Trans Cranial Magnetic Stimulation (TMS)

Trans cranial magnetic stimulation (TMS) is a procedure used to help in treatment-resistant depression, anxiety, OCD, and PTSD.

HISTORY 

The first TMS machine was developed in 1985 in Sheffield, England by Anthony Barker and his colleagues at Royal Hallamshire Hospital. The U.S. FDA approved NeuroStar TMS in 2008. However, the first true test of magnetic stimulation occurred way back in 1780 when Italian physician Luigi Galvani (“galvanized” - yes he was immortalized) discovered that electrical stimulation could cause a dead frogs leg - to move.

https://www.sciencedirect.com/science/article/abs/pii/S0166223697011016

MY EXPERIENCE 

I guess I am the frog in this scenario. 

The kind and wise doctor had me sitting in what looked like a dentist chair. He placed a small piece of equipment over my head. This felt like a skull cap. The skull cap was attached to the TMS machine.  

The doctor instructed me to hold up my left hand. He then asked one of the nurses assisting him to press the button on the TMS machine - this immediately sent magnetic signals to my brain. The magnetic pulse caused my pinky to move, just like the dead frogs leg moved. 

The doctor instructed one of the nurses to then move the skull cap slightly over a little bit. Again, the nurse was instructed to press the button again. This caused my ring finger to move this time. This procedure was continued until each finger wiggled and we eventually got to my thumb. When my thumb moved - we hit the sweet spot. The amygdala and the hippocampus were directly being targeted.

This, my initial TMS treatment, established my baseline. This is where we would know where to place the skull cap for the future sessions. The following sessions would last for about 20 minutes, from check-in till leaving the office. I did this treatment for 36 times total. 5 days a week until the 36 treatments were complete.

I felt my emotions going up and down like a roller coaster in the first couple of weeks. After about 14 or 15 sessions, I did start to see and feel much happier, lighter and less depressed.

Prior to beginning the treatment, and before each session. I was asked to fill out a patient health questionnaire. Also known as a PHQ9. This assessment gave me a baseline to where my depression level registered. After the 36 treatments, there was a significant and marked improvement in my depression levels. 

I maintained this significant improvement in my mental health for sometime. A secondary round of treatments have been recommended. 

In our initial consultation for the treatment, the doctor described TMS to me this way: some patients describe the sensation of the procedure akin to a little canary - barely tapping at their head. He also said there were other patients who described the sensation more like a big woodpecker - aggressively pecking away at their head. After the 36 treatments, I decided, it was a skinny woodpecker. The Skinny Woodpecker.

THEORY

The theory behind TMS is that there are neuronal pathways that lie dormant. Sometimes an early life, or an earlier time of a person‘s life, traumatic events can take place, and the trauma is never allowed to be fully processed. That unprocessed trauma can sit in the body for a lifetime. With the magnetic stimulation being sent to the amygdala and the hippocampus, those neurons and neuronal pathways are reawakened. This helps to alleviate some of the pain and suffering for many people. 

TMS increases activity of the synapse and helps in the secretion of neurotransmitters and causes neuronal plasticity or long-term potentiation.

https://pubmed.ncbi.nlm.nih.gov/19938752/

FUTURE 

There are potential new elements to the treatment. Some research has shown that as little as three to five intense Theta Burst TMS treatments may be beneficial in the improvement of a person‘s struggle with depression or other mental health condition.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3260517/

CONCLUSION 

TMS, in my opinion, is a great treatment option because of the non-invasive element, and the much written about benefits. TMS is FDA approved so most insurance providers will cover the procedure - however, copay and out of pocket expenses may vary.

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