Before Starting:
Often likened to a lazy boy chair, the TMS chair is cushioned and reclines such that the patient rests comfortably with his or her head supported by a headrest. The doctor, nurse or TMS technician may ask the patient to remove any metallic jewelry such as earrings, large necklaces, headwear or bracelets prior to starting. This is because, while pulsing, the magnetic coil can interact with metallic devices within 1 foot away, which may cause the metal to heat up and become slightly uncomfortable during treatment. Once the patient is seated, a small cushion is placed against the right temple to hold the head in place. During treatment, the patient is not constricted or held down in the chair in any way.
Brain Mapping:
Brain mapping is a procedure used to determine treatment location and energy level of TMS pulses required for optimum effect. Treatment location and energy level are tailored to individual patients, depending on size and shape of the head. Brain mapping takes place only one time, prior to the first treatment session, and it takes about 20-30 minutes to complete.
Though different TMS manufacturers have developed their own methods, the most commonly used brain mapping protocol is the one developed by Neuronetics Inc., which uses the NeuroStar TMS device. With this protocol, the patient is asked to hold up his or her right hand in a relaxed hitchhiker position while the elbow rests against a cushion. The attending physician gently places a magnetic coil against the middle left side of the patient’s head. Patients may hear and feel a light tap against the head—this is a single pulse emanating from the coil. This pulse is, in fact, electrically stimulating a portion of the motor cortex, or a group of neurons in the center top portion of the brain responsible for producing muscle contraction, that corresponds to hand and arm movement. When the pulse goes off, the patient will experience an involuntary twitch of the right hand, which will indicate to the doctor the region of the motor cortex that is being stimulated.
During brain mapping, the doctor and TMS technician or nurse together will observe hand movement corresponding to taps at various locations of the motor cortex. Once treatment location and energy levels are determined, the patient will proceed to the first TMS treatment session.
