What is rTMS
treatment ?
rTMS might be suitable for you, here's what it can do & who it can help:
Repetitive Transcranial magnetic stimulation (rTMS)
Non-invasive brain stimulation therapy
rTMS works on the principal that a magnetic field can induce an electric current (Faraday’s Law). What happens, is the patient sits comfortably in a chair while the technician positions the magnetic coil near a specific part of the patient’s head. When the machine is activated, it generates a powerful magnetic field, which in turn causes an electric current to flow in the adjacent brain tissue. It is this electric current which yields the therapeutic benefit. The procedure is not painful, but the patient will be aware that the machine is operating, as the magnet makes a certain amount of noise. There is also, typically, a mild sensation experienced on the scalp, this of a magnitude that would be generated by somebody tapping with a finger, i.e. it is not painful!
rTMS & addiction
rTMS is suitable for a range of conditions
In psychiatric practice, TMS has been used for the longest time in the treatment of depression. It is also used to treat anxiety and OCD, as well as other mental health conditions including psychosis. In some countries, its use is an established part of stroke rehabilitation as well as being used in other neurological conditions including migraine. The history of TMS usage in addiction does not go back as many years, but there is emerging evidence base. The early addiction research tended to focus on the reduction of craving in those dependent on stimulants. More recently, other types of addiction have been treated, including in those dependent on opioids and alcohol.
Different clinics will have different protocols, but a typical regime involves a person having one treatment per day, each treatment running to perhaps half an hour. There will be five such treatments in a week, with the course running over 2 weeks (that is 10 treatments). There will typically be a number of follow-up or “top up” sessions, these being on a weekly or fortnightly basis, with five further treatments.
Side effects & risks
Evidence of safe treatment
TMS has been used in a variety of settings and for a variety of conditions for many years. This has demonstrated that it can be considered a safe procedure, and as noted it is not invasive, that is, the patient is fully conscious and alert and no anaesthetic is required. The procedure is not painful; the most that the patient will experience is a tapping feeling on the scalp. This is not painful, indeed, it is not really even uncomfortable, merely a somewhat unusual sensation. TMS should be avoided in people who have had brain surgery, anybody who has had a recent cerebrovascular accident (a stroke), a cerebral aneurysm and any “metalwork” in the head (such as clips or metallic sutures to a brain surgery site). There is a small risk (that is one in xxxx thousand) that if TMS is given to those with depression it might trigger a manic episode. The most discussed potential risk of TMS is that it can enhance the risk of having an epileptic seizure (or fit). Here, the risk also seems to be very minimal, that is around one in xxxx thousand. If an individual is deciding whether or not to have TMS to treat alcoholism in particular, then the risk of seizure will certainly be discussed with a member of our clinical staff, as the risk of seizure is already high in this group. Patients need to make an informed choice, and look at the risk-benefit profile of TMS. The risk of seizure with TMS is low, whereas, the risk of serious ill-health or even death with alcoholism is very high. These matters are complex, and involve individual choice and staff will tailor the treatment to specific patient requirements and patient risks.
The evidence base
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Link to evidence
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