Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management
CPT4 code
Name of the Procedure:
Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Initial
Common name(s): TMS therapy
Technical/medical terms: Repetitive TMS, rTMS
Summary
Therapeutic repetitive transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. This treatment is typically done to improve symptoms of certain mental health conditions, such as depression.
Purpose
Medical condition/problem: TMS is mainly used to treat major depressive disorder (MDD) that hasn't responded to other treatments. Goals/expected outcomes: The objective is to reduce the severity of depression symptoms and improve the patient's overall quality of life.
Indications
Symptoms/conditions: Severe, treatment-resistant depression. Patient criteria: Individuals with major depressive disorder who have not improved with medications or other traditional therapies.
Preparation
Pre-procedure instructions: Patients usually do not need to fast but should inform their doctor about all medications and supplements they are taking. Diagnostic tests/assessments: A thorough psychiatric evaluation and possibly brain imaging studies to determine eligibility.
Procedure Description
- Cortical Mapping: Initially, the patient's scalp is mapped to identify the specific brain region to target.
- Motor Threshold Determination: Small electric pulses are delivered to find the minimal power needed to cause muscle movement, helping to customize the treatment.
- Delivery of TMS: A magnetic coil is placed on the patient's scalp, delivering repetitive magnetic pulses to stimulate nerve cells in the targeted brain area.
- Management: The procedure is typically managed by a trained technician or physician who adjusts settings as needed.
Tools/Technology: Magnetic coil, computer interface for control settings. Anesthesia/Sedation: Generally, no anesthesia or sedation is required.
Duration
Each session lasts about 30 to 60 minutes. A full treatment course usually involves daily sessions (5 days a week) over 4 to 6 weeks.
Setting
This procedure is usually conducted in an outpatient clinic or a specialized medical center.
Personnel
Healthcare professionals involved: Psychiatrists, specialized technicians, and occasionally nurses.
Risks and Complications
Common risks: Scalp discomfort, headache, light-headedness. Rare risks: Seizures, manic episodes in patients with bipolar disorder.
Benefits
Expected benefits: Significant reduction in depression symptoms, improved mood and functionality. Timeline: Benefits may be noticeable within the first few weeks of treatment, but it can vary.
Recovery
Post-procedure care: Patients can return to their normal activities immediately after each session. Recovery time: No downtime is required. Follow-up: Regular follow-up appointments to monitor progress and adjust treatment if necessary.
Alternatives
Other treatment options:
- Medications (antidepressants)
- Psychotherapy (cognitive-behavioral therapy)
- Electroconvulsive therapy (ECT)
- Vagus nerve stimulation (VNS)
Pros/Cons of alternatives:
- Medications: Non-invasive but may have side effects and delayed efficacy.
- Psychotherapy: Useful but time-intensive and may not work for all.
- ECT: Effective but more invasive and requires anesthesia.
- VNS: Requires surgical implantation but can provide long-term benefits.
Patient Experience
During the procedure: Patients might feel a tapping sensation on the scalp and hear a clicking noise with each magnetic pulse. Some may experience mild discomfort. After the procedure: Minor side effects like headache or scalp soreness might occur but typically resolve quickly. Pain management can include over-the-counter pain relievers if needed.