Deep TMS for OCD

Deep TMS (Transcranial Magnetic Stimulation) for OCD is a non-invasive treatment method used for treatment-resistant obsessive-compulsive disorder (OCD).

Deep TMS is a form of brain stimulation therapy that uses magnetic fields to stimulate nerve cells in specific areas of the brain. It is a more advanced version of standard TMS, allowing deeper penetration of the magnetic fields, targeting areas that are believed to be involved in the pathophysiology of OCD. By modulating the areas of concern, deep TMS can help reduce the symptoms of OCD, such as intrusive thoughts and repetitive behaviors.

Indications 

Deep TMS for OCD is typically recommended for those patients who have not achieved sufficient improvement from traditional OCD treatment options, such as medications and psychotherapy.

Obsessive-compulsive disorder is a condition where you feel compelled to perform certain acts repeatedly because of anxiety or certain fears. For example, you may be obsessed with the fear of getting an infection, and to deal with this fear you repeatedly wash your hands. You may be aware of what you are doing, but your fear dominates your reason, and the anxiety and stress produced can only be relieved by performing the compulsive act.

Preparation

In general, preparation for deep TMS for OCD may include the following:

• Your doctor will review your medical history, including any neurological or psychiatric conditions, medications, and any contraindications for TMS (such as having metal implants in the head).
• Baseline measurements of your OCD symptoms using standardized scales (for example, the Yale-Brown Obsessive Compulsive Scale) will be taken to track your progress.
• A thorough psychiatric assessment will be performed to evaluate the severity of your OCD symptoms, and to determine if Deep TMS is appropriate for you.
• Your doctor may review your current medications and make adjustments if necessary. Certain medications can affect the efficacy of TMS.
• You should remove any metal objects, such as jewelry, hairpins, or glasses with metal frames, before the treatment, as the magnetic fields can interact with metal.

Procedure

Deep TMS treatment for OCD does not involve any anesthesia or sedation, and patients remain awake and alert during each treatment.

In general, the procedure for a deep TMS session may include the following steps:

• The first session may involve brain mapping to identify the precise location for stimulation. This involves delivering single magnetic pulses to determine the motor threshold (the minimum intensity needed to produce a response).
• Once the target area is identified, the Deep TMS session begins. You will be seated comfortably in a chair. A healthcare provider will position the Deep TMS helmet or cap on your head. This device contains electromagnetic coils designed to deliver magnetic pulses to specific brain areas.
• For OCD, the treatment typically focuses on the anterior cingulate cortex and the medial prefrontal cortex - areas implicated in OCD pathophysiology.
• You may feel a tapping sensation on the scalp and hear a clicking sound as the machine operates.
• The treatment involves multiple sessions over several weeks, with each session lasting about 20-30 minutes.

Post-procedure care

After the session, you can resume your normal activities immediately, including driving. There is no downtime required. Regular follow-up appointments will be scheduled to monitor your progress and adjust treatment parameters if necessary. Over time, many patients experience a reduction in compulsive behaviors and obsessive thoughts, improving their quality of life.

Side Effects

Deep TMS for OCD generally is considered a safe and effective treatment. However, some patients may experience mild headaches, scalp discomfort at the stimulation site, or a tingling sensation in the face - all of which generally subside quickly.

Summary

Studies have shown that Deep TMS can significantly reduce obsessive-compulsive disorder symptoms. The FDA has approved it for treatment-resistant OCD based on clinical trial results. Research evaluating how well deep TMS works for treating OCD has found that about 45% of patients have reduced OCD symptoms after one month of treatment. Deep TMS is often used in conjunction with other treatments, such as medication and cognitive-behavioral therapy (CBT), for optimal results.