Transcranial Magnetic Stimulation R. Gregory Lande, DO

The views expressed in this article are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force/Department of Defense

Transcranial Magnetic Stimulation

Outline

Magnets in Medicine What is TMS? What is it used for? Future Directions

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Magnets in Medicine

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Magnets in Medicine M A G N E S

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Magnets in Medicine

Petrus Peregrinus

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Magnets in Medicine William Gilbert (1544-1603) English Physician Authored On the Magnet and Magnetic Bodies, and on the Great Magnet the Earth

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Magnets in Medicine

Pliny the Elder

Avicenna

Galen

Dioscorides

Albertus Magnus https://www.thunderbolts.info/wp/wp-content/uploads/2011/08/magnet_ironfilings_425x286.jpg

Magnets in Medicine

Sushruta

Gilbertus Anglicus

Wilhelm Fabricius http://en.wikipedia.org/wiki/Gilbertus_Anglicus

Magnets in Mental Health Animal

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M A G N E T I S m

Magnets in Mental Health

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Localized action

A Picture is Worth a Thousand Words

Training Requirements – Online Manufacturer mandated Hospital Privilege

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Training Requirements – On Site 3 days & 3 patients

TMS is not a first line treatment – reserved for resistant cases

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TMS Dose 10 pulses/sec Stimulation x 4 sec 26 sec rest time Total # pulses = 3000 Total treatment time = 37.5 minutes 20-30 daily sessions

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conductive, ferromagnetic, or other magnetic-sensitive metals implanted in the head or are non-removable and within 30 cm of the treatment coil.

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The Cost & Reimbursement Effective January 1, 2011, there are CPT category I codes for this procedure: 90867 Therapeutic repetitive transcranial magnetic stimulation treatment; planning 90868 delivery and management, per session. 90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management.

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1. The Blue Cross and Blue Shield Technology Evaluation Center (TEC) published an assessment of repetitive TMS (rTMS) for depression in 2011 and “reported The meta-analyses and recent clinical trials of TMS generally show statistically significant effects on depression outcomes at the end of the TMS treatment period.”

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2. Naturalistic studies have demonstrated the effectiveness of TMS in real world practice settings without the constraints of research-based patient selection criteria. The clinicianassessed response rate was 58%

Treatment Efficacy

References 1.

2.

Transcranial Magnetic Stimulation as a Treatment of Depression See: file:///C:/Documents%20and%20Settings/PC S/Desktop/Transcranial%20Magnetic%20Stim ulation%20as%20a%20Treatment%20of%20Depr ession%20and%20Other%20Psychiatric%20Dis orders.htm Carpenter LL, Janicak PG, Aaronson ST et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and Anxiety 2012; 29:587-596.

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Based on clinical experience and research findings TMS is a reasonable choice for treatment resistant depression.

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