History of TMS
Brain stimulation methods have been used for treatment purposes since quite ancient times. In the 1960s, a research for the effectiveness of low currents on brain began. Having been successfully implemented for the very first time during the 1980s by Anthony Barker et al., TMS is a non-invasive stimulation method being used today for research and treatment purposes. Science is a combination of expertise and engineering.
Technical Information on TMS
TMS is implemented on the skull through a helmet. By creating a magnetic field impact, it stimulates the electric current in the cerebral cortex and thus depolarizes the neurons. When implemented at low and high frequencies, TMS may have different effects. The high-frequency TMS causes excitation in the areas it is implemented, while the low-frequency TMS leads to inhibition in the same.
Studies carried out on major depression patients indicate that the left prefrontal cortex activity decreases while the right prefrontal cortex activity increases. The TMS studies implemented on right prefrontal cortex at high frequencies have been proven to be effective in the treatment of depression. TMS has the FDA (Food and Drug Administration) approval regarding the depression treatment. Apart from depression, it is also being effectively used in many psychiatric disorders.
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 18 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 left prefrontal cortex 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. This stimulation directly reaches the “Subcortical Limbic System” and “Reward System” playing a part in mood regulation, thus the antidepressant effect is created through Deep TMS. In a study carried out on laboratory mice, the neurochemical transformation in “Nucleus Accumbens” located in the reward system was measured via micro-dialysis, and an increase was observed in dopamine and glutamate without any changes in acetylcholine. Hence, the antidepressant effect was achieved through TMS.
Improvements are expected to occur in empathy, motivation, impulsive control and decision-making. Nevertheless, it does not cause any reactions in other parts of the body due to the fact that it is only implemented on the brain, nor do the side effects observed in the use of antidepressants occur.
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:
- Major Depression
- Bipolar Disorder (Manic Depression)
- Alcohol Addiction
- Smoking Addiction
- Cocaine Addiction
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder
A meaningful recovery rate is observed particularly when used in resistant depression patients and obsessive-compulsive patients. In Post-Traumatic Stress Disorder, it has been observed to be effective in regulating the memories causing emotional density.
The Deep TMS implemented on Dorsolateral Prefrontal Cortex and Insular Cortex was observed to decrease the craving for smoking and cocaine through the provocation administered prior to the treatment.
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.
Following the performance of the examination required, this application is included in the treatment process upon the joint decision of the attending physician and the patient. There may be cases where the TMS application is not suitable, or the attending physician may not recommend it. It may be implemented with or without medication, which is decided by the attending physician.
During the Deep TMS application, drugs can be taken in a doctor-controlled manner. Recovery was also reported in patients who were not subject to any medication.
Excessive alcohol consumption must cease one day prior to the application, and coffee consumption 3 hours before the same. Similarly, in the case of suicidal thoughts / happiness / anxiety prior to the application, the patient or his/her relatives must inform the attending physician on this issue.
During the application, all metal objects on the head are removed, the ears are plugged, and the patient is seated in a comfortable manner. The helmet is placed on the head by the practitioner. Sessions of approximately 20 minutes are implemented for minimum 5 times a week for 4 to 8 weeks, depending on the individual.
It was observed that the intensity of depression was less in case of the re-occurrence of depression, and that the recovery become faster when Deep TMS was applied once again.
When compared to the commonly-utilized rTMS, Deep TMS provides the opportunity of application on a wider area including the deeper, different parts of the brain, thus enabling the activation of more and more neurons. This, in turn, strengthens the clinical answer.