidney problems or who are pregnant and puerperal. In the major depression protocol, thanks to the magnetic field applied on the left dorsolateral prefrontal cortex (DLPFC) of the brain, the cortical blood flow, glucose and oxygen consumption, which have slowed down due to depression, go back to their usual speed. This causes an antidepressant effect. The brain areas, where significant changes have been observed following the TMS application, are the left anterior cingulate cortex, left insula, left upper temporal gyrus and right angular gyrus. An increase of volume in these areas and a decrease in the severity of depression have been found to be correlated. In addition to the aforementioned areas, Deep TMS is also capable of reaching the nucleus accumbens and frontal tegmentum area due to the fact that it effects a deeper and wider area. This difference between standard TMS and Deep TMS makes Deep TMS more effective in the treatment of major depression.

Deep TMS and Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is defined as intensely disturbing thoughts and repetitive behaviors. According to the neurobiological model, OCD is associated with motor areas, cortico-striato-thalamo-cortical pathways, prefrontal cortex and orbitofrontal cortex. Deep TMS aims at the medial prefrontal cortex and anterior cingulate cortex. Emotional and cognitive processes become integrated, while the there is an improvement in the control, attention, planning and short-term memory functions of the patient through the deep stimulation of such areas.

Deep TMS and Bipolar Disorder (Manic Depression)

In patients with bipolar disorder, Deep TMS is applied in the depression episode. Similar to the major depression protocol, the target area in the bipolar depression is also the left dorsolateral prefrontal cortex (DLPFC), and a high frequency is applied. The studies have reported that the patient’s depression disappeared following the treatment, and that no manic attacks were observed during the tests administered weeks later.

Deep TMS and Asperger’s Syndrome

Asperger’s Syndrome is an Autism Spectrum Disorder, which causes impairments in social relations and communication. In addition, slow, restrictive or recurring behaviors are observed. It is neurobiologically put forward that there is an imbalance in cortical stimulation or inhibition in the brain. Anterior cingulate cortex, left auditory center and low GABA level in the left motor area have been found to be related to social consciousness, mood and motor stereotypes. Imbalanced electrical zones in such areas are equalized, and a decrease is observed in the symptoms thanks to Deep TMS.

Deep TMS and Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder is a complex disorder consisting of perceptual, cognitive, emotional, physical and psychological problems. In neurobiological terms, it is considered that PTSD is associated with medial prefrontal cortex, hippocampus and amygdala. The disorder being associated with sub-cortex limbic structures causes a need for a deeper stimulation. Deep TMS is considered a safe method in stimulating such target areas.

Deep TMS and Cocaine Addiction

It is observed that usage is recurrent in cocaine addiction. It is considered that this condition is caused by a low dopamine level in the nucleus accumbens, and the studies have shown that the nucleus accumbens is modulated by the stimulations targeting the dorsolateral prefrontal cortex. In cocaine addiction, Deep TMS is applied on the medial prefrontal cortex and anterior cingulate, and this is found to be successful in preventing withdrawal and recurrence.

Deep TMS and Panic Disorder

Panic disorder is defined with recurring and unexpected panic attacks, and maladaptive behaviors developed against such attacks. In neurobiological terms, it is explained by the decrease of the activity in the prefrontal cortex, and impaired hyperactivity in the brain structures associated with fear (amygdala). Deep TMS is implemented on this area at high frequency due to the slowdown in the right dorsolateral prefrontal cortex. On the other hand, the low frequency, which is administered on the amygdala with the opportunity to provide deep stimulation, enables different areas of the brain to be balanced.

Deep TMS and Tourette’s Syndrome (Tics)

Tics are stereotypical, fast, arrhythmical, recurring motor movements and articulations that occur in episodes. Supplementary motor area (SMA) controls the relations between the limbic system and cognitive processes. Neuroimaging studies have reported an excessive activity on this area immediately before the occurrence of the tics. Deep TMS is implemented on the SMA bilaterally on patients with Tourette’s Syndrome.

Deep TMS and Schizophrenia (Negative Symptoms)

Regression or disappearance of specific capabilities, stagnation in affection, movements and facial expressions, or a decrease in speech, indifference, anhedonia and anti-sociality are negative symptoms observed in patients with schizophrenia. These symptoms are also observable in major depression, Parkinson’s, Alzheimer’s and epilepsy. It is considered to be caused by the slowdown in the frontal cortex and anterior cingulate area. Deep TMS aims to decrease the negative symptoms by eliminating the lack of dopamine in the prefrontal cortex through high-frequency stimulation.

Deep TMS and Schizophrenia (Auditory Hallucinations)

Auditory hallucinations in schizophrenia may cause stress, functional incapability, uncontrollable behaviors and violence in the patient. Auditory hallucinations associated with the speech perception area occur due to excessive activity in the left temporoparietal cortex. Thus, a low-frequency Deep TMS is applied.

Deep TMS and Alzheimer’s

In Alzheimer’s, the Deep TMS practice aims to restore the impaired plasticity in the dorsolateral prefrontal cortex. It is considered that it heals the cognitive functions through the stimulation of the neurons.

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