HOW DOES TMS WORK FOR DEPRESSION
Neuroscience research has found hyperactivities in the emotion center of the brain in patients with depression. This overactivation contributes to the prolonged perception of stress, a stronger reaction to potential threats, and a lowered expectation and motivation towards behaviors with reward, which in turn, causes the individual to gradually lose the ability to experience happiness.
In healthy population, the frontal lobe plays an important role in regulating the activities of the emotion centre of the brain.
Healthy State
In healthy population, the prefrontal cortex is able to regulate the activity of the emotion centre of the brain, preventing it from over-activating.
Depression State
The metabolism of the prefrontal cortex slows down and fails to regulate the activities of the emotion centre of the brain. As a result, it may overactivate and patients may experience symptoms such as depression and anxiety.
TMS Treatment
Transcranial magnetic stimulation therapy uses magnetic pulses to stimulate the frontal cortex of the brain in a non-invasive way, and utilizes the principle of neuroplasticity to restore its regulatory function to the emotional area of the brain to improve the symptoms of depression.
*Alexander, L., Wood, CM, Gaskin, PLR et al. Over-activation of primate subgenual cingulate cortex enhances the cardiovascular, behavioral and neural responses to threat. Nat Commun 11, 5386 (2020). https://doi.org /10.1038/s41467-020-19167-0
SmartFocus®TMS TREATMENT
A standard TMS treatment course for depression usually takes 4-6 weeks, 5 days a week, each session of treatment usually takes around 45 minutes.
During the treatment, the patient will be seated comfortably on a reclining chair with a comfortable headrest. No sedative medication or anesthesia would be employed.
PERSONALIZED TMS TREATMENT WITH SmartFocus® TMS
To achieve the best possible treatment effect, TMS needs to precisely target at specific brain regions, such as the left dorsolateral prefrontal cortex (Left DLPFC).
Due to the individual differences in head dimensions and brain anatomy, it is not easy to find the right location of the DLPFC in the brain, and also to deliver the magnetic pulses to that location accurately and consistently.
Individualized stimulation target setting
The first generation of non-navigated transcranial magnetic stimulation system can only roughly locate the left DLPFC by identifying the motor cortical hotspot and then moving 5cm anterior, known as the “5 cm rule”.
However, studies have shown that this method only correctly identifies the location of the left DLPFC in about 30% of patients (Herwig et al., 2001).
With the SmartFocus® navigated TMS treatment system, we could utilize the patient’s own brain MRI scan to identify the correct location of the left DLPFC or any other individualized target sites.
With the SmartFocus® navigation system utilizing the patient’s MRI scan of the brain, the precise location of the left DLPFC or any other individualized target sites within the individual’s brain anatomy can be targeted.
Patient A
Patient B
Individualized stimulation intensity setting
It is generally believed that the scalp to cortex distance at the hand motor cortex area is equal to that at the left DLPFC area.
Therefore, the stimulation intensity is usually fixed at 120% of the resting motor threshold (120% rMT).
However, in fact, the scalp to cortex distance at the hand motor cortex area might not be equal to that at the left DLPFC area, see Figure below.
To avoid over-stimulation or under-stimulation during the treatment, SmartFocus® TMS utilizes its unique electric-field navigation technology to set individualized treatment intensity according to the patient's own brain anatomy.
Individualized stimulation direction setting
To maximize the stimulating effect, it is important to stimulate cortex in a specific direction. SmartFocus® TMS system can display the direction of the induced electric-field in real time, ensuring that the electric field induced could the treatment target at the best orientation.
Our center adopts the only TMS system in the world that is clinically validated by neurosurgeons, the 3rd generation TMS technology (SmartFocus® TMS). It is equipped with the advanced 3D brain image guided and e-field navigation tools to optimize the treatment location, dose and orientation, providing patients with a personalized treatment.
SmartFocus® TMS TREATMENT IN 5 STEPS
1 Preview
Before the first treatment, the client needs to perform a quick MRI scan of the brain to provide brain structure data to the TMS machine.
2 Measure
Based on the MRI scan, a 3D brain model would be created and the therapist can adjust the treatment parameters according to the 3D brain image.
3 Targeting
The specific area of your brain that needs to be stimulated is targeted, using SmartFocus® TMS navigation.
4 Treatment
After targeting the specific area, we can then deliver the treatment with precise stimulation intensity.
5 Repeat
Vital treatment data is saved and ready for the next treatment session.
Did you know...?
Not all TMS treatments are the same!
COMPARISON OF DIFFERENT TMS TECHNOLOGIES
is your best choice
CLINICAL TREATMENT OUTCOMES
A large number of clinical studies in the past 25 years have confirmed the efficacy of TMS in the treatment of depression. The latest international clinical guidelines of TMS for treatment also strongly recommend TMS treatment for depression with definite efficacy (Evidence level: A ). The latest SmartFocus® TMS system has also been approved by the US FDA for treatment of depression in 2018.
SmartFocus® TMS
Real world clinical treatment data*
Recent real world clinical treatment outcomes has revealed positive treatment outcomes for patients receiving 3rd generation SmartFocus® TMS treatment - nearly 80% of the patients show significant alleviation in depressive symptoms, over 50% were in remission at end of treatment.
*Data obtained from 311 patients with treatment-resistant depression after having completed the Nexstim SmartFocus® rTMS treatment
It is believed that with the deepening of brain connectomics research in the future, brain scientists will have a more accurate and individualized understanding of the functional connectivity between the prefrontal cortex and emotional areas of the brain, and the benefits of magnetic brain stimulation therapy The curative effect is expected to be further improved.