Frequently Asked Questions

Our team at Optimis understands not everyone has heard of Transcranial Magnetic Stimulation.

We appreciate the unknown can be frightening, so our team of patient advisors have pulled together the most commonly asked questions.

Please feel free to contact us should you wish to talk or meet face to face.

What is TMS?

Transcranial Magnetic Stimulation, or TMS, is a targeted magnetic pulse designed to stimulate the brain for the treatment of different mental health conditions.

Is TMS safe?

TMS is a safe procedure with over three decades of intense clinical and scientific research behind it. In the UK, the National Institute for Health and Care Excellence (NICE) approved TMS as a safe and effective treatment for depression in 2015. 

From 1 November 2021, rTMS therapy will be listed on the Australian Medicare Benefits Schedule (MBS) under items 14216, 14217, 14219 and 14220 for the treatment of major depressive disorder, based on a recommendation of the Medical Services Advisory Committee (MSAC). 

The listing of rTMS services on the MBS aligns with the Australian Government’s commitment to ensure Australians can access affordable healthcare that reflects contemporary clinical practice. Most patients do not experience any significant side effects.

How Does TMS Work?

The treatment coil creates a focused magnetic pulse that is used to target the relevant area of the brain for the medical condition being treated. As the magnetic fields pulse, small electrical currents are produced. 
 
These electrical currents excite or calm activity in the brain centres. This reactivates neural pathways and the cumulative effect results in changes in the way the brain operates.

What is TMS Used for?

TMS has now been established as an effective alternative to some antidepressants and is being increasingly used to treat depression, obsessive-compulsive disorders (OCD), some symptoms of psychoses (auditory hallucinations) and PTSD, among other conditions.

High frequency rTMS in prefrontal brain regions stimulate neurons involved in 
mood regulation. 

TMS may modify brain circuits, neuron growth factors (BDNF), neurotransmitters (serotonin, dopamine), and increase brain-derived (endogenous) opioids. Research also suggests that targeting the stimulation more precisely within the area of the dorsal prefrontal cortex can improve symptoms of depression. This region of the brain is responsible for “executive functions”, such as selecting appropriate memories and inhibiting inappropriate responses. 

Other psychiatric symptoms, such as OCD, require specific modification to the stimulation regions.

What Happens during an TMS Procedure?

A patient sits in a treatment chair. Patients are asked to remove any magnetic-sensitive objects (such as jewellery) since TMS uses magnetic pulses that can heat magnetic metals. Patients wear earplugs during treatment for hearing protection, as TMS can produce a loud clicking sound with each pulse. 

During the first session, a motor threshold is found. This is the amount of machine energy needed to make the hand move when the coil is placed on the head in areas associated with movement. This measure tells the physician the patient’s TMS treatment dose to stimulate neurons. 

The TMS coil is properly positioned over the patient’s head for the motor threshold and subsequently repositioned into the treatment location. During the treatment, the patient hears a series of clicking sounds and feels a tapping sensation on their head under the treatment coil.

Who Administers TMS?

TMS is always prescribed by a TMS physician and then administered by a trained TMS operator. A motor threshold is always determined by a TMS physician. 

The treatment itself is administered by an experienced TMS operator under the supervision of the rTMS physician or by the TMS physician themselves. 

The TMS operator or physician will always be present to monitor the patient during the treatment. 

The patient can stop a treatment at any time by verbalising this request to the TMS operator.

How long is an TMS Procedure?

Your first ‘mapping’ session can take up to an hour, which will include time for your introduction to TMS and for all measurements to be taken by your TMS practitioner. 

Each session after this will be 30 minutes long.

How long does the TMS course take?

The number of sessions required will be prescribed following an assessment with one of our clinicians, where we take the individual’s condition into account. 

As a guide, approximately 20 - 30 sessions is usually needed to optimise the desired treatment outcomes.

Will I feel comfortable during the treatment?

You lie in a comfy chair while having the treatment, and although you are asked not to move your head, you can still read or listen to music to help you relax.

Do I Need to be Hospitalised for a Course of rTMS?

No. Unlike ECT, rTMS does not require any sedation or general anaesthesia, so patients are fully awake and aware during the treatment. There is no “recovery time”, patients can drive home afterwards and return to their usual activities.

What Are the Side-Effects of TMS?

There are few side effects associated with TMS. Pain sensation at the site stimulation is sometimes reported early in the TMS series. This experience significantly decreases over the course of TMS stimulation. 

Thereafter the most common side effect is headache, which is reported in nearly half of patients treated with TMS. Headaches are mild and generally diminish over the course of the treatment. Over-the-counter pain medication, such as ibuprofen, can be used to treat these headaches. 

The TMS machine produces a noise but there is no evidence to suggest there is hearing loss if earplugs are worn during the treatment. TMS is not associated with many of the side effects caused by medications, such as gastrointestinal upset, dry mouth, sexual dysfunction, weight gain, or sedation.

The most serious but rare risk of TMS is seizures, however, the risk of a seizure is exceedingly low. Nevertheless, at Optimis your nurse will be there with you observing for the entirety of your treatment.

What would make me ineligible for TMS Therapy?

Patients with any type of non-removable metal in their heads (not including braces or dental fillings) should not receive TMS. TMS in those situations could cause objects to heat up, malfunction, and result in serious injury or death. 

Below is a list of metal implants that can prevent a patient from receiving TMS: 

•  Aneurysm clips or coils 
•  Stents in the neck or brain Implanted stimulators 
•  Electrodes to monitor brain activity 
•  Metallic implants in your ears and eyes 
•  Shrapnel or bullet fragments in or near the head 
•  Facial tattoos with metallic or magnetic-sensitive ink 
•  Other metal devices or object implanted in or near the head
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