rTMS

rTMS

Authored by Pin Ng PhD

Edited by Hugh Soames

Reviewed by Michael Por, MD

What is rTMS

The mere word ‘cocaine’ conjures up many thoughts from Wall Street in the 1980s and Netflix films about Colombian drug lords. For many people, cocaine is one of the hardest, most extreme drugs that a person can take alongside crack and heroin. It is often considered a drug that is difficult to get and only a problem for a certain segment of the population.

In the United States and United Kingdom, cocaine is a major problem. According to a 2016 study in the U.S., nearly 1.9 million individuals claimed to be current cocaine users.1https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf In 2019, the Guardian reported that use in the U.K. was growing and leading to the deaths of young people. Many of these individuals didn’t live through the rise of coke in the 1980s and only see the drug as a fun party item that films on Netflix are made about.

In the fight against cocaine use, a new innovative treatment has been introduced known as rTMS.2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592198/ Cocaine is unique as, it is not only extremely harmful, but there are no medical substitutes for treatment like with heroin. Withdrawal symptoms can be dealt with but the craving for more cocaine is the biggest problem users – from first time users to addicts – have with the drug.

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a form of neuromodulation.3https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32837-X/fulltext The treatment is safe and effective in the fight against cocaine addiction. rTMS works by placing a purpose‑made electromagnetic coil against a patient’s scalp. The coil delivers short, powerful magnetic pulses and induce electric currents in the patient’s cerebral cortex.

Receiving transcranial magnetic stimulation rTMS

The treatment may sound frightening, like the electroshock therapy used on mental health patients in the 1960s and 1970s. However, rTMS is safe, painless, and offers few side effects. After an rTMS therapy session, clients are safe to drive, go back to work, or complete their daily routines. Sessions are completed without anesthetic.4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271460/ There is no need for medication or hospitalization when undergoing the treatment. Just as importantly, there is no recovery time needed and clients do not have to spend 28 days in residential rehab.

Is rTMS transcranial magnetic stimulation approved

Experts have prescribed rTMS to treat more than just cocaine addiction. In the U.S., the Food and Drug Administration has prescribed it to treat depression. In the U.K., it is also being used to help patient’s overcome depression along with OCD.5https://www.sciencedirect.com/topics/medicine-and-dentistry/repetitive-transcranial-magnetic-stimulation Its effectiveness in the treatment of cocaine addiction could be one of the more significant therapies offered, however.

Research has found that transcranial magnetic stimulation changes a person’s brain activity, connectivity, and metabolism. It is the therapies ability to change these three areas that reduce and ends a person’s craving for cocaine.

Getting rTMS

Clients attend 15 sessions of transcranial magnetic stimulation treatment therapy. Sessions take place over the course of a three-week timeframe with clients participating in five rTMS treatments per week. The therapy also improves a patient’s depression and mood. Patients can undergo further maintenance sessions each month to continue their recovery from cocaine addiction and create long-lasting effects.6https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

Medical health providers and recovery specialists may prescribe rTMS alongside behavioral and psychological treatments for added value.

Deep rTMS

Deep transcranial magnetic stimulation (rTMS) is designed to stimulate reward and motivation pathways in the brain.7https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329899/ These are located within the subgenital anterior cingular cortex and are the main difference between the two. Deep TMS and rRMS have proven to be safe methods of treating depression, but what are some of the main differences between these two?

The deep TMS is designed to stimulate this area of the brain, and the depth varies depending on the patient. The focal point of the electromagnetic field is the dorsolateral prefrontal cortex located in the forehead. This area resembles the subgenual cingular cortex, which is affected by deep T-MSM, but with a depth of about 1.5cm. The strength of electromagnetic fields must be calibrated during treatment so that the depth varies according to the patient.

The dorsolateral prefrontal cortex is responsible for executive cognitive functions, and these functions include working memory, decision-making, executive function, attention, memory processing, and decision-making.

The relevant theories for possible causes of depression suggest that depression may result from the inability to let go of something unattainable or to solve problems related to negative affectivity through goal-oriented thought processes. This phenomenon is essentially the same as the temporary sadness that occurs in children when they are told “no.”

TMS therapy is performed with an H1 coil placed on the front half of a hat or device worn by the patient and applied to a magnetic field by applying the field to the head. The advantage of radial application of magnetic fields is that these fields can penetrate deeper into the brain without harming the patient.

The coil used in transcranial magnetic stimulation applies a magnetic field vertically to a narrow area of the head. The repetitive impulses enable the magnetic fields to become stronger and stronger without harming the patient.

The strength of the magnetic field increases with repeated pulses for longer, but the longer the pulse, the stronger the field. While rTMS therapy uses the 8-coil to apply a magnetic field vertically, deep TMS therapies use the H-1 coil to apply a magnetic field radially. To reach further nerve centers that cause depression, they must penetrate about 4 cm deep into the brain.

Recent studies found that deep TMS therapies were longer lasting in patients on medication resistant depression.8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280107/

Deep rTMS side effects

Deep TMS stimulates reward and motivation pathways in the brain and stimulates brain cell activity. The most common side effects of T-MS are headaches and headaches, but they are less common than other types of brain stimulation, such as brain injury or brain damage.

Repeated TMS stimulates executive and cognitive functions in the brain, and treatment takes about 20 minutes. For T-MS different coils are used, but each requires a different type of coil, like the one used for repeated T-MS. The repetition of T-MSM stimulates the activity of brain cells in a specific area of the prefrontal cortex, the area responsible for decision-making and executive function. The treatments last about 40 minutes and cause no side effects, except a slight increase in blood pressure.

 

References: rTMS transcranial magnetic stimulation

  1. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;1:1106–7. [PubMed] []
  2. Kolin A, Brill NQ, Broberg PJ. Stimulation of irritable tissues by means of an alternating magnetic field. Proc Soc Exp Biol Med. 1959;102:251–3. [PubMed] []
  3. Sorrell RG, Muhlenfeld J, Moffett J, Stevens G, Kesten S. Evaluation of pulsed electromagnetic field therapy for the treatment of chronic postoperative pain following lumbar surgery: A pilot, double-blind, randomized, sham-controlled clinical trial. J Pain Res. 2018;11:1209–22. [PubMed] []
  4. Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) Clin Neurophysiol. 2014;125:2150–206. [PubMed] []
  5. Wang YP, Gorenstein C. Psychometric properties of the beck depression inventory-II: A comprehensive review. Braz J Psychiatry. 2013;35:416–31. [PubMed] []
  6. Fitzgerald PB, Hoy K, McQueen S, Maller JJ, Herring S, Segrave R, et al. A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression. Neuropsychopharmacology. 2009;34:1255–62. [PubMed] []
  7. George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: A shamcontrolled randomized trial. Arch Gen Psychiatry. 2010 [PubMed] []
  8. George MS, Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995;6:1853–6. [PubMed] []
  9. Dunner DL, Aaronson ST, Sackeim HA, Janicak PG, Carpenter LL, Boyadjis T, et al. A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: Durability of benefit over a 1-year follow-up period. J Clin Psychiatry. 2014;75:1394–401. [PubMed] []
  10. Hızlı Sayar G, Ozten E, Tufan E, Cerit C, Kaǧan G, Dilbaz N, et al. Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health. 2014;17:311–5. [PubMed] []
  11. National Institute for Health and Care Excellence. Transcranial Magnetic Stimulation for Treating and Preventing Migraine. National Institute for Health and Care Excellence. 2014:1–8. []
  12. Pascual-Leone A, Houser CM, Reese K, Shotland LI, Grafman J, Sato S, et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroencephalogr Clin Neurophysiol. 1993;89:120–30. [PubMed] []
  13. Wassermann EM, Grafman J, Berry C, Hollnagel C, Wild K, Clark K, et al. Use and safety of a new repetitive transcranial magnetic stimulator. Electroencephalogr Clin Neurophysiol. 1996;101:412–7. [PubMed] []
  14. George MS, Lisanby SH, Sackeim HA. Transcranial magnetic stimulation: Applications in neuropsychiatry. Arch Gen Psychiatry. 1999;56:300–11. [PubMed] []
  15. Bortolomasi M, Minelli A, Fuggetta G, Perini M, Comencini S, Fiaschi A, et al. Long-lasting effects of high frequency repetitive transcranial magnetic stimulation in major depressed patients. Psychiatry Res. 2007;150:181–6. [PubMed] []
  16. Sarkhel S, Sinha VK, Praharaj SK. Adjunctive high frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive-compulsive disorder but improved secondary depression. J Anxiety Disord. 2010;24:535–9. [PubMed] []
  17. Wedegaertner F, Garvey M, Cohen LG, Hallett M, Wasserman EM. Low frequency repetitive transcranial magnetic stimulation can reduce action myoclonus. Neurology. 1997;48:119–25. []
  18. Sakkas P, Mihalopoulou P, Mourtzouhou P, Psarros C, Masdrakis V, Politis A, et al. Induction of mania by rTMS: Report of two cases. Eur Psychiatry. 2003;18:196–8. [PubMed] []
  19. Zangen A, Roth Y, Voller B, et al. Transcranial magnetic stimulation of deep brain regions: evidence for efficacy of the H-coil. Clin Neurophysiol. 2005;116:775–9. [PubMed] []
  20. George MS, Lisanby SH, Avery D, et al. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010;67:507–16. [PubMed] []
  21. Isserles M, Shalev AY, Roth Y, et al. Effectiveness of deep transcranial magnetic stimulation combined with a brief exposure procedure in post-traumatic stress disorder – a pilot study. Brain Stimul. 2013;6:377–83. [PubMed] []
Summary
rTMS
Article Name
rTMS
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Clients attend 15 sessions of rTMS treatment therapy. Sessions take place over the course of a three-week timeframe with clients participating in five rTMS treatments per week. The therapy also improves a patient’s depression and mood. Patients can undergo further maintenance sessions each month to continue their recovery from cocaine addiction and create long-lasting effects.
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Worlds Best Rehab
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