What happens before transcranial magnetic stimulation?
Before you undergo TMS, a healthcare provider will probably refer you to a specialist with training and experience in using this treatment. The specialist will also talk to you before treatment to make sure you meet the criteria for having TMS or if there are any conditions or circ*mstances that mean you shouldn’t receive it.
Reasons that you shouldn’t undergo TMS can include:
- Any kind of implant that’s electronic or contains magnetic metal. TMS is dangerous for anyone with cochlear implants, metal plates on their skull, etc. TMS involves a powerful magnet, which can pull on any magnetic metal in such implants. That pull could cause severe pain or even injuries if it moves an implant.
- A history of seizures, epilepsy or other conditions/circ*mstances that affect your brain. While it’s rare, TMS can cause seizures. If you have a seizure-related condition or take a medication that increases the risk of seizure, your provider might recommend changing your medications or trying another treatment method altogether.
If your provider determines that TMS is a good and safe option for you, they’ll talk with you about the treatment schedule they recommend. TMS takes multiple treatments — typically three to five per week — spread out over several weeks. For FDA-approved protocols for depression, a typical TMS course happens every weekday over six weeks for a total of 30 treatments. However, some newer treatment courses can greatly reduce the course of treatment down to a single week.
Because there’s some variability in treatment courses, your provider is the best person to explain the recommended course of treatment sessions. They can provide the most accurate information specific to your case.
What happens during transcranial magnetic stimulation?
TMS is a noninvasive procedure. The only thing you might need to do right before the procedure is to take off glasses with metal frames or remove any metallic jewelry items. Removing all metallic jewelry is a safety precaution in case they contain any magnetic metals you don’t know about.
The magnetic coil for TMS is inside a nonmagnetic case or housing. Some devices use a magnet inside a helmet that you wear. Others have the magnet attached to an extension arm (much like the type of arm that allows a healthcare provider to position an overhead light during a medical procedure). Your provider will have you sit in a specially designed chair underneath or beside the magnet.
Once you’re seated comfortably, your provider will give you earplugs (or another type of hearing protection). That’s because the sound of the magnet is loud enough to damage your hearing (using hearing protection is also standard with MRI scans for this same reason).
After you have hearing protection in place, your provider will position the magnet on your head. That either involves putting on the magnet-containing helmet (with a chin strap, so it stays in place) or positioning the extension arm with the magnet at its end, so the outer case of the magnet is against your face. The specific placement depends on the condition you have.
Before starting the treatment, your provider will give single-pulse stimulations on your scalp. This helps to find the right location and setting for your treatments. Once the magnet is in position, they’ll start the treatment. Early on, you’ll feel a tapping-like sensation from the magnet as your provider slowly increases the strength of the magnetic pulses.
As the pulse strength increases, you’ll notice a twitch or movement in your hands, especially in your thumbs. This is normal, and your provider will watch for it because it helps them know when the pulse strength is high enough.
After finding and setting the right pulse strength, your provider will have the magnet deliver pulses with a specific timing or pattern. You’ll hear clicking sounds during the treatments as the magnet turns on and off. This is also normal. There may be pauses between a series of pulses. That’s because the electricity that powers the magnet also makes the magnet heat up, and those pauses give the magnet time to cool.
Depending on the type of TMS you’re receiving, including the pattern of magnetic field pulses, the treatment sessions can last anywhere from a few minutes to half an hour. Your provider is the best person to tell you how long a session will take.
Treatments after your first session
The sessions that follow the first TMS treatment are usually very similar to — or the same as — the first session. Your provider may make some adjustments to the treatment, depending on changes in your symptoms since the first treatment or side effects that you experienced.
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What happens after TMS?
Once a treatment session is over, you can return to your usual routine or schedule for the day. If you have lingering side effects, such as twitching or unusual sensations in your head or face, your provider may ask you to wait a few minutes before leaving. Most of the symptoms that follow a treatment session are mild and only last a few minutes (more about these under the Risks and Benefits section).
