Can I get TMS Treatment if I Have a Physical Disability?
Transcranial Magnetic Stimulation (TMS) therapy has been around since the 1980’s. The procedure has emerged as a treatment option for major depressive disorder or depression that has been unresponsive to medication and psycho-cognitive therapy. TMS therapy is a non-invasive procedure which uses magnetic fields to induce nerve cell stimulation in the areas of the brain responsible for controlling mood and emotions. TMS therapy aims to re-activate nerve cells in areas of the brain that are not as active in people with depression. Repetitive transcranial magnetic stimulation therapy involves the use of repeated magnetic fields and is known as (rTMS).
rTMS differs from other types of brain stimulation therapies as it does not involve surgery or electrode implants.
Main contraindications to rTMS therapy primarily include a history of metal implantable devices, such as:
- Metal clips, plates, or rods
- Stents and filters
- Implanted electrodes for deep brain procedures, such as vagal stimulation and ECT
- Pacemakers, access ports, and medication pumps
- Hearing implants
- Bullet or Metal Fragments
What if I Have a Bad Heart?
According to a research study conducted by Florida International University and the Neuroscience Department at Baptist Hospital in Miami, rTMS therapy does not cause significant changes in blood pressure or heart rate after the procedure. Impulses during the procedure do stimulate the nervous system, potentially increasing heart rate while the pulses are administered. Experts recommend ECG monitoring during the procedure to monitor heart function.
Patients with a prior history of heart disease or that are on medication to control abnormal heart rhythms should speak with their cardiologist regarding the procedure prior to considering rTMS.
What if I have Migraines?
rTMS therapy is an approved therapy for the treatment of migraines for individuals over the age of 18. The procedure is not recommended for pediatric patients. According to the American Association of Neurology, medications are the first-line therapy for both prophylactic and symptomatic migraine headaches. rTMS trials for patients with migraines have confirmed the treatment is effective and safe for migraine prophylaxis.
rTMS is generally reserved for severe migraine headaches or those that are not controlled with traditional medications and/or Botox. A study performed in 2015 by Zardouz, et. al demonstrated that recurrent headaches were reduced by 82.1% over a 2-month treatment window. Patients with migraine headaches and a prior history of seizures should not undergo rTMS and should discuss their options with their neurologist.
What if I have Cancer?
rTMS therapy is effective in managing the major depressive disorders resulting from a diagnosis of cancer. Depending on the location and extent of the cancer rTMS may be contraindicated. Patients undergoing chemotherapy and/or radiation should discuss this option with their oncologist and neurologist prior to beginning therapy. Patients suffering from localized or metastatic tumors not affecting the brain or spinal cord are generally approved for treatment therapy with rTMS. For patients with intracranial tumors, potential seizure activity must be determined.
Patients with brain tumors wishing to begin rTMS therapy must undergo evaluation by their oncologist regarding tumor size and location, swelling around the area, and the type and aggressiveness of the tumor. According to a study published by Surya, et. al in 2016, patients with slow-growing small to modest size tumors, such as certain meningiomas, did not suffer evidence of seizure disorders following both rTMS treatments and electroconvulsive therapy (ECT), even in the 34% that have suffered epileptic episodes in the past. The study also indicated substantial improvements in depressive symptoms following an average of 36 treatments with rTMS.
Will Transcranial Magnetic Stimulation Affect my Weight?
Preliminary studies regarding the use of rTMS have shown positive results in the management of obesity. A study performed by the University of Milan, Italy over a 9 week period revealed that treatment with rTMS therapy not only alleviated depression but reduced cravings in 16 obese study participants.
Weight itself is not a contraindication to receiving rTMS therapy; however, patients considering the use of rTMS should have a thorough and complete evaluation for other health issues, such as irregular heart rate and the presence of heart disease prior to commencing therapy. Persons receiving rTMS will have their weight monitored regularly to ensure healthy weight levels are maintained for persons at risk for becoming underweight.
RTMS therapy is emerging as a beneficial therapy option for the management of depression, pain, obesity, and addiction disorders. The safety of TMS treatment in conjunction with other psychological or physical afflictions is still under investigation and is becoming more clear year after year. Although the procedure has been approved by the FDA for the management of depression and the treatment of migraine headaches, alternative uses of rTMS for treatment of other psychological, mood, cognitive, and neurologic conditions are currently under trials and investigation.