What Is Repetitive Transcranial Magnetic Stimulation?

Learn About the Uses, Effects, and History of rTMS for OCD

Hospital, pain centre. France. An rTMS session (repetitive transcranial magnetic stimulation) carried out by a nurse.
BSIP/UIG / Getty Images

Repetitive Transcranial Magnetic Stimulation (also known as rTMS or Repetitive TMS) is a relatively non-invasive procedure that involves placing a small magnetic device directly on the skull. This sealed device contains a coil of wire that carries electricity and produces a magnetic field similar in strength to a magnetic resonance imaging (MRI) scan. The flow of electricity that pulses through the device to targeted areas causes cells in the brain called neurons to become either more or less active.

How rTMS Works

The activity level of neurons has been linked to symptoms of mental illness, like obsessive-compulsive disorder (OCD), which helps explain the theory behind rTMS. Specific brain regions can be stimulated repeatedly to cause long-lasting changes in the activity of the neurons. It is thought that these changes may lead to a decrease in symptoms, though the treatment is new enough that studies are still being done. The side of the brain and brain area targeted often depends on the illness being treated. 

History of the Treatment

rTMS was initially introduced in 1985 as a less damaging form of the older and much more invasive electroconvulsive therapy (ECT). In 2008, the FDA approved it for use in the United States with depression that has not been treatable with at least one medication. It has also been approved in New Zealand, Australia, Canada, Israel and the European Union for use with depression that does not respond to other treatment.

The effectiveness of rTMS for other disorders, such as schizophrenia, stroke, brain injury, anxiety, migraine and pain is still being researched.

Safety and Side Effects

rTMS is generally considered safe when used in accordance with established guidelines, although some patients report experiencing headaches, scalp discomfort, light-headedness or muscle tightness or tingling.

Epileptic seizure is a more serious, although rare, side effect of TMS and usually only occurs if the patient has a history of seizures. rTMS cannot be used in patients who have a pacemaker or certain metal implants or devices. 

What You Can Expect

Repetitive TMS treatments can be given once a day or many times a day for days or weeks at a time, depending on the treatment protocol. Typically, sessions last anywhere from 20-60 minutes and are given five days a week for about six weeks. No anesthesia is used, meaning that you are awake, but it is painless, though you may feel a light tapping or knocking in the head. You may choose to wear earplugs since the treatment tends to be noisy.

The treatment's long-term effects seem to last for at least six months, though a maintenance therapy, such as a medication or psychotherapy, may be needed as well. Further treatments may be necessary later if symptoms return. Your doctor will continue to monitor you after completing treatment.     

Because its effectiveness is variable and not well-established, rTMS is not used as a primary treatment.

However, because it is so non-invasive and has few side effects, it can be a good option for people in search of alternative ways to combat mental illness or pain, particularly if other treatments have failed. Talk to your physician about whether or not rTMS might be right for you.

Sources:

Ruffini, C., Locatelli, M., Lucca, A., Benedetti, F., Insacco, C., Smeraldi, E. "Augmentation effects of repetitive transcranial magnetic stimulation over the orbitofrontal cortex in drug resistant obsessive-comulsive disorder patients: A controlled investigation. Primary Care Companion to The Journal of Clinical Psychiatry 2009 11: 226-230.

Slotema, C.W., Blom, J.D., Hoek, H.W., Sommer, I.E.C. "Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. Journal of Clinical Psychiatry 2010 (e-published ahead of print).

http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml

http://www.neuromodulation.com/TMS

Continue Reading