Introduction of TMS
TMS means Transcranial Magnetic Stimulation. It uses magnetic field to transfer a small electric field into our brain. Neurons, the cells in the brain, communicate by “firing”, constantly charging and discharging. In other words, communication in the brain is based on electricity.
TMS means Transcranial Magnetic Stimulation. It uses magnetic field to transfer a small electric field into our brain. This is just the physics Faraday taught us: every changing magnetic field induces a changing electric field. Neurons, the cells in the brain, communicate by “firing”, constantly charging and discharging. In other words, communication in the brain is based on electricity. TMS therapy works because each magnetic pulse creates a local electric field, just strong enough to activate the neurons in focus. As these neurons are now forced to fire, they activate other, nearby neurons and strengthen connections to other parts of the brain. So, you could say TMS speaks the same language as the brain itself.
As a non-drug option, TMS only influences the brain and doesn’t alter the rest of our body’s chemistry. It is completely non-invasive and considered safe. There is no need for a needle or swallowing pills; magnetic fields simply pass through brain tissue, harmlessly.
Abundant clinical research has been done to investigate therapeutic effects of TMS, particularly in psychiatry and neurology, such as depression, anxiety disorders, chronic neuropathic pain, stroke rehabilitation, aphasia, tinnitus, obsessive compulsive disorder, and also Alzheimer’s disease. To be an effective therapy, TMS needs to reach the part of our brain closely related to the corresponding psychiatric and neurological diseases. However, targeted treatment sites for TMS are usually quite small. We can’t see them. In fact, no-one can, unless we have a brain scan.
TMS used without image-based navigation simply estimates a spot for stimulation. We believe it is important that TMS targets the right location in our brain – otherwise we may not get the benefit patients truly need. So, in our medical center, we use the latest 3D brain imaging navigated TMS to personalize TMS therapy for each patient, which is called SmartFocus® TMS.
Why SmartFocus TMS Is Different?
SmartFocus® TMS is not like the others: It’s an E-field navigated TMS. When a TMS coil is activated, it produces a stimulating electric field (E-field) in the cortex. Researchers have shown that the location of this E-field in the cortex is dependent on both the conductivity, as well as the geometry, of the underlying brain tissues. That means it is dependent on the unique shape and conductivity of every patient’s brain and its cortex.
So, the shape of the human head and brain is far from spherical and calculating the location requires sophisticated modelling of tissue geometry. The unique multi-sphere model used by SmartFocus® TMS has been scientifically-validated to accurately determine the location and orientation of the maximum induced E-field in the brain.
SmartFocus technology is capable to take all this into consideration so that the user of the system can be confident that whatever location, angle or tilt of the TMS coil relative to the head, a stimulus with the calculated and displayed E-field will be reliably delivered to the targeted cortical location. And the patient can be confident that he or she gets the treatment session personalized just for his or her brain.
SmartFocus TMS -
Personalising the TMS therapy for you
Brains are like people, we are all individuals – and different. That is why the therapy steps with SmartFocus® TMS include personalising the TMS just for you.
In the first therapy session:
1. SmartFocus therapy preparations start with taking your MRI scan. With the scan the sophisticated SmartFocus software can model the complexity of your individual head in a 3D form on a screen so that also your healthcare provider, a doctor or a nurse for example, can see it.
2. After developing the 3D model of your brain, the operator can measure the optimised TMS dose for you. This is done by placing EMG electrodes over your hand muscles. Using TMS pulse the operator, guided by the Smartfocus software, can determinate the correct stimulation level for you.
3. Because the operator has uploaded your MRI scan to the sophisticated software, the exact target area in your brain can also be determinated.
Same dose, same location – every time
4. After setting the right stimulus and finding the right target spot on your unique brain, the TMS treatment can start.
5. After the first session the system automatically stores all the settings made for you: In the next treatment sessions you’ll always receive the same optimized dose at the same location without the preparations mentioned in steps 1-3.
After a therapy session you can leave the clinic and continue your daily routine.
1. Is it safe?
TMS is non-invasive, which means that it doesn’t require any needles or anaesthetic. It is administered as an outpatient procedure for just over half an hour per session. FDA states that there are no major safety concerns with TMS. There is a very small risk of having a seizure (1 out of 30,000 sessions), but this is probably comparable to the risk associated with taking an antidepressant tablet. Before embarking on the treatment, a clinician will go through a safety checklist with you and rule out any potential safety issues.
2. How often will I have the treatment, and for how long?
Each TMS session takes about half an hour. Treatment for Depression using TMS is short but intense. 5 sessions each week will be required and the average treatment course lasts around 4-6 weeks.
3. Is it compatible with other treatments?
Yes, you can still have medication, including antidepressant medication if necessary, and you can also have psychotherapy, or any other psychological interventions, such as attending groups, etc.
4. Will I experience any discomfort?
The magnetic pulses produce a clicking sound, which can be loud, but you will be wearing ear plugs. You will feel a tapping sensation on your scalp where the coil is placed. In most cases, this sensation is neutral and perfectly bearable, although in a minority of cases it can be a little uncomfortable. If this happens, the clinic nurse will alter the position of the coil to make it more comfortable.