Research and Treatment Tools

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation (TMS) is a technology which is an effective treatment for
depression and also showing substantial promise as a therapy for a range of other conditions.

TMS is a non-invasive treatment which works by using a magnetic field to stimulate nerve cells in superficial areas of the brain. A hand-held, plastic-coated coil is placed close to the scalp of the person receiving TMS treatment. An electrical current passes through the coil, creating a magnetic field that stimulates electrical activity in the nerve tissue below the coil.

The effect of the stimulation varies with the frequency and intensity of stimulation and the orientation of the stimulation coil. TMS stimulation has been shown to have effects on mood, motor (control of movement) and cognitive (thinking and planning) functioning.

As well as a therapeutic tool,TMS can be used as a method to investigate brain function.

 

TMS as a treatment method

Studies have been evaluating the use of TMS in the treatment of patients with depression for over 15 years. At MAPrc we have been at the centre of a worldwide research effort focused on evaluating and more recently improving the use of TMS treatment for patients with depression. We have conducted an extensive series of clinical trials that have contributed to robustly demonstrating that TMS is an effective treatment. We have also conducted extensive research evaluating the use of potentially new and improved forms of TMS treatment.

Because it is a non-invasive therapy that is carried out while the person receiving it is awake and alert, TMS has important advantages over older therapies such as electroconvulsive therapy (ECT). These include: low risk of side-effects or serious complications, avoidance of the need for anaesthesia and its associated risks, lower costs and less inconvenience to the patient, avoidance of the stigma that ECT sometimes carries, and the fact that TMS is suitable for use in medically unwell people who may not be able to tolerate certain medications or ECT.

TMS is now becoming a widely used treatment for depression around the world. There are clinical programs providing TMS treatment globally, including the US, and its place in clinical practice is gradually being refined.

In addition to using TMS in depression, studies are now exploring its use in other disorders including bipolar disorder, autism, Asperger's disorder and substance abuse. We have conducted, and continue to conduct innovative studies like these, including in depression, autism, schizophrenia, fibromyalgia and obsessive compulsive disorder. You can find more information about this research on the Psychiatric Neurotechnology: current projects page                          

Contact details
Email: tms-enquiry@monash.edu
Phone: 9076 6595

 

TMS as a probe of brain function 

TMS is widely utilised as a technique in studying normal and abnormal brain activity. When TMS pulses are applied to the muscle area of the brain, a muscle response is produced, for example in the hand, which can be measured and characterised accurately. This allows researchers to study the function of the motor control system. When TMS pulses are applied to other brain regions, they can be used to interfere with or temporarily augment other brain activities allowing study of these brain functions.

Researchers have also combined TMS with brain imaging methods such as EEG and NIRS as a method of studying brain function in non-motor brain regions. When EEG is recorded during a TMS pulse, we can measure the brain's electrical response to the TMS pulse, which reflects the normal functioning of the brain being stimulated. In a similar way, the brain's vascular response to stimulation can be measured with NIRS.

Researchers within MAPrc have extensively used TMS-EEG and TMS-NIRS methods to study brain function and the response to TMS in healthy subjects and in a number of illness states including depression, schizophrenia and addiction.

 

Transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) is a relatively new brain stimulation technique. It uses a very gentle electrical current (1-2 mA) to change the activity level of cells in specific areas of the brain. The low current is not enough to cause brain cell to fires, but it changes the environment around nerve cells in the area of the brain that is stimulated making them more or less likely to fire. 

Like TMS, tDCS is a non-invasive technique which does not require any anaesthetic and has minimal side-effects. It also has potential use as a way of investigating brain function but is mostly being explored in the possible treatment of conditions such as chronic pain, epilepsy, stroke, Parkinson's disease and depression. Currently, it is being investigated as a treatment for depression in people whose symptoms have not been resolved with medication (treatment-resistant depression). 

Over recent years, researchers within MAPrc have conducted a careful series of studies demonstrating that tDCS has the potential to modulate and improve aspects of brain cognition, including learning and memory. These studies are ongoing and hopefully will lead to the development of tDCS methods as treatments for disorders with cognitive dysfunction such as schizophrenia, head injury and Alzheimer's disease.  You can find more information about this research on our current Treatment Studies and Investigative Studies.

 

Magnetic seizure therapy

Magnetic seizure therapy (MST) is a very new treatment approach for severe depression that we are currently actively investigating. MST, like ECT, involves the induction of a seizure for therapeutic purposes. The major difference, however, is that in MST the seizure is induced using magnetic stimulation rather than the electrical current that is used in ECT. 

Magnetic fields are able to pass freely into the brain, making it possible to produce a very focused seizure in a specific area. The widespread nature of the seizures produced by ECT is thought to be responsible for the memory loss that people report following ECT. Therefore, by avoiding the use of direct electrical current and inducing a focal seizure, it is thought that MST will be able to improve depressive symptoms without the memory loss seen in ECT. 

MST is a medical procedure performed by doctors. It involves having a general anaesthetic and a muscle relaxant. The brain is then stimulated with a controlled series of magnetic pulses using a coil that is placed at a precise location on the head. The magnetic pulses cause a seizure in the brain which will last up to two minutes. Because of the muscle relaxants and the anaesthetic, patients do not convulse or 'fit' and do not feel any pain. Patients wake up five to ten minutes following the procedure. 

Initial studies, with MST have suggested that it might produce similar antidepressant effects to those seen with ECT but without the same side effects. We are currently conducting a randomised controlled trial to evaluate these propositions. You can find more information about this research on our current Treatment Studies and Investigative Studies.

 

 MAPrc Monash Alfred Psychiatry Research Centre, Level 4, 607 St Kilda Road, Melbourne 3004

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