Question 1

What is Nexstim's NBT system?

Accepted Answer

Nexstim’s Navigated Brain Therapy (NBT) system is based on unique navigated Transcranial Magnetic Stimulation (nTMS) technology which allows for accurate, reproducible and non-invasive brain stimulation. Its initial application in the United States is the treatment of depression. Nexstim’s NBT System is unique because its clinically-proven MRI-based navigation allows the user to visualize the electric field inside the patient’s brain and accurately target therapy.

Question 2

What are the indications for use of NBT?

Accepted Answer

Nexstim NBT® System 2 is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.  Exploratory studies are being conducted for other conditions and can be used off label to treat other mental health and neurological conditions.

Question 3

What is General TMS?

Accepted Answer

TMS is an effective, non-invasive alternative for the large number of patients not responding to medication and therapy. It is a non-invasive magnetic stimulation of the brain, similar to the magnetic field produced by an MRI machine. The TMS system delivers magnetic pulses to stimulate nerve cells (neurons) in the areas of the brain which affect mood and cognition. TMS does not require anesthesia and is not to be confused with ECT (Electro Convulsive Therapy).  Without navigation, the exact cortex area - Dorso Lateral Pre Frontal Cortex - requiring TMS treatment is correctly targeted in just 30% of patients.  Our neuronavigated system allows for a precise target location for stimulation.

Question 4

Why is SmartFocus TMS different?

Accepted Answer

Your healthcare provider needs the tools to make sure the right dose of TMS therapy is given to the right part of the brain. Much like people, all brains are unique - and different. Targeting TMS requires an MRI scan of your head for your healthcare provider to see into your brain, and sophisticated software to model the complexity of your individual brain. This is what Nexstim SmartFocus TMS does. And it is unique.

Question 5

Does TMS work for conditions other than Depression?

Accepted Answer

There is a great deal of research being conducted on the use of TMS for a wide range of psychiatric and neurologic disorders. More studies are urgently needed. In early studies, TMS may be effective for the following conditions:

Depression in pregnant women Obsessive Compulsive Disorder (OCD) Post Traumatic Stress Disorder (PTSD)
Chronic neuropathic pain Adolescent mania
Dysarthria after subacute stroke Spasticity after stroke Migraine Smoking cessation: in combination with nicotine replacement Tinnitus Regional Pain Syndrome Communication and linguistic deficits in Parkinson disorder Alzheimer dementia Mild TBI-related headaches In Schizophrenia, TMS has been shown to improve working memory

In Canada TMS is also used to treat Bipolar Disorder   Before beginning TMS therapy, our psychiatrist will see you for a comprehensive psychiatric evaluation to determine if you will benefit from TMS.

Question 6

What are the side effects?

Accepted Answer

TMS is generally a safe procedure and does not have many side effects. Common side effects include mild headache and scalp pain or discomfort, muscle twitching, skin irritation on the scalp where the muscle electrode sensors are placed, and temporary hearing changes (no problems with hearing due to TMS have occurred when earplugs have been properly worn).

Question 7

What are the possible risks of TMS ?

Accepted Answer

While cortical magnetic stimulation is generally considered a very safe procedure, there are, of course, risks. Patients should be carefully observed for worsening symptoms or signs of suicidal thinking, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treating doctor if symptoms worsen. Serious side effects are rare. This may include seizures (under ordinary clinical use, the estimated risk of seizure is approximately 1 in 30,000 treatments (0.003%) or 1 in 1000 patients (0.1%).

Question 8

Who should not be given NBT Therapy?

Accepted Answer

Patients with non-removable conductive, ferromagnetic, or other magnetic-sensitive metal anywhere in the head or within 12 in (30cm) of the stimulation coil. Examples include cochlear implants, implanted electrodes or stimulators, aneurysm clips or coils, stents, bullet fragments, ocular implants, and stents.   Patients who have an active or inactive implanted device (including device leads), including deep brain stimulators, cochlear implants, cardiac pacemakers, and vagus nerve stimulators. Contraindicated use could result in serious injury or death. Patients with increased intracranial pressure or patients with intracardiac lines, intravenous pumps, or dose calculators.

Question 9

What is the first treatment session like?

Accepted Answer

The SmartFocus TMS technology platform is unique and allows for highly accurate targeting of stimulation through its 3D navigation system, personalized based on a patient’s MRI scan. MRI scans are very common, non-invasive procedures. Your clinician will help arrange your visit to a local imaging center before your first treatment session.    Your first visit to the TMS treatment room will include a setup process. After loading your MRI head scan, the system will create a 3D view of your brain anatomy. Your clinician will use Nexstim's science-based algorithm to identify the exact point for stimulation in the cortex, the left dorsolateral prefrontal cortex (DLPFC).   Next, your clinician will personalize the TMS dose to your needs. To do this, the clinician places several electrodes on the palm of your hand. These pick up the muscles’ responses to single pulses of TMS over the top of your head, the motor cortex. With this information, the clinician accurately and reliably measures the excitability of your brain, your "alertness". This setup process needs to be performed only once, taking around 20 min. The TMS dose is personalized and all information on dose and navigation is stored, allowing for treatments to be repeated with guaranteed precision at the correct location.

Question 10

What is the procedure like?

Accepted Answer

First, the clinician will attach a self-adhesive, disposable tracker "badge" onto your forehead for the duration of the session. Then, by pointing to select places around your head, the clinician will align, “co-register”, the 3D brain model to your actual head. Now you will be part of a system which knows, at all times, precisely where your head and brain are in relation to the TMS coil which gives the therapy.    Once you have found a comfortable position, your clinician will adjust the TMS coil to be over the cortex targeted for the stimulation, the left DLPFC. This will not take long, as the system has the exact positioning data from your first visit. The clinician will be able see from a computer screen when the setup is completed. Now you are ready for your treatment session. You should use earplugs or headphones offered. A trained user will monitor you at all times and will make adjustments, should you feel any discomfort.  The effectiveness of TMS relies on multiple TMS sessions. Typically, you would attend one 45-60 minute session for five weekdays over six weeks, or as your physician recommends.

Question 11

Will my insurance pay for it?

Accepted Answer

Our staff will work with your insurance company to determine if insurance will cover all or part of the cost of TMS. Many insurance companies will cover a significant portion of TMS treatment in medication resistant depressed patients. Medicare covers the procedure. For patients withouth coverage who have financial hardship, we offer a sliding fee scale.

Question 12

Can I continue taking medications during TMS therapy?

Accepted Answer

Yes. You do not need to stop your medications for TMS therapy.

Question 13

Is TMS an option for patients who cannot tolerate the side effects associated with antidepressant medications?

Accepted Answer

TMS therapy does not have side effects commonly seen with medications such as weight gain, sexual dysfunction and sedation. The most common side effects reported with TMS are headache and scalp pain or discomfort. These are generally mild to moderate and rapidly diminish with time. As with all indications, the use of TMS for patients who can not tolerate side effects will be carefully evaluated and discussed in detail with you.

Question 14

Will I be able to go to work after the procedure?

Accepted Answer

Yes. You will come for a session that is about 30-40 minutes long, sometimes shorter. You will be awake during the procedure. You can listen to music, watch TV, or just rest while you receive TMS therapy.

Question 15

Does it cause memory impairment?

Accepted Answer

It has not been shown to impair memory.

Question 16

Can I receive therapy during TMS?

Accepted Answer

Yes. In some cases this may improve the results of TMS treatment.