TMS is prescribed by a Consultant Psychiatrist. The treatment itself is administered by an TMS technician who has had the required training to safely administer the treatment under the supervision of a Consultant Psychiatrist. The technician will be with you during your treatment and can answer any questions you may have. You can stop a treatment at any time by asking the staff member present. The treatment can be paused and resumed at any point during the session.

Given the high magnetic fields needed, you are unable to receive rTMS treatment if you have any type of non-removable metal in or around your head. Therefore, people who have any of the following should not receive TMS:

• Aneurysm clips or coils
• Stents in the neck or brain
• Deep brain stimulators
• Cardiac pacemakers or implantable cardioverter defibrillator (ICD)
• Cochlear implants
• Deep brain stimulators
• Electrodes to monitor brain activity
• Metallic implants in your ears and eyes
• Metal shards, shrapnel in or near the head
• Facial tattoos with metallic or magnetic-sensitive ink (please discuss with us if you are unsure)
• Other metal devices or objects implanted in or near the head
• Devices outside of the head such as cardiac pacemakers, Insulin pumps may malfunction if the rTMS coil is accidentally operated too close to them.

There is a risk of rTMS triggering a seizure. Therefore, rTMS should not be used in patients who:

• Have a diagnosis of epilepsy or have previously had a seizure.
• If you have a brain disorder (e.g. recent stroke).
• Patients actively using illicit drugs or alcohol.
• If your health is such that the event of a rTMS induced seizure would be particularly dangerous: for example, patients with serious heart disease or raised intracranial pressure.
• If there is the possibility of pregnancy.

The research into the use of TMS in these populations is extremely limited:

• In children and adolescents and those over 70.

TMS is non-invasive, which means that it doesn’t require any needles or anaesthesia. rTMS is a well-tolerated procedure with few side effects. Current evidence suggests around 1 in 20 people may experience an adverse effect. It is uncommon for patients to cease rTMS treatment due to side effects. NICE states that there are no major safety concerns with rTMS. Before starting treatment, a clinician will go through a safety checklist with you and rule out any potential safety issues.

The magnetic pulses produce a clicking sound which can be quite loud. This can lead to transient changes in hearing. This is easily prevented by using ear plugs which will be offered at the start of every treatment. No evidence suggests these effects are permanent if earplugs are worn during the treatment.

You will feel a tapping sensation on your scalp where the coil is placed. In most cases, this sensation is neutral, although in a minority of cases it can be a little uncomfortable. The most common side effect is scalp irritation underneath the coil as rTMS can cause muscle twitching in the scalp or face during the session. If either of these things happen, the position of the coil and/or stimulation settings can be altered to make it more comfortable. For some people, this leads to a mild headache which can usually be treated with simple painkillers such as paracetamol. Headache tends to reduce as sessions continue. In addition, some people feel slightly more tired after treatment.

Very rarely people feel faint or dizzy during the treatment and it isn't harmful. This can happen at any time during treatment and the technician will discontinue treatment and lie you flat until you feel better. Treatment can usually continue the following day. Differentiating whether someone has had a rTMS induced seizure versus an episode of fainting can be difficult.

There is a low risk of seizure during the treatment which is the most serious concern with rTMS. It is estimated that seizure may occur in 1 per 30,000 to 1 per 60,000 rTMS treatment sessions. The increase in seizure risk stops once the coil is switched off, so you will not be at increased risk of seizures once you go home.

If you take insulin, there is occasionally a drop in blood sugar during treatment. We will therefore check this after treatment and offer a snack if needed.

Patients with a history of bipolar disorder may be at risk of experiencing an episode of mania with rTMS.

While rTMS is a safe procedure, it is important to point out that because it is a new treatment, there may be unforeseeable risks that are not currently recognized.

The first session will be approximately 1 hour long. On arrival, you will be introduced to the team. You will have an assessment with one of the doctors to confirm suitability with the opportunity to ask questions and discuss any concerns. If you agree to start treatment, we will ask you to sign a consent form and complete baseline questionnaires. We will show you the treatment area.

TMS is administered by a specially trained staff member who will monitor you throughout your treatment. You will be asked to remove any jewellery, including necklaces, earrings, face or tongue studs, hairgrips, mobile phone and debit/credit cards as these can be affected by the magnetic field. You will be seated in a comfortable chair, and several measurements are made to ensure correct coil placement. These measurements are marked on a specially designed cap to find the target area next time.

Depending on what TMS protocol you have been recommended, your motor threshold will be obtained by applying several brief pulses from the TMS machine. Your motor threshold is the minimum amount of magnetic energy to make your thumb twitch; this varies from person to person. Once this has been determined the coil is placed over the target area using a flexible positioning arm. You will be offered earplugs to wear for comfort and hearing protection. During treatment, you will hear a series of clicking sounds and feel a tapping sensation on your head underneath the treatment coil. A technician will stay with you throughout your treatment. You will be sitting in a comfortable chair completely awake and alert. You can listen to music or read a magazine however it is important to keep your head still. The clinic chair is fitted with head supports to make this a little easier. If you have any concerns during the treatment, the treatment can be stopped immediately.

As TMS does not require any sedation or general anaesthesia, and you are fully awake and aware during the treatment there is no recovery time. Some patients may feel tired after the treatment, this is normal. We recommend that you should not drive home after your first treatment.

Please style your hair to lie as flat as possible as the cap is tight fitting. Consider bringing a hairbrush to use afterwards if your hair needs this.

Your next session will be shorter as you will not have another assessment or require further measurements and can go directly to treatment. Afterwards, you can drive home if you wish, provided you felt well after your first treatment. You should be able to return to work or daily routines as needed while receiving this therapy.

The staff will give you an allotted time for your appointment. The treatment usually takes approximately 30 - 60 minutes depending on the type of treatment you are receiving.

During treatment, the team may need to reassess your progress and nurses may ask you to complete questionnaires to measure improvement. You will have a further review with a Consultant Psychiatrist at the midpoint and the end of treatment.

AIM Neuromodulation is based at Broadway Lodge Weston-Super-Mare and rTMS is given at our offices there.

Our address is: AIM Neuromodulation Limited, 37 Totterdown Lane, Weston-Super-Mare, Somerset, BS24 9NN

The team can be telephoned on: 01934 318440

Free parking is available onsite.

If you choose to bring a family member or friend, they are welcome to attend your appointments.

It is possible to have days off treatment if you are unable to make one due to illness or other commitments.

You will need to remove any hearing aids, jewellery, including necklaces, earrings, face or tongue studs, and hairgrips. You can take your phone into the room but this will need to be put to one side during treatment. You can wear your own clothes. Please ensure you have had something to eat and drink before your appointment. There will be plenty of time to use the bathroom before your treatment if you need to.

We believe the magnetic fields generated in TMS are not harmful. Long-term studies looking specifically at the effects of TMS generated magnetic fields would be helpful in confirming this. It has been found that chronic exposure to magnetic fields even greater than those generated during TMS appears to be safe.

Depending on the prescribed treatment and indication you can have more than one session of TMS per day.

Yes, TMS does not need anaesthesia therefore you are advised to make sure that you have something to eat and drink before your appointment.

You should take your medication as prescribed, unless otherwise specified by your doctor. Generally, your mental health medication will remain unchanged during treatment.

The procedures for TMS and electroconvulsive therapy (ECT) are very different. The way that they stimulate brain cells is also different. TMS does not require general anaesthesia and does not involve the intentional production of a seizure.

The procedures for rTMS and electroconvulsive therapy (ECT) are very different. The way that they stimulate brain cells is also different. rTMS does not require general anaesthesia and does not involve the intentional production of a seizure.