Transcranial Magnetic Stimulation
What is transcranial magnetic stimulation?
Transcranial magnetic stimulation or TMS is a neurological technique to create an electrical current in the brain using a powerful magnetic field. The magnetic field passes though the scalp and the skull safely and painlessly. In TMS, a current passes through a coil of copper wire that is encased in plastic and held over the patient's head. This coil resembles a paddle or a large spoon and is held in place either by the doctor, a trained technician, or by a mechanical fixation device similar to a microphone pole. As the current passes through the coil it generates the magnetic field that penetrates the scalp and skull and induces a current in the brain.
TMS has been studied for more than twenty years and researchers at Beth Israel Deaconess Medical Center were on the forefront of developing this exciting technology. A certain type of TMS has been approved by the Food and Drug Administration (FDA) to
treat depression. Other forms of TMS are used in clinical research into the function of the nervous system to study the nerve fibers that carry the information about movements from the brain cortex to the spinal cord and the muscles. BIDMC researchers are also studying TMS as a possible treatment for other disorders such as Parkinson's disease, Epilepsy, Schizophrenia, Traumatic Brain Injury, Autism, and Alzheimer's Disease.
What is repetitive TMS?
Technical developments in the devices used for TMS made it possible in the late 1980s to apply TMS in trains of many stimuli per second instead of once every few seconds. This form of TMS is called repetitive TMS or rTMS. Repetitive TMS can be used to study how the brain organizes different functions such as language, memory, vision, or attention. In addition, rTMS seems capable of changing the activity in a brain area, even beyond the duration of the rTMS application itself. In other words, it seems possible to make a given brain area work more or less for a period of minutes, or even weeks when rTMS is applied repeatedly several days in a row. This has opened up the possibility of using rTMS for therapy of some illnesses in neurology, rehabilitation, and psychiatry (see FDA approval for Depression).
Are there any adverse effects?
TMS, particularly rTMS, can have adverse effects although the risk is quite low. There is a potential to induce a seizure or epileptic convulsion, even in subjects without any predisposing illness. That's one reason why the appropriate safety guidelines and precautions need to be followed, and the person performing rTMS needs to be properly trained. Subjects considering TMS treatment or participation in a TMS study should also understand that not everyone is appropriate for the treatment. It is critical to undergo proper screening prior to TMS and to discuss your complete health history with your physician and/or investigators.
BIDMC-The Experienced TMS Team
No medical practice in New England has more experience with TMS than Beth Israel Deaconess Medical Center. Dr. Pascual-Leone, Director of the Berenson-Allen Center for Noninvasive Brain Stimulation, is known as one of the pioneers of TMS, conducting the first controlled clinical trial demonstrating its effectiveness for Depression. Other TMS providers throughout the country and the world call on the BIDMC team to answer questions about the technology and to help train their staffs. BIDMC staff has treated over 500 patients with TMS, completed multiple research studies, published over 300 papers on brain stimulation, and trained over 200 individuals in the proper application of TMS in clinic and research.
In addition to providing the most advanced technology and leading specialists, Beth Israel Deaconess is renown for its compassionate care. Our team will answer your questions and help you and your family feel comfortable before, during, and after the treatments. We strive to treat everyone who walks in our door like a member of our own family.
If you have questions about
TMS for depression or ongoing clinical trials on TMS, please email
Articles About TMS
To learn more about TMS consult the following articles:
- TMS: Studying Brain-behavior Relationship by Induction of "Virtual Lesions". Trans Royal Philosophical Society 354(1387): 1229-8(1999), Pascual-Leone A, Bartres-Faz D, Keenan JP.
- TMS in Cognitive Neuroscience: Virtual Lesion and Neurochronometry. Current Opinion in Neurobiology 10: 232-237 (2000), Pascual-Leone A, Walsh V, Rothwell J.
- Studies in Cognition: The Problems Solved and Created by Transcranial Magnetic Stimulation. J Cog Neurosci 15: 948-960 (2003), Robertson EM, Theoret H, Pascual-Leone.
- Transcranial Magnetic Stimulation in Neurology. Lancet Neurology 2: 145-156 (2003), Kobayashi M, Pascual-Leone.
- Fregni F, Pascual-Leone A. Transcranial Magnetic Stimulation for the Treatment of Depression in Neurological Disorders. Curr Psychiatry Reports 7: 381-390 (2005).
- Pascual-Leone A. Disrupting the brain to guide plasticity and improve behavior. Prog Brain Res. 2006;157:315-329.
- Wagner T, Valero-Cabre A, Pascual-Leone A. Noninvasive human brain stimulation. Annu Rev Biomed Eng. 2007;9:527-65.
- Fregni F, Freedman S, Pascual-Leone A. Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques. Lancet Neurol. 2007;6(2):188-91.
- Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol. 2007;3(7):383-93.
- Frye RE, Rotenberg A, Ousley M, Pascual-Leone A. Transcranial magnetic stimulation in child neurology: current and future directions. J Child Neurol. 2008;23(1):79-96.
- Wu AD, Fregni F, Simon DK, Deblieck C, Pascual-Leone A. Noninvasive brain stimulation for Parkinson's disease and dystonia. Neurotherapeutics. 2008;5(2):345-61.
- Rossi S, Hallett M, Rossini PM, Pascual-Leone A; Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009 Dec;120(12):2008-39. Epub 2009 Oct 14.