TMS Origin
What does TMS stand for?
Transcranial Magnetic Stimulation
When can a patient come back for a second TMS round if wanted/indicated?
After 6 months to a year - can be approved again by insurance
Insurances that cover TMS
All Commercial
Medicare
TriWest & Tricare
(NOT Colorado Medicaid)
Two brain areas that are targeted with TMS?
Left Dorsolateral Prefrontal Cortex &
Anterior Cingulate Cortex
How long does TMS Treatment take?
Five days a week for 6 weeks; close to 8 or 9 weeks if patient tapers (3-2-1)
30 - 36 sessions
Comparable to which medical imaging technology?
MRI
True or False:
TMS increases the risk of stroke
False
Patient type that is approved for TMS?
Diagnosis of MDD, recurrent, severe
Treatment Resistant Depression
Age 15 & older
Previous CBT/DBT therapy with medications
True or False:
TMS is like ECT- painful, causes memory loss, and requires anesthesia.
False
TMS is NOT painful, doesn't cause memory loss, and doesn't require anesthesia
When should a patient expect to see results?
Within 2-4 weeks of treatment
Depends on the patient and how they tolerate the treatment
Which 2 TMS machines are used by FCC
Double points if you know the machine here at West Littleton!
Magventure
Brainsway
One absolute medical contraindication to TMS
Ferrous metal in/around the head/neck region
Amount of anti-depressants needed to have trialed before TMS gets approved
2
Side effects of TMS?
Common: headache, fatigue scalp sensation at treatment site
Uncommon: ears ringing
Rare: Seizure
% of patients who saw improvement in depression with TMS at FCC
Approximately 90% for adults
78% of teens
When was TMS invented?
The first stable device was invented in 1985.
"Relative contraindications" that need to be ruled out before TMS?
Bipolar disorder, Substance abuse, Seizure/other neurological disorder such as TBI, h/o intracranial bleed
True or False:
Although TMS is FDA-approved for 3 conditions, here at FCC we also use it for:
MDD Severe dx (w/o psych features)
True
What clinical behaviors worsen TMS outcomes?
Poor sleep
Cannabis and Alcohol use
Can TMS cause worsening depression
NO
But can see increased irritability, fatigue, and emotional divots (up and down) through weeks 2-3 of treatment
Who are the staff on the TMS Team here at West Littleton?
Anita Kumar - MD & TMS Lead, Jennifer Osborne - MD, Quinn Robertson - PA, Codee Spiers - PA, Bree Jackson - TMS Care Coordinator, Emily Fairburn - TMS Tech
Three conditions that TMS is FDA approved to treat in the US
MDD, OCD, smoking cessation
Ways to refer patients to TMS?
1. Direct referral from provider
2. Schedule TMS Consult with Anita Kumar MD
3. Have patient contact Bree for cost-estimate and to see if TMS is an option
Does what you are thinking when you are receiving TMS effect the outcome of the treatment?
Yes. Negative/pessimistic thoughts when receiving treatment negates the benefit of TMS.
What is the most important clinical consideration when a patient is receiving TMS?
COMFORT