How does TMS work?

  • At the basic level, our brains communicate via electric currents. TMS uses the principles of electromagnetic induction to non invasively and painlessly introduce electric currents into specific brain areas to produce changes such as improved connectivity, regulation of neurotransmitters.
  • Our brains are neuroplastic meaning that they are able to change (for example functionally, structurally) and this gives us an opportunity to treat some brain conditions by inducing these kinds of changes.
  • The challenge of TMS therapy relates to the accurate targeting of brain regions associated with patent symptoms.

What is TMS used for?

  • Different kinds/forms of TMS have been used for a variety of brain applications such as mapping of brain areas (such as in research and brain surgery) and to examine the connections between different regions of the brain.
  • rTMS (repetitive TMS) is the form that is used clinically to treat conditions such as depression and OCD, and it is called ‘repetitive’ because it uses multiple magnetic pulses in a treatment and people also need to have a number of treatments to have a clinical effect.
  • This therapeutic effect occurs over time and is rarely experienced instantly.
  • rTMS was first approved by the FDA for treatment of Major Depressive Disorder in 2008.
  • Since then, rTMS has been approved by the FDA for refractory OCD (in 2018), smoking cessation (in 2020) and depression with anxious features (in 2022). There is a lot of ongoing research into other uses for rTMS.
  • Since it was first approved for depression in 2008, there have been a multitude of studies which have scientifically proven that rTMS is an EFFECTIVE treatment for depression, with response (some reduction in symptoms) rates of over 53% and remission (no more symptoms) of over 27%.
  • These results are very good when compared to antidepressant meds (38% response rate and 18% remission rate)
  • In Australia, rTMS has been approved on the PBS as a treatment for treatment resistant depression since Nov 2021. This means that Medicare pays a subsidy for this treatment for people who have qualified for treatment.

What is Neuronavigated TMS?

    • Neuronavigated TMS (nTMS) is a newer approach of rTMS that uses a navigation system to precisely target specific brain areas with TMS. Click here to watch a video of this in action: (source: Nexstim. 2020)
    • Think of our navigated system akin to driving a car with GPS in the dark. Every brain shape is different and the current estimates of systems without neuronavigation (eg “skull cap” or “5cm rule”) can lead to an accuracy rate of 30pc (Herwig et al, 2001)
    • To do this, we need an MRI. This will allow us to map what we can visualise of the brain’s surface.
    • Since rTMS is a treatment that needs to be done repetitively over a number of weeks, it is important to be accurate with the treatment and targeting of the same specific brain region each and every time
    • Thus, we use the most accurate rTMS machine on the market, NEXSTIM. To read their patient information booklet, please click here.

What is the process of undertaking Neuronavigated TMS as a patient?

  • We refer our patients to obtain a basic brain Magnetic Resonance Imaging (MRI) scan, which shows us exactly where to target. This MRI scan is uploaded into our Nexstim system. Nexstim uses SmartFocus 3D neuro-navigational mapping technology to ensure that each time you have your rTMS treatment, it is targeted to the specific area required.
  • This combines something they refer to as ‘E-field’ visualisation, which shows exactly where and exactly how the brain is being stimulated subject to your own individual anatomy. Nexstim makes zero assumptions about targeting the right area, and delivering the right amount of therapy, and ensures that the amount of therapy is individually designed for each session.
  • This is because the brain’s resting state changes from day to day. We ensure that our patients have rTMS treatment in the exact brain area, with the same therapeutic dosage, every time.
  • We make zero assumptions about your brain anatomy and brain health, and explore each patient and each session individually to ensure the greatest clinical effect.

About Nextstim’s Neuronavigation

  • Nexstim TMS machines have been produced for over 20 years and are used for a variety of purposes, including research and neurosurgery.
  • Nexstim is the only company in the world to have their TMS machines FDA and CE approved for motor mapping (2009) and speech mapping (2012) which are important aspects of neurosurgical planning. This shows how anatomically accurate Nextstim is, which we hope will translate to more effective clinical effectiveness for our patients.
  • In recent data using Nexstim; Of the first 403 patients completing treatment at clinical sites in the U.S., 200 (49.6%) had achieved clinical remission and 307 (76.2%) had obtained a clinical response at end of treatment based on Beck’s Depression Inventory (BDI) and Patient Health Questionnaire – 9 (PHQ-9) scores[1]. These are higher than what is consistently reported for non-navigated TMS.

How do rTMS and Neuronavigated TMS differ?

Neuronavigated TMS (nTMS) is a newer approach to rTMS that uses a navigation system to precisely target specific brain areas with TMS.

Improved accuracy: nTMS uses a 3D navigation system to accurately locate and target specific areas of the brain. This results in more precise stimulation and fewer errors in the targeting of brain regions. This means that nTMS can be used to stimulate smaller or deeper brain areas that are difficult to access with traditional TMS.

Customization: With nTMS, the stimulation can be customized to the individual patient’s brain anatomy. This allows the stimulation to be tailored to the specific needs of the patient and increases the effectiveness of the treatment.

Higher treatment efficacy: Due to the increased accuracy and customization, nTMS can provide a higher level of efficacy compared to normal TMS. This is especially true in cases where patients have failed to respond to traditional TMS, as nTMS can target the specific area of the brain responsible for the patient’s symptoms.

Reduced side effects: The improved accuracy of nTMS means that there is less chance of stimulating unintended areas of the brain. This reduces the risk of side effects and makes nTMS a safer and more tolerable treatment option.

Increased patient comfort: The navigation system used in nTMS ensures that the TMS coil is positioned more accurately, reducing the need for repeated coil adjustments during the treatment. This results in less discomfort and increased patient comfort during the treatment.

Overall, neuronavigated TMS offers a more precise, effective, and comfortable treatment option for patients suffering from a range of neurological and psychiatric conditions. While traditional TMS remains a valuable tool in the field of brain stimulation, nTMS has the potential to provide even better outcomes for patients.

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Admin FAQs

Are there any nearby parking spaces?

The HHC Niddrie clinic is surrounded by free 2-hour council car parks or there is a paid longer term car park there’s also across the road the Woolworth car park available.

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