Indications for TMS
Dr Rustin Berlow discusses several different indications being looked at in the TMS literature and research.
Depression, stroke and chronic pain
Right now, the FDA-cleared indication is depression – major depressive disorder that’s been resistant to treatment with medications. The two most likely indications on the horizon are stroke and chronic pain. There’s a company who either has already or is about to get approval for a device that will be able to treat stroke but any device can be used to treat it if you know what you’re doing. Stroke is complicated because everywhere that it happens is going to have a different effect on the patient. So treatment planning is more complex with stroke and TBI (traumatic brain injury).
Chronic pain I think is going to be an indication because the federal government, as far as I understand, has funded a study of 200 patients treated with TMS for chronic pain. That’s notable because it’s going to be the largest TMS study in history and it’s going to be the largest chronic pain study in history, as far as I know. It will be a randomized double-blind trial of several University medical centers plus one community clinic. I think chronic pain is already approved in Europe and it’s very effective. It works very well.
ADD, Anxiety and PTSD
The next indications that I think are very promising are attention deficit disorder in children, generalized anxiety disorder and post-traumatic stress disorder. The PTSD indication will have a big impact on the VA medical center, which is currently doing research in TMS to see what way it can benefit veterans.
The opiate epidemic and responding to it and other addictions with TMS is a very promising possibility but there’s very very little data on it at this point.
Autism and Dementia
Two other indications that show promise with TMS are autism and dementia, especially dementia, the Alzheimer’s type and frontotemporal dementia. One of the reasons why TMS would be a very good idea for these two conditions is that medications and other treatments have not offered very much relief or reduction in suffering from people with these conditions. The details of how TMS is done in dementia and autism have not been worked out, but there are some people who do specialized treatments for those conditions and report good results.