Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation Overview

dtms therapy

However, for those who do not benefit from these treatments, or who experience only a fractional reduction in symptoms, alternatives have been limited. Over the past few years, Transcranial Magnetic Stimulation (TMS) has emerged as a new option and has advanced from experimental to a more widely available therapy backed by research studies concluding its effectiveness. TMS is non-invasive and surgery-free. It is being increasingly introduced at hospitals and clinics in a number of countries including India, which raises queries in the minds of OCD patients if it can really cure their problem to an extent.

What is TMS?

TMS, as the name suggests is a non-invasive tool for “stimulating” (or changing) activity in the brain using magnetic fields. With the help of this magnetic field, certain specific areas of the brain, including those involved in OCD, are targeted, and stimulated. The patient may feel a tapping sensation on their head during procedure, but they are not being “shocked” by electricity.

It is of 2 types:

  • rTMS (or repetitive TMS): targets the prefrontal cortex (dmPFC), motor area (pre-SMA), and bilateral and prefrontal cortex (dlPFC) – has positive effects for patients with OCD. It sends magnetic pulses only upto 1.5cm into the brain.
  • dTMS (or deep TMS): targets the anterior part of cingulate cortex (ACC) and dmPFC, found to be helpful. No significant negative effects have been seen. It can send magnetic pulses about 4cm into the brain. dTMS is more widely used compared to rTMS.

What’s it like to receive TMS therapy?

TMS is meant to be an add-on therapy that patients receive alongside medication and/or ERP.
TMS procedure is generally provided in OPD settings. Treatment sessions are conducted 5 days a week for 4-6 weeks. Initially, each procedure involves a personalized, short “provocation” session where the patient’s OCD symptoms are triggered with intent to engage the brain circuit that will be targeted and magneto-electrically stimulated during the treatment. Following provocation, the actual dTMS treatment duration is approximately 20 minutes. The patient is awake during the procedure. A loud, clicking sound and a ‘tapping’ sensation may be felt during the procedure, for which the patient may be provided with ear plugs.

What are the Side effects of TMS?

Reported side effects of TMS include:

  • Scalp discomfort.
  • Light-headedness.
  • Tingling sensation, tremors, or twitching/spasms of facial muscles.
  • Mania (in patients with bipolar disorder).
  • Seizures (fits). The later 2 are rare side effects.

Will TMS work for me?

A month following treatment, research has found that OCD symptoms reduce in about 45% of patients. This could be over 55% according to some other studies. Some patients return after a period of time for “maintenance” treatment. This may mean returning for singular sessions, once weekly for the next few weeks.

Who should not receive TMS?

The magnetic field generated during the procedure may interact with metal implants or device in the body. Some examples are:
 Aneurysm coils or clips.
 Neck or brain stents.
 Metal implants in or around ears or eyes.
 Tattoos on face or neck that have magnetic ink.
 Implanted stimulators, like in heart or brain.
Its always important to check with your doctor and disclose if you have any of the above.
There are a few other treatment options:
 Transcranial Direct Current Stimulation (tDCS).
 Gamma knife.
 Ablative neurosurgery.
Surgeries are usually the last resort (e.g., Cingulotomy, Capsulotomy, sub-caudate tractotomy). Deep Brain Stimulation (used in the treatment of Depression, anxiety) is also being used in OCD patients. It has been approved by the FDA.

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