Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation Therapy TMS Italy

Transcranial Magnetic Stimulation (TMS) is an innovative and very promising treatment for various neurological and psychiatric pathologies, the use of which has been approved by the American Food and Drug Administration (FDA) and by the European Community. It is usually carried out in synergy with other therapies, such as e.g. pharmacology, psychological interviews and rehabilitation.

This therapeutic method that utilizes a magnetic field to exert an impact on brain functioning.  The functioning of TMS is based on a known phenomenon, namely the neuroplasticity of the brain: neurons modify their structure and function as a result of stimuli, traumas or pathologies. Transcranial magnetic stimulation can restore neuronal cells to the status quo, contributing to the regression of some psychiatric and neurological pathologies. The technique has low side effects compared to pharmacological therapies, such as a slight sense of dizziness or headaches, which subside over time. However, the procedure is not indicated on patients who have clips or stents for aneurysms, prostheses or metal splinters in the neck-head area, or face tattoos made with an ink containing metals. TMS is a particularly advantageous therapy because it does not require anesthesia or recovery time after the session, so the patient can immediately return to his daily life.

Pathologies treated with TMS Therapy

Transcranial Magnetic Stimulation (TMS) is used in the treatment of the following pathologies:

  • Depressive disorders
  • Bipolar Disorders
  • Obsessive Compulsive Disorder
  • Anxiety disorders
  • Personality disorders
  • Psychotic disorders
  • Disorders related to substances of abuse and addictive disorders
  • Disorders related to traumatic and stressful events
  • Gilles de la Tourette syndrome
  • Alzheimer’s disease
  • Parkinson’s disease

In the treatment of depression, today it is customary to use multiple therapeutic approaches in an integrated manner. Generally, we talk about drug therapy and psychotherapy. 

Transcranial Magnetic Stimulation aims to remodulate neuronal activity through the magnetic impulses emitted by a device and can be used both as an integration to traditional therapies, drugs and psychotherapy, to improve the effects of traditional treatments, and as an alternative to medical therapy. In particular, it can be indicated, together with psychotherapy, for those patients who have contraindications to taking drugs due to other pathologies (heart disease, liver disease, nephropathy) or in patients who refuse drug therapy due to experienced side effects or simple personal aversion. A very recent study from 2021, published by Publimed confirms the effectiveness of TMS in regressing the symptoms of drug-resistant depression.

In patients with Parkinson’s, transcranial magnetic stimulation is used to support traditional pharmacological therapy, and the maximum benefit is obtained when the patient also follows courses of physiotherapy or, better to say, neuromotor rehabilitation. In this case, in fact, the area of the brain that is stimulated through the magnetic waves is the motor cortex, which is one of the main areas of the brain responsible for movement control. TMS in combination with physiotherapy allows the patient to have improvements on the motor symptoms of the disease.

In patients with Alzheimer’s, TMS remodulates the plasticity of the precuneus, an area of the brain involved in memory functions. Recent scientific evidence has shown that this brain structure is one of the first to ‘suffer’ from Alzheimer’s disease and is already compromised in the prodromal stages of the disease. However, in typical forms of Alzheimer’s, the brain structures primarily involved in degenerative phenomena are those located in the medial temporal lobes. In fact, the early stages of the disease are dominated by memory disturbances. The neuromodulatory strategy using TMS consists in stimulating the precuneus, which, at least in part, suffers due to mechanisms of disconnection with the medial temporal structures. This neuromodulation has been shown to be effective in slowing the progressive accumulation of cognitive deficits, the aggravation of which leads individuals with initial Alzheimer’s disease to a state of dementia.

Timing is therefore very important in treatment: in fact, stimulation is more effective in early Alzheimer’s. This makes a precise diagnosis from the first symptoms and a careful evaluation by the neurologist essential to maximize the benefits of the treatment, which must be administered with anatomical accuracy on the basis of neuroimages obtained with Magnetic Resonance. The ultimate goal is to improve memory, slowing down the degenerative process of the brain cells (neurons) of the precuneus and the structures connected to it, which perform important cognitive functions.

Transcranial magnetic stimulation, TMS, together with cognitive behavioral therapy, CBT (Cognitive Behavioral Therapy), helps reduce the desire to smoke or to consume other psychostimulant substances, if used frequently.

The brain regulates emotions especially through the limbic system, composed of a series of nuclei and deep nerve fibers that connect, among others, with the orbito-frontal cerebral cortex, an area of the brain that plays a fundamental role in the emotional response and in the subsequent decision-making. The regulation function of this system, both for its activation and for its inhibition, is carried out by neurotransmitters, chemical substances naturally present in the nervous system, which have the ability to excite or inhibit the brain circuits responsible for the development of emotions and many other functions of the nervous system.

Nicotine, and psychostimulants in general, interfere with the action of various neurotransmitters. Simply put, these substances alter the messages that the brain processes in particular in the limbic system. The mechanisms through which these substances carry out this action are different but, in general, it can be said that they modify the quantity of some neurotransmitters present in our brain such as dopamine, a neurotransmitter useful for consolidating memory and a mediator of pleasant sensations, and glutamate, which favors the exchange of information between neurons and has a stimulating and natural activation function of the circuits of our nervous system.

Psychostimulant substances or an excess of psychoactive drugs introduced into the body from the outside, through the activation of the circuits of the limbic system, intensify the sensation of pleasure and sense of gratification. Hence a sensation of false well-being which, in the event of problematic and prolonged use, leads to addiction and a desire that is difficult to control, defined as craving, to take the psychostimulant substance to which the whole organism, and in particular the brain, is by now used to it.

TMS and cognitive-behavioral therapy, used in synergy, are effective for treating patients who make problematic use of nicotine or other psychostimulant substances. The aim of treatment is for the person to have the opportunity to choose to stop using nicotine or other psychoactive substances, without being dominated by craving. This is possible only by restoring decision control, which occurs above all in the orbito-frontal area of the brain, freeing this function from the conditioning of false emotions. The process, from the initial clinical assessment of the patient to the completion of the series of TMS treatment sessions, takes approximately one month. In some cases it is useful to continue with boosters with TMS sessions in the following months.

Preparation for TMS Procedure

The comprehensive TMS treatment program begins with a pre-TMS outpatient consultation evaluation, where the specialists assess your suitability for the treatment and provide answers to any queries you may have. In your initial treatment session, they conduct a brain mapping procedure to determine your unique TMS “dose”, ensuring a tailored approach to your therapy. Throughout your therapy journey, a trained TMS technician will closely monitor your daily progress and administer the TMS therapy. The TMS therapy may be optimized with other services aiming to restore your wellbeing, such as rehabilitation, cognitive exercises, consultations with psychologists and/or neurologists.

Throughout a TMS treatment session, you are comfortably seated in a reclined chair. You remain completely conscious and attentive, with the option to engage in conversation, listen to music, watch videos, or simply relax using earplugs.

An average treatment session typically spans from 20 to 30 minutes, during which you will experience a sequence of gentle taps on your head beneath the TMS coil. It’s not uncommon for certain patients to encounter slight discomfort on their scalp beneath the coil or occasionally experience a lingering headache after the initial few sessions. These sensations are ordinary, can be addressed by modifying the stimulation parameters, and usually dissipate within the initial week of daily sessions.

TMS Procedure Description

The treatment is painless, the patient is asked to remove earrings, jewelry, glasses, credit cards and other objects that could interact with the magnetic waves. TMS is performed sitting down, wearing headphones to block out noise and placing the head under a device that generates a magnetic field. The emitted waves interact with the neuronal cells located in the areas responsible for controlling mood or motor skills, depending on the objective of the treatment and the pathology to be treated. Thus a process of neuromodulation occurs.

An average treatment session typically spans from 20 to 30 minutes, during which you will experience a sequence of gentle taps on your head beneath the TMS coil. It’s not uncommon for certain individuals to encounter slight discomfort on their scalp beneath the coil or occasionally experience a lingering headache after the initial few sessions. These sensations are ordinary, can be addressed by modifying the stimulation parameters, and usually dissipate within the initial week of daily sessions.

TMS requires multiple treatments — typically three to five per week — spread out over several weeks.  

Benefits of TMS Therapy

Similar to medications, the response time to TMS therapy can differ among patients. For optimal results in treating depression with TMS, it is advisable to undergo TMS sessions on weekdays consistently, typically spanning four to six weeks. It’s worth noting that, frequently, there may not be any noticeable shift in mood during the initial weeks of treatment. Clinical trials have shown that the majority of patients observed substantial benefits as early as the conclusion of the second week of TMS treatments, while a minority of needed more than 30 sessions before experiencing relief from depressive symptoms.

A study published in 2018 in The Lancet, a prestigious international scientific journal, reports that 47% of patients treated with TMS for major depression responded to therapy and 27% achieved remission of symptoms. Further studies show that TMS is a promising technology to treat neurological pathologies such as Alzheimer’s and Parkinson’s disease on which it seems to have efficacy in the remission of motor and cognitive symptoms.

In general, the data confirm the efficacy of transcranial magnetic stimulation in neurophysiological pathologies and its safety as a minimally invasive technique with low risk for the patient.

TMS offers a distinct advantage over other depression treatments by precisely honing in on the intended brain region or “target.” This precision allows clinicians to focus solely on specific areas of the brain while leaving others unaffected. TMS does not result in memory issues or cognitive impairments, nor does it alter a person’s personality. When patients find relief from their depression symptoms through TMS, they often experience improved cognitive abilities and overall functioning.

In comparison to other depression treatments, TMS is associated with minimal side effects. Research indicates that approximately one out of every five individuals may experience a mild to moderate headache or tenderness in the scalp following TMS treatment. These discomforts, however, typically resolve within the initial week and can be effectively managed.

Packages of Transcranial Magnetic Stimulation

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Transcranial Magnetic Stimulation for Parkinson’s Disease

TMS therapy has demonstrated its potential in assisting individuals with Parkinson’s disease in managing or reducing typical symptoms such as freezing, tremors, and stiffness. This program carried out in Turin, Italy has an average duration of 3 weeks and combines several services to enhance the effectiveness of the therapy.

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According to the World Health Organization (WHO), Alzheimer’s disease stands out as the most prevalent type of neurodegenerative dementia and ranks as the seventh leading global cause of mortality. Transcranial Magnetic Stimulation (TMS) has potential therapeutic effects in Alzheimer’s Disease. Duration of the TMS therapy in Turin: 3 weeks

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