A closer look at rTMS

What is repetitive transcranial magnetic stimulation (rTMS)?

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method of brain stimulation. The basic principle of repetitive transcranial magnetic stimulation (rTMS) is to target short magnetic pulses over the scalp in specific brain regions that regulate mood.

rTMS is a medically safe treatment that has been evidenced to significantly decrease symptoms of depression and OCD, as well as individuals suffering from treatment-resistant depression. 

It is thought that up to one-third of people with major depressive disorders will not respond to standard treatment (including anti-depressant medications and therapies). For individuals that fall into this treatment-resistant category, rTMS can be a life-changing solution for major depression. 

Treatment is delivered in an outpatient setting, with no sedation needed. It is generally well-tolerated by most patients and has minimal side effects. 

Why choose rTMS treatment at Nightingale Hospital?

In 2014, Nightingale (in partnership with MagnaCentre™) was the first private hospital in the UK to pioneer rTMS treatment. Since then, we have been the most experienced provider of rTMS treatment in the UK, delivered by our expert and internationally experienced practitioner team.

Deep TMS using BrainsWay’s H-Coil

Not only were we the first private hospital in the UK to deliver repetitive transcranial magnetic stimulation (rTMS) treatment, but we were also the first private hospital in the UK to offer rTMS using a BrainsWay H-coil.

rTMS is typically delivered using a figure-8 shaped coil. The standard figure-8 coil uses a highly focused magnetic field. This type of coil has limitations when it comes to accurately targeting the specific sections of the brain which are impacted in depression and OCD.

There are two main advantages to using noninvasive Deep TMS technology:

• The ability to reach the brain’s deeper brain structures directly helps prevent a decrease in the magnetic field’s intensity. This helps maintain the field’s effectiveness without needing to increase the intensity to a level that risks causing undesirable side effects.
• The ability to avoid the need for an increase in intensity allows dTMS to broaden the scope of its electromagnetic field, reaching more relevant brain regions and structures while maintaining a safe level of activation. The deeper, broader field also enhances the correct brain region targeting, eliminating the need for complex neuronavigation equipment.

It has been suggested that the deeper and wider penetration provided by H-coils accounts for the superior response rate and greater reduction of depression severity reported in the first head-to-head trial between the H-Coil and figure-8 coil published in 2019.

Repetitive transcranial magnetic stimulation (rTMS) at Nightingale Hospital is delivered in partnership with MagnaCentre™, led by Dr Michael Craig.

What are the benefits of repetitive transcranial magnetic stimulation (rTMS)?

• Research and clinical trials worldwide have reported it to be an effective treatment for depression and OCD
• rTMS is a non-invasive treatment, which requires no sedation
• It is an outpatient treatment and well-tolerated by the majority of people
• People experience minimal side effects
• Daily activities can be resumed immediately after each session (e.g driving)

What are the side effects of repetitive transcranial magnetic stimulation (rTMS)?

rTMS is generally well tolerated by most patients but can cause some minor short-term side effects including:

• Headaches
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
• Light-headedness
• Discomfort from noise during treatment
• Other rare side effects include seizures (2 per 1,000 cases)

When compared to anti-depressant medication and ECT, rTMS is proven to have far fewer side effects.

When is repetitive transcranial magnetic stimulation (rTMS) not suitable?

• If you have a co-morbid neurological disorder, history of epilepsy and/or neurosurgery
• If you have metal plates in the head/brain, the presence of pacemakers or other electronic
  implants, inner-ear implants, metal or magnetic objects in the brain and medication
  pumps. (Standard amalgam dental fillings do not pose an issue)
• If you are below 18-years-of-age

Useful resources

• What evidence exists for Deep TMS effectiveness?
• Treatment-resistant depression services at Nightingale Hospital
• You can read a recent patient testimonial about rTMS for depression treatment here.