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 mapping. The first 15 minutes will be spent with the TMS Coordinator completing the appropriate paperwork in order to receive TMS therapy. The last 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 your head and 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 which may take 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 efficacy. The energy level will vary patient to patient, as it is customized to each individual patient.
The TMS technician will administer your first treatment, which may last anywhere from 19 to 30 minutes, depending on the specific protocol determined by the mapping. The coil will be placed on your left prefrontal cortex and will deliver a rapid train of pulses: 10 pulses per second over four consecutive seconds, with a rest period in between each train. TMS 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; however, the sensation is caused by the nerves of your scalp being stimulated. You may find this tapping uncomfortable. Please advise your TMS technician of this discomfort and he/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.
During each daily treatment the coil will be placed in precisely the same location on your left prefrontal cortex. The coil delivers focused magnetic stimulation directly to the target areas of your brain that are under-active. 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 events.