RTMS

Brain stimulation in psychiatric practice uses electrical currents or magnetic fields to alter neuronal firing

WHAT IS RTMS?

• TMS is a non-invasive method of brain stimulation in which magnetic fields are used to induce electric currents in the cerebral cortex, thereby depolarizing neurons.
• Uses a rapidly changing magnetic field to induce weak electric currents, through pulses.
• One of the newer brain stimulation technique.
• TMS is the application of a rapidly changing magnetic field to the superficial layers of the cerebral cortex, which locally induces small electric currents(“eddy” current).
• Discovered by Michael Faraday through his experiments in 1831 and later quantified in Maxwell's equations of electromagnetism.

HOW DOES RTMS ACTS?

• TMS directly stimulates cortical neurons.
• Pulsed magnetic field from TMS produces local eddy current in cortical neurons. This further stimulate for secretion of neurotransmitters.
• TMS causes release of neurotransmitters at frontal region of brain which further alleviated the depressive symptoms.
• TMS also causes neurobiological effect through neuroplastic changes in circuits. This may lead to behavioural change.
• TMS Modulates Excitability in a Frequency Dependent Manner. It means high frequency stimulationn causes excitation of neurons whereas low frequency causes inhibition of neurons. So depending on the frequency of stimulation various brain regions may be either stimulated or inhibited.

USES OF RTMS

• FDA has currently only approved rTMS as a treatment for Major Depressive Disorder (MDD).
• OTHER ILLNESS WHERE IT MAY BE USED ARE
• Amblyopia
• Amyotrophic lateral sclerosis
• Auditory hallucinations associated with schizoaffective disorders
• Chronic pain
• Dysphasia
• Dystonia
• Epilepsy
• Fibromyalgia
• Hemispatial neglect
• Major depression
• Migraine
• Obsessive-compulsive disorder
• Parkinson’s disease
• Phantom limb
• Stroke
• Non-fluent aphasia
• Tinnitus

SAFETY OF RTMS

• No systemic side effects.
• No adverse effect on cognition.
• Most common adverse event associated with treatment was scalp pain or discomfort – < 5% of patients discontinued due to adverse events.
• No seizures reported during clinical studies (over 10,000 treatments).
• Long term safety demonstrated in 6 months follow-up.
• Tension headache.
• Short term changes in hearing threshold related to the noise generated.
• Cognitive changes only during stimulation

CONTRAINDICATION OF RTMS

Metallic (Ferro or Paramagnetic) hardware near the coil can be moved or heated by TMS. Therefore, the presence of metal anywhere in the head, excluding the mouth, is generally a contraindication to TMS.

Individuals with cardiac pacemakers and implanted medication pumps should not participate in rTMS studies without a clear potential benefit (e.g, treatment of severe and refractory depression).

We at spandana have been providing RTMS service for many years and multiple patients who were refractory to other treatments had got benefit. The stories of succesfull treatment in patients with depression, anxiety and OCD are in abundance.

WHAT HAPPENS DURING RTMS TREATMENT?

During treatment you will be comfortably seated in a chair with your head leaning back. This allows us to ensure correct positioning of the coil, which will deliver the magnetic pulses.

The treatment will be delivered using a magnetic coil. The coil is normally positioned on the left or right Dorso-Lateral Prefrontal Cortex (an area a few inches above the temple beneath the skull). You will be still for the duration of your treatment (approx 30 minutes). We will do everything we can to ensure our patients are at ease during the treatment. RTMS treatment is completely non-invasive and you won’t need to be sedated.

Some patients do experience slight tingling sensations or headaches at the start of the treatment but your nurse will make sure you feel comfortable throughout the procedure. You will be able to go straight back to work after the treatment.

Repetitive Transcranial Magnetic Stimulation (RTMS) treatment is a cutting edge treatment, but the nature of this is that patients are sometimes wary. Research has shown that RTMS provides effective treatment for depression without the side effects normally experienced with traditional medication.