Deciding to commit to 36 sessions of Transcranial magnetic Stimulation can be a daunting step when you don’t know what to expect. In this post, we will go over exactly what you can expect when you decide to begin the process of TMS treatment here at Texas 360 TMS.
The Initial Consultation and Clearance
The first step to starting TMS treatment is to schedule a free initial consultation with one of our TMS Coordinators. This can be done on the homepage of our website; simply click the time you would like to schedule an appointment and enter in your name, phone number, and email address. Initial consultations are typically done over the phone. However, if you would like a zoom or in person initial consultation, please reach out to us via email or phone in order to make this request–we will be happy to accommodate! During an initial consultation, a TMS Coordinator will get acquainted with you and your current situation, asking questions about your general medical history and your specific history of mental health, whatever you’re seeking help for. We will also gather information on your insurance if you are seeking to be covered for TMS. Rest assured that all contact made with potential patients is secured, and no information you give will ever be shared with anyone other than our psychiatrist, Clinical Operations Director, and TMS Technician. Once we have this information, we will have a good idea if you qualify for TMS treatment.
We will then set you up for a clearance with our psychiatrist. The psychiatric clearance typically lasts 30 minutes over Zoom, and will cover your medical history more in depth. Our psychiatrist will explain to you the science behind TMS, and what you can expect from treatment. Once the psychiatrist clears you for TMS treatment, our staff will reach out to you to schedule your cortical mapping, which is the initial TMS appointment. We will also send you initial paperwork to fill out before your first appointment.
The Cortical Mapping
The cortical mapping refers to the process we use to set up treatment for you specifically. When you come in for this appointment, we will be sure to answer any remaining questions you have about TMS as in depth as we need to. It is not uncommon for someone to be nervous at this appointment–we can assure you we are equipped to help you stay comfortable, calm, and confident throughout the whole process. When it comes time for you to sit in the treatment chair, our TMS Coordinator will set the chair to your preferences for comfort. Next, we will utilize the TMS technology to calibrate the machine to your head circumference. We will then use a small, handheld TMS coil–termed the “mapping coil”–to stimulate the spot C3 on the left side of your motor cortex, which will elicit a small motor movement in your right thumb. The motor movement is an indication that we have correctly identified a landmark on your brain. Sometimes it takes a few tries to elicit a motor response; do not worry, this is completely normal and attests to our individual differences! It does not mean you will not respond to treatment. Next, the stimulation will be lowered by small increments while we look for the minimum amount of intensity that it takes to stimulate your brain; this is termed the “Motor Threshold”, or MT for short. Your MT is how we know what “dose” of TMS to give you, per say. Every brain takes a different amount of intensity to be stimulated; this is based upon the thickness of your hair and skull, your brain chemistry, and any substances you might have recently taken that alter your brain chemistry (such as prescription drugs, alcohol, or illicit substances).
Now that we have found your MT, we have two points of data: your sensitivity to treatment, and a landmark on your brain. We can then use this landmark to navigate to a specific treatment target. For example, we would navigate 5.5 centimeters forward to the Dorsal-lateral Prefrontal Cortex, or DLPFC for short, in order to treat depression. The machine will save that spot in its system for us to navigate to every subsequent treatment.
What Does TMS Feel Like?
The feeling of TMS varies by individual, but it is typically painless. People have previously described it as “a tapping sensation”, “a buzzing”, “the feeling of static electricity”, and “a massage”. Because the head is highly sensitive, we will make sure that treatment is comfortable for you; there are typically micro-adjustments that we can make in terms of coil placement that will make the sensation feel less irritating if that is the case for you. It is very typical to hear that the feeling is underwhelming–there can be a disproportional amount of anticipation during the initial appointment for a minimal sensation. Keep in mind that we will operate at a percent of your MT for treatment, typically administering the first treatment at 80% and increasing intensity by 3-5% each treatment until you eventually get to the treatment intensity goal for that protocol, which can be anywhere from 90%-120% of an MT. We will always notify you if/when treatment intensity is rising and will always work with you to achieve maximum comfort without jeopardizing treatment efficacy.
The First Treatment
TMS treatment will last between 3 minutes and 18 minutes, depending on which protocol the psychiatrist has prescribed. The Intermittent Theta Burst Stimulation, or iTBS, is 3 minutes and 16 seconds. The machine stimulates for 2 seconds, and then pauses for 6 seconds; it does this 20 times. The rTMS protocol lasts 18 minutes and 45 seconds; during this protocol, the machine will stimulate for 4 seconds, and then pause for 10 seconds–it will do this 75 times. If you are curious about the differences in treatment protocols, stay tuned for next week’s blog!
During treatment, we will dim the lights and put on calming scenery/music if you prefer it. It is speculated to be beneficial for you to be focusing on emotions, feelings, or experiences you’re aiming to feel during treatment, as TMS will generate the most positive neuroplasticity in whatever neurons are active at the time. Thus, we want to make the treatment room as conducive to a positive experience as possible for you; we will note any recommendations or requests you have to set the room for every subsequent treatment.
After The First Treatment
Once you have finished your first treatment, we will get you on the schedule for subsequent treatments. You will be booked out for a 15-30 minute appointment based on which protocol has been prescribed to you! At Texas 360 TMS, it is of the utmost importance that we create a fluid treatment experience for you; thus, we make scheduling, rescheduling, and communication as direct and flexible as possible. If you have any questions about our services, or would like to book an initial consultation for free, please visit our home page! We hope to see you soon at Texas 360 TMS.
