Clinical TMS Applications

TMS Applications

Transcranial Magnetic Stimulation (TMS)

Magnetic stimulation induces a small transient electrical current in human tissue using a very strong magnetic field. The magnetic field is created by passing current through a coil held close to the area of the body to be stimulated. It is safe, comfortable, non-invasive and used widely in research and therapy.

Transcranial magnetic stimulation (TMS) is a technique for noninvasive stimulation of the human brain. Stimulation is produced by generating a brief, high-intensity magnetic field by passing a brief electric current through a magnetic coil. The field can excite or inhibit a small area of brain below the coil. All parts of the brain just beneath the skull can be influenced, but most studies have been of the motor cortex where a focal muscle twitch can be produced, called the motor-evoked potential. The technique can be used to map brain function and explore the excitability of different regions. Brief interference has allowed mapping of many sensory, motor, and cognitive functions. TMS has some clinical utility, and, because it can influence brain function if delivered repetitively, it is being developed for various therapeutic purposes.

References and Credits:

Dr. Reza Jalinous' Guide to Magnetic Stimulation

https://doi.org/10.1016/j.neuron.2007.06.026

FDA-Cleared TMS Therapy System:
Insights and Key Facts

What is TMS Therapy?

Transcranial Magnetic Stimulation (TMS) Therapy is a non-invasive neuromodulation treatment that uses magnetic fields to stimulate nerve cells in the brain. It is primarily used to treat depression, particularly in patients who have not responded adequately to antidepressant medications.⁽¹⁾⁽²⁾

FDA Clearance

The U.S. Food and Drug Administration (FDA) has cleared several TMS therapy systems for use in treating major depressive disorder (MDD). FDA clearance indicates that the device has met specific safety and efficacy standards for its intended use.⁽³⁾

Mechanism of Action

TMS therapy involves placing an electromagnetic coil on the patient’s scalp which delivers magnetic pulses to targeted areas of the brain associated with mood regulation. This stimulation is thought to enhance neural activity in these areas and improve symptoms of depression.⁽⁴⁾⁽⁵⁾

Procedure

The treatment is typically administered in a clinical setting. A standard session lasts about 40-60 minutes, and patients often receive treatment five times a week for several weeks. The procedure is generally well-tolerated, with most patients experiencing minimal discomfort.⁽⁶⁾⁽⁷⁾

Indications

FDA-cleared TMS systems are indicated for use in patients with major depressive disorder who have not achieved sufficient benefit from antidepressant medications or who are unable to tolerate medication side effects.⁽⁸⁾

Efficacy

Clinical studies and trials have shown that TMS therapy can lead to significant reductions in depressive symptoms and, in some cases, remission. Effectiveness can vary, and ongoing assessments by healthcare providers are essential for determining the optimal treatment plan.^(9)(10)

Safety and Side Effects

TMS therapy is generally considered safe. Common side effects include mild scalp discomfort, headache, or tingling during the procedure. Serious side effects are rare but may include seizures or persistent mood changes.^(11)(12)

Insurance Coverage

Insurance coverage for TMS therapy can vary. Many insurance plans, including some Medicare and Medicaid programs, may cover the cost if specific criteria are met, such as treatment-resistant depression.^(13)(14)

Notable FDA-Cleared Devices

Examples of FDA-cleared TMS systems include the Brain Ultimate TMS System, MAG&More/neuroCare, Apollo TMS System, etc. Each device may have unique features or variations in the delivery of magnetic stimulation.

Ongoing Research

Research into TMS therapy is ongoing, with studies exploring its effectiveness in treating other psychiatric and neurological conditions, including anxiety disorders, PTSD, and chronic pain.^(15)(16)

References:

American Psychiatric Association. (2020). Practice Guideline for the Treatment of Patients with Major Depressive Disorder. APA
National Institute of Mental Health (NIMH). (2023). Transcranial Magnetic Stimulation (TMS) Therapy. NIMH
U.S. Food and Drug Administration (FDA). (2022). FDA-Cleared TMS Devices. FDA
Huang Y.-Z. et al. (2017). "Transcranial Magnetic Stimulation (TMS): Basic Principles and Clinical Applications." Journal of Clinical Neuroscience, 39, 55-59.
Padberg F. & George M. S. (2009). "Transcranial Magnetic Stimulation (TMS) for Major Depression." CNS Spectrums, 14(6), 335-342.
Charney D. S. & Sklar P. (2014). "Clinical Use of TMS in Depression." The Journal of Clinical Psychiatry, 75(7), 699-706.
O’Reardon J. P. et al. (2007). "Efficacy and Safety of Transcranial Magnetic Stimulation in Major Depression: A Multi-Center Randomized Controlled Trial." Biological Psychiatry, 62(11), 1208-1216.
FDA. (2023). Indications for Use for FDA-Cleared TMS Devices. FDA
Deldin P. J. et al. (2017). "Effectiveness of TMS for Depression: A Review of the Evidence." American Journal of Psychiatry, 174(10), 987-1001.
Kuyk S. et al. (2018). "Long-Term Efficacy of TMS for Depression." Journal of Affective Disorders, 235, 59-64.
George M. S. & Aston-Jones G. (2010). "Noninvasive Brain Stimulation for the Treatment of Depression: A Review of TMS." Journal of Neurotherapy, 14(3), 182-188.
Rossi S. et al. (2017). "Safety of Transcranial Magnetic Stimulation (TMS)." Brain Stimulation, 10(3), 229-239.
Insurance Information Institute. (2024). Coverage for TMS Therapy. III
Medicare.gov. (2024). Medicare Coverage of TMS Therapy. Medicare
NIMH. (2023). Ongoing Research on TMS. NIMH
Jorge R. E. et al. (2021). "Exploring New Applications of TMS Therapy: Beyond Depression." Journal of Clinical Psychiatry, 82(5), 678-689.