rTMS is acronym for repetitive Transcranial Magnetic Stimulation and it refers to a non-invasive procedure in which brain electrical activity is influenced by a pulse of magnetic field. This procedure is done to influence brain cells activities of specific regions of the brain with resulting valuable therapeutic effects.
rTMS is used for the treatment of drug addiction and as alternative treatment, or to augment medications and/or psychotherapy in certain mental illnesses such as depression, anxiety, bipolar, schizophrenia etc.
For example, in depression, antidepressant medications and psychotherapy are the first line treatments for major depression. These treatments, however, do not work for all patients. In these instances, rTMS might be used as an alternative treatment, or to augment antidepressant medications or psychotherapy. Patients who have failed to achieve an adequate response from antidepressants, or who are unable to tolerate medications, might consider rTMS therapy.
rTMS as a non-invasive brain stimulation technique can be used in the treatment of addiction to illicit drugs such as cocaine, and also alcohol and tobacco addiction.
For each rTMS session, the patient sits in a specially designed treatment chair. Because rTMS uses magnetic pulses, before beginning a treatment, patients are asked to remove any magnetic-sensitive objects (such as jewellery, credit cards).
During the first rTMS session, several measurements are made to ensure that the TMS coil will be properly positioned over the patient’s head. Once this is done, the TMS coil is suspended over the patient’s scalp. The TMS physician then measures the patient’s motor threshold, by administering several brief pulses. The motor threshold is the minimum amount of power necessary to make the patient’s thumb twitch, and varies from individual to individual. Measuring the motor threshold helps the TMS physician personalize the treatment settings and determine the amount of energy required to stimulate brain cells.
Once the motor threshold is determined, the coil is then brought forward so that it rests above the front region of the patient’s brain. Treatment is then commenced. During the treatment, patients will hear a series of clicking sounds and will feel a tapping sensation under the treatment coil.
Succeeding treatment sessions do not require that the motor threshold be determined again, unless indicated otherwise, such as when changes in medications are made during the course of the treatment.
rTMS therapy involves a series of treatment sessions. Treatment sessions are approximately 40 minutes each, and administered 5 days a week. A typical course of rTMS is 4 to 6 weeks.
rTMS does not require any sedation or general anaesthesia, so patients are conscious during the treatment. There is no “recovery time”, so patients can drive home afterwards and/or return to their usual activities if necessary.
rTMS is well-tolerated and associated with few side-effects and only a small percentage of patients discontinue treatment because of these. The most common side-effect, which is reported in about half of patients treated with rTMS, is headaches. These are mild and generally diminish over the course of the treatment. Over-the-counter pain medication can be used to treat these headaches.
About one third of patients may experience painful scalp sensations or facial twitching with rTMS pulses. These too tend to diminish over the course of treatment although adjustments can be made immediately in coil positioning and stimulation settings to reduce this discomfort.
rTMS has not been associated with many of the side-effects caused by antidepressant medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.
The most serious risk of rTMS is seizures. However, the risk of a seizure is exceedingly low. At Synapse Services, we follow up-to-date safety guidelines that are designed to minimize the risk of seizures. While rTMS is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognized.
Patients with any type of non-removable metal in their heads (with the exception of braces or dental fillings), or within twelve inches of the coil should not receive rTMS. Failure to follow this rule could cause the object to heat up , move, or malfunction, and result in serious injury or death. The following is a list of metal implants that can prevent a patient from receiving rTMS:
1. Aneurysm clips or coils
2. Stents in the neck or brain
3. Implanted stimulators
4. Cardiac pacemakers or implantable cardioverter defibrillator (ICD)
5. Electrodes to monitor brain activity
6. Metallic implants in your ears and eyes
7. Shrapnel or bullet fragments in or near the head
8. Facial tattoos with metallic or magnetic-sensitive ink
9. Other metal devices or object implanted in or near the head
An rTMS clinician is an addiction and mental health clinician and professional who has been trained on the use of the TMS equipment. Training involves practical sessions involving the manufacturer and rTMS application specialist.
If you are considering an rTMS therapy, you can speak to one of our rTMS clinicians or schedule to visit the rTMS treatment center in any of our rTMS facilities in Abuja or Lagos.