NEURO WELLNESS SPA

HISTORY OF TRANSCRANIAL MAGNETIC STIMULATION

How did TMS come about, and how has it progressed over the last decade?

NEURO WELLNESS SPA

HISTORY OF TRANSCRANIAL MAGNETIC STIMULATION

How did TMS come about, and how has it progressed over the last decade?

TMS IN DEPRESSION TREATMENT

The use of repetitive transcranial magnetic stimulation (rTMS) has greatly increased as the technology has been refined. Since the FDA cleared the first indication of repetitive TMS (rTMS) for treatment resistant depression in 2008, the availability of rTMS has steadily grown both inside and outside the United States. Currently, there are five FDA cleared devices for TMS therapy.

TMS IN DEPRESSION TREATMENT

The use of repetitive transcranial magnetic stimulation (rTMS) has greatly increased as the technology has been refined. Since the FDA cleared the first indication of repetitive TMS (rTMS) for treatment resistant depression in 2008, the availability of rTMS has steadily grown both inside and outside the United States. Currently, there are five FDA cleared devices for TMS therapy.

FDA-INDICATED TMS DEVICES

The first FDA-indication device for rTMS was the Neurostar® TMS System with a 37.5 minute protocol at a high frequency (10 Hz). The magnet capacity was limited to a total of 3,000 pulses due to the coil design and heat accumulation. The device was also limited in that it could only be used on the left dorsolateral prefrontal cortex (DLPFC).
 
The second device, approved by the FDA in 2013, was the Brainsway™ Deep TMS System. The most significant differences were the coil design and length of treatment. Brainsway introduced an H coil design with a 20.2 minute protocol at a higher frequency (18 Hz) than its predecessor.
 
In 2015, the FDA cleared two more systems: the MagVita TMS Therapy System manufactured by Tonica Elektronik and the Rapid2 Therapy System manufactured by Magstim. Like the Neurostar®, both feature the figure eight coil; however, these systems offer a 14 minute, high frequency protocol.

FDA-INDICATED TMS DEVICES

The first FDA-indication device for rTMS was the Neurostar® TMS System with a 37.5 minute protocol at a high frequency (10 Hz). The magnet capacity was limited to a total of 3,000 pulses due to the coil design and heat accumulation. The device was also limited in that it could only be used on the left dorsolateral prefrontal cortex (DLPFC).
 
The second device, approved by the FDA in 2013, was the Brainsway™ Deep TMS System. The most significant differences were the coil design and length of treatment. Brainsway introduced an H coil design with a 20.2 minute protocol at a higher frequency (18 Hz) than its predecessor.
 
In 2015, the FDA cleared two more systems: the MagVita TMS Therapy System manufactured by Tonica Elektronik and the Rapid2 Therapy System manufactured by Magstim. Like the Neurostar®, both feature the figure eight coil; however, these systems offer a 14 minute, high frequency protocol.

ADVANCES IN TMS THERAPY

FASTER & MORE EFFICIENT

As device technology becomes more and more sophisticated, the amount of time needed to treat patients has decreased. This is significant because it allows more patients to receive therapy. Perhaps the greatest breakthrough yet was in August, 2018, when the FDA approved a new 3 minute protocol known as intermittent theta burst stimulation (iTBS) for the MagVita TMS Therapy System.

TMS FOR USE OUTSIDE OF DEPRESSION

Time isn’t the only aspect of improvement for rTMS. As research continues and clinical use expands, science seeks to enhance and expand the benefits of rTMS. In early August, the FDA approved the marketing of the Brainsway™ Deep TMS System for obsessive compulsive disorder (OCD). With ongoing controlled trials and systematic reviews, rTMS is likely to receive more FDA indicated protocols for other mental health diagnoses such as generalized anxiety disorder, mild cognitive impairment, cigarette cessation, and more.

HUMBLE BEGINNINGS

The physical principles of rTMS can be traced back to English physicist, Michael Faraday, in 1881. He “observed that a pulse of electric current passing through a wire coil generates a magnetic field. The rate of change of this magnetic field determines the induction of a secondary current in a nearby conductor… Because magnetic fields can pass the skull with almost no resistance, TMS can induce relatively large currents in targeted cortical areas (Horvath, p. 137).” More than a century later, Anthony Barker and colleagues developed the first reliable transcranial magnetic brain stimulator. As evidenced above, TMS has since gone through multiple evolutionary stages involving coil design/capacity, coil placement, prescribed protocols (based on type, frequency and duration of magnetic stimuli) and FDA-indications. With continued clinical trials and expanded use, along with brain mapping, rTMS technology will be at the forefront for expanding our knowledge of the brain and of neurobiology. In the words of Dr. Aaronson, Director of the Clinical Research Program in the Sheppard Pratt Health System, “We are at the beginning of a revolution in the care of psychiatric illness.” iii

SOURCES

i. Janicak, P. G., & Sackett, V. (2018, April 16). Advances in transcranial magnetic stimulation for managing major depressive disorders. Retrieved November 30, 2018, from MD Edge.

ii. Horvath, J. C., Mathews, J., Demitrack, M. A., & Pascual-Leone, A. (2010). The NeuroStar TMS device: conducting the FDA approved protocol for treatment of depression. Journal of visualized experiments : JoVE, (45), 10.3791/2345 2345. doi:10.3791/2345

iii. LeBano, L. (2014, October 14). Transcranial magnetic stimulation: device comparison and clinical experiences. Psych Congress Network. Retrieved November 30, 2018, from Psych Congress.

iv. MedScape

v. FDA

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