Initial Mapping & First Treatment
On the date of your initial mapping, you will arrive at the office 30 minutes prior to the start of your scheduled appointment. The first 15 minutes will be spent with the TMS Coordinator completing the appropriate paperwork. The next 15 minutes will be spent with a certified TMS Technician who will ask you a few pretreatment questions. During this time, you will be asked to remove any metallic jewelry near or around your head, including any metallic hair clips. The removal of the metallic items is to prevent interaction with the magnetic coil, which can cause the items to heat up and become slightly uncomfortable during treatment. You will then be reclined in the chair and the TMS Technician will adjust the headrest to optimize your comfort. Once you are comfortable, a small cushion will be gently placed against your right temple to secure your head in place. It’s important to note that during treatment you will not be constricted or held down in the chair in any way.
The physician will enter the TMS treatment room and will begin the mapping; the mapping process takes approximately 20 to 30 minutes to complete. During this time, a series of short tests are conducted in order to identify your motor threshold (MT) and treatment location. The physician and the TMS Technician will monitor your right hand for movement corresponding to a single pulse at various locations on your motor strip. Movement in the right hand is important in determining the energy level of the pulse required for optimal treatment efficacy. This energy level is customized to each individual patient, and as such it will vary from person to person.
Once the mapping is complete, the TMS Technician will administer your first treatment, which may last anywhere from 19 to 30 minutes depending on the treatment parameters determined during the mapping. The coil will be placed on your left dorsolateral prefrontal cortex and will deliver a rapid train of 10 pulses per second over four consecutive seconds, with a 10-20 second rest period in between each train. The TMS machine produces a loud click with each magnetic pulse, and you may feel a tapping sensation at the treatment site. Rest assured, nothing is physically tapping you on the head; the sensation is caused by the stimulation of the nerves of your scalp. You may find this tapping uncomfortable. Please advise your TMS Technician of this discomfort, as he or she may be able to make adjustments to reduce your discomfort. Please note that minimal discomfort is common during the first one to two weeks of treatment.
During each daily treatment, the coil will be placed in precisely the same location on your left dorsolateral prefrontal cortex. The coil delivers focused magnetic stimulation to directly target under-active neurons in your brain, with the ultimate goal of reducing your depressive symptoms. During treatment, you will be awake and alert. You can use this time to meditate, catch up on reading, watch television, or chat with your TMS Technician.
Immediately following treatment, you may resume normal activities. Because there are no effects on alertness and memory, you can drive yourself to and from treatment. During or after treatment you may experience a mild headache and/or discomfort at the treatment site. These are common side effects that typically resolve after one to two weeks. You may take an over-the-counter analgesic one hour before the start of treatment, or after treatment to help with discomfort. In clinical trials, fewer than 5% of people discontinued treatment due to adverse side effects.