Transcranial magnetic stimulation (TMS) in Montreal | PSYSOL
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Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation


RTMSTranscranial magnetic stimulation (TMS) is a therapeutic procedure that helps modify brain activity using a magnetic field that comes from an external source, located near the scalp. Transcranial magnetic stimulation is safe, effective and non-invasive.

 

Following a session lasting about half an hour that requires no special preparation, patients can go about their business without restriction. The source of the magnetic stimulation is a device that generates a variable magnetic field that is then transmitted to the brain using a coil placed close to the scalp, vis-a-vis the area of the brain to be stimulated.

 

The device can generate a single stimulation at a time. In that case, we’re talking about simple transcranial magnetic stimulation. It can also generate multiple stimulations, which is referred to as repetitive transcranial magnetic stimulation (rTMS). It’s this latter that’s generally used in psychiatric treatments.

 

The magnetic field produced near the scalp easily passes through the different anatomical structures and reaches the intended brain structures. It modifies their activity to allow them to function better.

 

Depending on the stimulation parameters used, the effect on the brain structure will be either stimulating or inhibiting. We seek to produce a stimulating effect in the structures that are functioning too slowly. This is the case with the left dorsolateral prefrontal cortex (LDLPFC) in major depression. On the other hand, we seek to produce an inhibiting effect in the structures that are functioning excessively. This is the case with the temporoparietal cortex (TPC) in cases of tinnitus or auditory hallucinations.

 

Our specialists adjust the stimulation parameters according to each patient’s specific needs.

The controllable parameters are:

  • the area of the brain to be stimulated;
  • the stimulation frequency (high or low);
  • the frequency type;
  • the intensity of the stimulations;
  • the duration of the stimulation, interstimulation, and rest intervals;
  • the total number of stimulations during the session; and
  • the number of sessions.

Transcranial magnetic stimulation is a treatment whose safety and effectiveness has been widely demonstrated by thousands of studies around the world, particularly for cases of major depression. Its effectiveness has also been demonstrated for the treatment of auditory hallucinations and neuropathic pain. Several studies show encouraging results for the treatment of tinnitus and other conditions, but the standard of proof remains lower than for depression, hallucinations, and neuropathic pain.

 

TMS is an excellent choice for people who experience side effects to medications, find them ineffective, present contraindications to them, or who simply choose not to take medications for any other reason. CANMAT guidelines suggest considering rTMS after a treatment trial with a single antidepressant has failed.

 

Like any other treatment, rTMS also has its limits. It can’t be used on people who have metallic objects in their skulls or neighbouring regions, and its safety has not been established for pregnant women.

 

Some mild side effects are possible but uncommon, such as headaches that rarely require taking a simple analgesic or a tingling sensation in the scalp.

 

The only significant side effect is the occurrence of a seizure during the session. This is an extremely rare risk given the modern devices used and the safety measures applied. These rare cases in the literature occurred in patients having predisposing conditions, and the seizures never required taking any other measure besides stopping the treatment. They resolved themselves spontaneously and without any intervention in a few minutes. In addition, a detailed questionnaire is administered prior to any treatment to eliminate contraindications and risk factors for convulsions.

 

Please note that this treatment is not covered by the Régie de l’Assurance Maladie du Québec (RAMQ) when it is administered in a private clinic (such as Psysol) and, as such, you will have to cover the cost for it. However, the RAMQ covers it completely when it is administered in a hospital environment. You can therefore receive this treatment for free at the hospital. To our knowledge, at least three hospitals offer it in Montréal (the Neuromodulation Centre at CHUM, the Neuromodulation Research Clinic at Douglas Hospital, and the Royal Victoria Hospital). Search engines such as Google will let you easily access up-to-date information on this subject.

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