From the Desk of Dr. Kent
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The Brainsway deep TMS (transcranial magnetic stimulation) employs a patented H1 coil which differs from all other TMS devices on the market that use a figure 8 coil. This figure 8 coil stimulates the brain more superficially and narrowly. The Brainsway device was developed to reach more broadly and deeper into the brain where many of the structures associated with mood and other brain disorders lie.
The unpatented figure 8 coil has been in use since the 1990s and FDA approved after 2 tries in the US in 2008. The following companies use this technology: Neurostar, Magstim, MagVenture, eNeura. In fact anyone can build and market this coil as it is not patented.The Brainsway H1 coil deep TMS was developed later, patented in 2004, and FDA approved in the US in 2013 after one application. An increasing number of providers who previously used the figure 8 coil standard or superficial TMS have switched to The Brainsway H1 coil deep TMS. I will refer to this device (The Brainsway) simply as dTMS or deep TMS. dTMS targets the areas associated with depression more broadly and deeply and are more likely to not miss key areas of the brain. This allows the physician to feel more confident in the accuracy of treatment and the improvement in the results.
With standard or superficial TMS, the accuracy of treatment is more in question. The actual reported response and remission rates vary between studies, but in a large pooled data study 29.3% of patients responded to standard TMS with a 18.6% remission rate (1). With dTMS the response rate is between 38-46% and the remission rate is 33% (2). With continuation therapy of 18 additional weeks, the response rate for dTMS climbs to 81% with a remission rate of 71% (3). It does appear that more is better over time. These are remarkable numbers. The area being treated isn’t an exact spot in the brain. It’s more of an area with multiple connections and individual variability. dTMS is more likely to hit the area in question. dTMS, also does not need to increase the neurostimulation beyond what is tolerable to the patient to achieve these results. With the standard TMS, the stimulation levels would have to be increased beyond what is tolerable to the patient to increase it’s reach in the brain.
Deep TMS treatment sessions only last 20 minutes whereas superficial TMS sessions range from 37-55 minutes in length. dTMS has a similar tolerability to superficial TMS. The drop out rates may be slightly better for dTMS, if not the same as standard TMS. The bottom line is that deep TMS achieves equal or better results, with shorter sessions and similar tolerability.
Because dTMS penetrates deeper and more broadly than standard TMS, there are many other indications that are being studied world wide for this exciting new technology. These include, but are not limited to post traumatic disorder (PTSD), obsessive compulsive disorder (OCD), attention deficit disorder (ADD), addictions (cocaine, nicotine, gambling), bipolar disorder, negative symptoms of schizophrenia, autism, parkinson’s disease, Alzheimer’s, stroke victims and pain disorders. These other indications do not yet have FDA approval and would be considered “off label” treatments for TMS and wouldn’t be covered by insurance. This is likely to change in the future as there are over 60 world wide multi center trials ongoing studying these indications. In Europe, TMS is being used more broadly to treat these conditions.
With the advantages of coming onto the market a little later than standard TMS, the Brainsway device has the wisdom to produce a 2nd generation patented coil that is superior in it’s efficacy, shorter treatment duration and versatility. In fact, Brainsway is developing specific coil technologies for each indication, rather than one size fits all. The future of dTMS is very exciting for patients who have had to suffer with limited treatment choices. There is now a noninvasive, well tolerated, safer alternative. For these reasons, I have made the switch from standard TMS to deep TMS.
1. Berlim, M.T., van den Eynde, F., Tovar-Perdomo, S. and Daskalakis, Z.J. (2014) ‘Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials’, Psychological Medicine, 44(2), pp. 225–239. doi: 10.1017/S0033291713000512.
2. World Psychiatry 2015; 14:64-73
3. The World Journal of Biological Psychiatry, 2011; Early Online:1-9
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