Non-invasive neuromodulation involves delivering neuromodulation without any surgical procedures. There are several forms of non-invasive neuromodulation, including Transcranial magnetic stimulation (TMS). TMS when delivered repeatedly for a certain disease is called rTMS.

An electromagnetic field is created around the patient’s head with used of a specialised coil. This electromagnetic field will alter the neural circuits of the brain to restore the balance of diseased brain state. Different types and combinations of the stimulation and the target brain region could induce different biological effects, and many certain stimulus models can induce prolonged effects on neural activity and may even exist after the period of treatment itself. The most widely accepted mechanism for the long-term neural effects of rTMS is that rTMS can alter synaptic plasticity, mainly the long-term potentiation/depression (LTP/LTD) of excitatory synaptic transmission. The advantage of rTMS is that it does not cause any discomfort (mild headaches in some patient), it is reversible and does not involve any anaesthesia.

Repetitive TMS is usually done in a doctor’s office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks. However, the number of sessions and the duration of the course will be dependent on the indication for which rTMS is offered.

• Patient sits in a comfortable sofa and is given earplugs in order to avoid any discomfort.
• The operator will take necessary measurements and design the protocol for the patient, specific to the disease being treated.
• A helmet containing the rTMS coil will be than put on the patients head.
• The patient will experience a small clicking sound during the time the rTMS is being delivered.
• After the session you would be free to go back to your normal activities including driving.

Jaslok hospital and Research Centre is one of the few places in India that offers the facility of deep TMS. Deep TMS has the potential of penetrating brain to a greater depth than the routine rtms. This additional capability of penetration offers better chance of reaching wider areas of brain network in order to control the symptoms of the patient. Not only this, many of the newer indications that are unlikely to be addressed by routine rtms can also be addressed by this deep TMS.

Another shortcoming of routine rTMS is area of coverage that it can offer. Because of the limited area of coverage, it is sometime difficult to place the conventional figure of 8 coil in an exact location on the head without a detailed physiological and anatomical mapping. The deep TMS resolves this issue by its unique coil design reducing the need of brain mapping.

The following picture illustrates that benefit of Deep TMS over the conventional rTMS in treating depression.

Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about one to one and a half hour.

• rTMS helmet will be placed on your headand switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You’ll also feel a tapping sensation on your forehead. This part of the process is called mapping.
• Your doctor will determine the amount of magnetic energy neededby increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.

Generally, rTMS is considered safe and well-tolerated. However, it can cause some side effects.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

• Headache
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
• Light-headedness

Your doctor can adjust the level of stimulation to reduce symptoms or may recommend that you take an over-the-counter pain medication before the procedure.

• You should have a recommendation from your treating doctor for considering rTMS
• If you do not have any recommendation or referral, the rTMS department will guide you to the specialist from the team of doctors with vast experience at Jaslok Hospital and Research Centre.
• If you have a metal implanted or a pacemaker implanted, you should inform your doctor.

• Other contraindications for the procedures include:
• Aneurysm clips or coils
• Stents
• Implanted stimulators
• Implanted vagus nerve or deep brain stimulators
• Implanted electrical devices, such as pacemakers or medication pumps
• Electrodes for monitoring brain activity
• Cochlear implants for hearing
• Any magnetic implants
• Bullet fragments
• Any other metal device or object implanted in your body

Some of these are relative contraindications and your doctor can only guide you.

These evaluations help make sure that rTMS is safe and a good option for you.

Most likely, during your first appointment:

Results of rTMS varies from person to person and also from indications to indications. You are advised to look at each disease indication listed on this website to review what is the latest literature available concerning each disease and expected outcome.

Explore Jaslok hospital Clinical studies of tests and procedures to help prevent, detect, treat or manage conditions. Write to us: (Provide email id)