Name: Abd-Manaaf Bakere
Rotation 2: Psychiatry
Rotation Location: Queens Hospital Center.

Repetitive Transcranial Magnetic Stimulation (rTMS) in Psychiatric and Neurological Disorders

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique used in the treatment of various psychiatric and neurological disorders. This summary provides an overview of the indications, adverse effects, equipment, technique, and the importance of an interprofessional team in utilizing rTMS for conditions such as treatment- resistant depression, PTSD, OCD, Tourette syndrome, and movement disorders.

Indications for rTMS:

rTMS has demonstrated therapeutic potential in conditions such as treatment-resistant depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), Tourette disorder, chronic pain syndrome, generalized anxiety disorder (GAD), bipolar disorder, and various movement disorders. The U.S. Food and Drug Administration (FDA) has approved rTMS for major depressive disorder (MDD), and subsequent approvals have expanded its use for other conditions, showcasing its versatility in psychiatric and neurological care.

Adverse Effects and Contraindications:

While rTMS is generally well-tolerated, potential adverse effects include pain at the stimulation site, posttreatment headaches, neck pain, and muscle twitching. Seizures are a rare but significant concern, making it contraindicated for patients with epilepsy. Pre-existing neurological diseases, adolescents, changes in medication regimes, and substance use during rTMS should be considered to prevent lowering the seizure threshold. Awareness of contraindications and potential adverse effects is crucial for safe and effective treatment.

Equipment and Technique:

rTMS relies on the Faraday law of electromagnetic induction, using a coil to generate high- intensity magnetic fields that modulate cortical excitability. The choice of coil, whether round or figure-of-eight-shaped, influences the neural circuit activated. Treatment parameters, including frequency, intensity, and duration, are individualized based on factors such as motor threshold, age, and disease state. The stimulation targets specific brain regions, and the technique involves both low-frequency(<1Hz) and high-frequency(>1Hz) paradigms. Sessions are outpatient procedures where patients experience a tapping sensation on the forehead during stimulation.

Interprofessional Team Coordination:

The successful utilization of rTMS requires an interprofessional team approach. Psychiatrists, psychologists, social workers, nurse practitioners, and primary care providers collaborate to evaluate patients, consider medication trials, and educate patients on the importance of follow-up

sessions. Continuous communication among team members ensures comprehensive patient care. Social workers play a role in managing daily activities, assessing the effectiveness of therapy in routine tasks, and preventing relapse through psychotherapy and medication continuation.

Clinical Significance and Outcomes:

rTMS has shown efficacy in treating treatment-resistant MDD, PTSD, GAD, bipolar depression, stroke complications, and various movement disorders. It is well-tolerated and offers a promising alternative to traditional treatments. Studies suggest positive outcomes in the reduction of depressive symptoms, and its safety extends to stroke-related complications and Parkinson’s disease.

In conclusion, rTMS stands as a valuable non-invasive treatment option for a range of psychiatric and neurological disorders. Its application requires a careful assessment of indications, consideration of contraindications, and collaboration among healthcare professionals to optimize patient outcomes. As research continues, rTMS holds the potential to further enhance healthcare outcomes for individuals with neuropsychiatric conditions.