Chapter 34: Transcranial Magnetic Stimulation

 

 

 

My psychiatrist at the Amen Clinic believes I would be a good candidate for Transcranial Magnetic Stimulation.  My brain scans showed decreased activity in the left and right inferior orbital prefrontal cortex on both studies (concentration & rest), more severe at rest.  SIDE NOTE:  When there is decreased activity in the inferior orbital prefrontal cortex during a resting state and it improves with concentration, it is often associated with depressive disorders, and may be responsive to antidepressant medication.

Transcranial Magnetic Stimulation reaches the prefrontal cortex areas of the brain very well.  It does not stimulate the deeper areas of the brain.  That is why my doctor believes I would be a good candidate.  I also have problems with activity in deeper parts of my brain.  If you are interested in seeing my brain scans, go to Chapters 11 & 13.

My medical insurance company believes TMS is experimental and will not help pay for the therapy.  The Neuropsychiatric Institute near the city where I live offers TMS treatment and have had the necessary equipment since January 2010.  I know they have a patient assistance program and I would need to get the details to see if I could afford the therapy at this time.  I think doing the research for this blog chapter will help me decide if I could make this treatment happen!

NEUROSTAR TMS DEPRESSION THERAPY SYSTEM 

FIRST TO BE GIVEN FDA APPROVAL

  

Sean Fallon, author of this post, at GIZMODO

"Last year, Neuronetics' NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy system became the first device of its kind to be cleared by the FDA for treating depression. Although, the similarity to a dentist chair was probably not a great idea.

Nonetheless, trials on 164 patients with unipolar, non-psychotic major depressive disorder using the device proved that treatment with short magnetic field pulses to the left prefrontal cortex can be a viable alternative to medication. After 30 40-minute daily sessions, half of the patients in the trial experienced significant improvement, while a third reported complete resolution. Plus, the only statistically significant side effect was mild discomfort in the treatment area. Currently, patients can receive NeuroStar treatments in a psychiatrist's office while remaining completely awake and alert.

Given all of the uncertainty and danger surrounding many psychiatric drugs, NeuroStar seems like it's worth a shot for people suffering from serious bouts of depression. It could also be a sign of things to come. Perhaps technology like this will one day be implanted directly into our brains—making us feel awesome all the time."

http://gizmodo.com/5403423/neurostar-tms-depression-therapy-system-first-to-be-given-fda-approval

Transcranial Magnetic Stimulation requires the following:

1. Prescription by a Psychiatrist
2. 20-30 Outpatient Treatments, Usually Daily
3. Treatment for 4-6 Weeks
4. 37-40 Minute Sessions
5. Patient is Awake, No Anesthesia or Sedation
6. Usually $325.00 or More For Each Session (Depends on the treatment facility) 

This is the link to the NeuroStar TMS Therapy website.  It will give you more detailed information about the treatment:

http://www.neurostartms.com/Patient/Home.aspx

I thought the video on the NeuroStar website was educational and encouraging.  To watch it, go to this link:  (Sorry it was not possible to embed the video)

http://www.neurostartms.com/NeurostarTMSTherapyforDepression/NeurostarTMS-Video.aspx

GOOD BASIC INFORMATION ON TRANSCRANIAL MAGNETIC STIMULATION 

FROM THE MAYO CLINIC

By Mayo Clinic Staff

RISKS
Transcranial magnetic stimulation is the least invasive of the brain-stimulation procedures used for depression. Unlike vagus nerve stimulation or deep brain stimulation, transcranial magnetic stimulation doesn't require surgery or implantation of electrodes. And, unlike electroconvulsive therapy, it doesn't require seizures or complete sedation with anesthesia. However, transcranial magnetic stimulation does have some risks and can cause some side effects.

Common side effects
Transcranial magnetic stimulation often causes minor short-term side effects. These side effects are generally mild and typically improve after the first week or two of treatment. They can include:

• Headache
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
• Lightheadedness
• Discomfort from noise during treatment

Uncommon side effects
Serious side effects are rare. They can include:

• Seizures
• Mania, particularly in people with bipolar disorder
• Hearing loss due to inadequate ear protection during treatment

More study is needed to determine whether transcranial magnetic stimulation may have any long-term side effects.

  

HOW YOU PREPARE

Before having the procedure, you may need a medical examination to make sure it's safe and a good option for you. You may be asked a number of questions about your depression. Tell your doctor or health provider if:

• You're pregnant or thinking of becoming pregnant.
• You have any metal or implanted medical devices in your body. Transcranial magnetic stimulation usually isn't recommended if this is the case.
• You're taking any medications, including over-the-counter medications, herbal supplements or vitamins. Bring a list of what you're taking to your doctor's appointment and include dosages and how often you take them.
• You have a history of seizures or mania. Tell your doctor about any past injuries or surgeries and about any other physical or mental health problems you have.

Little preparation is needed. Transcranial magnetic stimulation isn't invasive, doesn't require anesthesia and can be performed in a doctor's office. You don't need to arrange for someone to drive you home after treatment. Before considering treatment, however, check with your health insurance company to see whether transcranial magnetic stimulation is covered. Your policy may not cover it. 

 

WHAT YOU CAN EXPECT

Transcranial

Your first treatment
Before treatment can begin, your doctor will need to identify the best place to put the magnets on your head and will need to find the best dose of magnetic energy for you.

This is what will most likely occur during your first appointment:

• You'll be taken to a treatment room. You'll be asked to sit in a reclining chair, and you'll be given earplugs to wear during the procedure.
• An electromagnetic coil is placed against your head. The electromagnetic coil is switched off and on repeatedly, up to 10 times a second to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You'll also feel a light tapping sensation on your forehead. This part of the process is called mapping.
• The amount of magnetic energy needed is determined. Your doctor will increase the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed depending on your symptoms and side effects.
• Once the coil placement and dose are identified, you're ready to begin. The treatment itself will last about 40 minutes. The entire appointment typically lasts about one to two hours.

During transcranial magnetic stimulation
Here's what to expect during each treatment:

• You'll sit in a comfortable chair. The magnetic coil is placed against your head.
• The machine is turned on. You'll hear clicking sounds and feel tapping on your forehead.
• Each treatment session lasts about 40 minutes. You'll remain awake and alert.
• After treatment, you can return to your normal daily activities.

There are different ways to perform the procedure. Techniques may change as more is learned about the most effective ways to perform treatments.

  

RESULTS

Some research showed that transcranial magnetic stimulation improved depression symptoms, while in other studies it didn't seem to help. If transcranial magnetic stimulation works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

Transcranial magnetic stimulation may be less likely to work if:

• Your mental illness causes detachment from reality (psychosis)
• Your depression has lasted for four or more years
• Electroconvulsive therapy (ECT) has not worked to improve depression symptoms

It's not yet known if transcranial magnetic stimulation can be used to treat depression for the long term, or whether you can have periodic maintenance treatments to prevent depression symptoms from returning. The effectiveness of transcranial magnetic stimulation may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate. 

http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185

If you are interested in reading a more in depth article on the background, development, practical implementation, and applications of TMS go to:  

http://www.scholarpedia.org/article/Transcranial_magnetic_stimulation

I am also considering going to Newport Beach (Amen Clinic) to have TMS done.  The doctor there does one TMS treatment and an EEG on the brain.  There needs to be a day in between, and then another TMS treatment is performed and another EEG on the brain.  The EEG's results give the doctor information to help him predict if TMS is going to be effective for that particular patient.  I will find out if this procedure is still being used, and if it is used at the Neuropsychiatric Institute near my home.

I think affordable medical treatment should be available to anyone who might benefit from it!