Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management
CPT4 code
Name of the Procedure:
Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Motor Threshold Re-determination with Delivery and Management
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 includes an additional step of re-determining the motor threshold, ensuring optimal stimulation levels for effective therapy.
Purpose
Therapeutic TMS is used primarily to treat depression, particularly in cases where traditional treatments like medication and psychotherapy have not been effective. The goal is to improve mood and alleviate symptoms by stimulating specific areas of the brain involved in mood regulation.
Indications
- Major depressive disorder (MDD)
- Treatment-resistant depression
- Patients unresponsive or intolerant to antidepressant medications
- Anxiety disorders (in some cases)
Preparation
- No specific fasting or dietary restrictions are usually required.
- Patients should inform their doctor about any medications they are taking.
- A baseline assessment and initial motor threshold determination will be done before starting treatment.
Procedure Description
- The patient is seated comfortably, and a magnetic coil is placed against their scalp.
- The motor threshold is re-determined by delivering brief magnetic pulses and observing for muscle responses.
- Once the motor threshold is confirmed, repetitive magnetic pulses are delivered to targeted areas in the brain.
- Each session typically lasts for about 30-60 minutes.
- The procedure is repeated over multiple sessions, usually 5 times a week for 4-6 weeks.
Duration
Each session typically lasts 30-60 minutes, with the entire course spanning several weeks.
Setting
The procedure is performed in an outpatient clinic setting.
Personnel
- Trained technician or nurse to operate the TMS equipment
- Psychiatrist or neurologist overseeing the treatment
- Support staff for patient care and management
Risks and Complications
- Common: mild headaches, scalp discomfort, tingling or twitching of facial muscles.
- Rare: seizures, hearing problems, mood swings.
- Complications are typically managed by adjusting the treatment parameters or providing supportive care.
Benefits
- Alleviation of depressive symptoms
- Improved mood and daily functioning
- Potential benefits may be realized within a few weeks of starting treatment
Recovery
- Patients can resume normal activities immediately after each session.
- There are no significant post-procedure restrictions.
- Regular follow-up appointments to monitor progress and adjust treatment as needed.
Alternatives
- Antidepressant medications
- Psychotherapy (Cognitive Behavioral Therapy, etc.)
- Electroconvulsive therapy (ECT)
- Pros and Cons: Medications have systemic side effects; psychotherapy requires long-term commitment; ECT is more invasive than TMS but may be more effective in severe cases.
Patient Experience
- Mild discomfort during and after sessions, like headaches or scalp sensitivity.
- No need for anesthesia, patients remain awake and alert.
- Most patients tolerate the procedure well with minimal discomfort, and pain management measures are available if needed.