Dr. Ali Elahi discusses the procedures and sensations involved in rTMS stimulation and the potential side effects
Most patients may not know how easy and comfortable TMS can be, so what we do is, we have patients come in and we make some measurements on the scalp and we then place a coil, which is like a ceramic coil, over the areas that actually cause a thumb twitch and that’s how we find what we call the motor threshold.
So, patients come in, they sit down, there are no IV lines, there are no invasive procedures, we simply make some measurements of the scalp using a measuring tape. We use that data to find a motor threshold and then within a few minutes, usually 20 to 30 minutes, we can find an area of the brain that causes the motor twitch. After we find that, then we find the target location for treatment and there are different ways to do it. We have formulas and protocols and we also have neuronavigation units where we actually see exactly where we’re going, using MRI data, and with these tools, we can actually target the part of the brain we want to stimulate.
So a patient can expect to just sit there and watch TV, watch a program on television while we’re finding the target area, and then once we do, we turn on the stimulation. Most patients feel a slight tapping sensation on the scalp. There may be a mild headache, usually resolved with over the counter medications, such as Tylenol or Advil, and then after the treatment is done, the patient’s free to go home. Most patients don’t have any side effects and no residual symptoms.
There’s a whole list of potential side effects, the most notable would be the risk of seizures, which patients should know, is the same risk as you would have with medications. There is a one-in-thirty thousand risk. All the research protocols and the major centers that have tried TMS and have reported the outcomes actually have not seen many seizures at all. We have protocols in place to protect and to reduce that risk but that’s it. Most patients feel, again, no side effects, perhaps a mild headache, and it’s a very easy-to-tolerate type of procedure.