MagnaCentre™ – Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment for Depression and Obsessive Compulsive Disorder

In September 2014 the MagnaCentre™, formed a partnership with the Nightingale Hospital, to deliver state of the art repetitive Transcranial Magnetic Stimulation (rTMS) treatment to patients with resistant depression. This partnership has led to the first hospital based rTMS service in the UK, and the only service in the UK to offer H-Coil ™ technology.

What is rTMS?

Repetitive Transcranial Magnetic Stimulation (rTMS) is the latest effective, non-pharmacological, treatment for depression. The basic principle of rTMS is to target short magnetic pulses over the scalp to produce electrical currents in specific brain regions that regulate mood.

In November 2015 NICE stated that: 'Transcranial magnetic stimulation for depression is safe enough and works well enough for use in the NHS. NICE looked at 7 studies involving over 6000 patients. Generally, the studies showed that the treatment improved depression symptoms and quality of life. In some cases, it allowed patients to stop taking antidepressants'. 

It is routinely used in many first class international hospitals (e.g. Johns Hopkins Hospital, USA). It is also increasingly used in Scandinavian and other European countries. When indicated it is now covered by several of the major healthcare insurance companies in the UK (e.g. AXA PPP, Cigna).

Who may be suitable for rTMS?
  • Approximately 1/3rd of patients with depression, and 2/3rds of patients with OCD do not respond to treatment. In this situation, rTMS is a significant treatment option
  • Those who cannot tolerate the side effects of medication, such as weight gain, sexual dysfunction and sleep problems
  • Those who do not want to have ECT
  • Women with post natal depression who wish to breastfeed and avoid transmission of medication
Benefits of rTMS
  • Highly effective in treating the debilitating effects of depression and/or OCD
  • A long lasting treatment with minimal side effects
  • Treatment is well tolerated by most people
  • Unlike ECT, does not require anaesthesia or lead to memory loss
  • Daily activities can be resumed immediately after each session
  • You can drive straight after treatment
Side effects of rTMS

rTMS is a safe procedure when the published safety guidelines are adhered to. These are comprehensively followed at the Nightingale Hospital. rTMS is extremely well tolerated by most people but can cause some minor short-term side effects including:
  • Headaches
  • Scalp discomfort at the site of stimulation
  • Tingling, spasms or twitching of facial muscles
  • Lightheadedness
  • Discomfort from noise during treatment
  • Other rare side effects include seizures (2 per 1,000 cases)
Treatment pathway and cost of rTMS

The standard evidenced-based protocol for depression, using an H1 coil, applies 20 daily treatment sessions, each lasting 20 minutes, over 4 weeks (@£225 per session)
The standard evidenced-based protocol for OCD, using an H7 coil, applies 29 daily treatment sessions, each lasting 20 minutes, over 6 weeks (@£200 per session)
Each treatment session lasts around 20 minutes.

The Helmet ('H') Coils

The rTMS service at Nightingale Hospital operates using 'H' coils. These were developed following research at the National Institute of Mental Health, (USA). These are the latest type of rTMS coil, which may produce antidepressant effects of greater magnitude than other coils due to the stimulation of deeper and more widespread prefrontal reward-mediating neural pathways (Ref: Roth Y, et al  Brain Stimulation, 7:194-205, 2014). 'H' coils use the same stimulator hardware and the patient undergoes an identical procedure in the clinic as for rTMS using a “conventional” Figure-8 TMS coil. The primary difference is in the geometry of the rTMS coil placed on the patient’s head:
Width: The standard Figure-8 coil uses a highy-focused stimulation field that can be ‘hit-or-miss’ when it comes to targeting the relevant brain circuitry. The H-coils supply a wider field, designed to stimulate important brain regions more consistently;
Depth: H-coils induce an effective field at a depth of approximately 3cm below the skull, compared to less than 1.5cm for the standard rTMS Figure-8 coil. It has been proposed that this deeper penetration leads to greater effectiveness.

Recently there has been the first head to head randomised controlled study comparing placebo, Figure-8 and H-Coil rTMS. The study reported that the response was significantly better in H1-coil, than in Figure-8 coil group OR = 2.33; CI95% 1.04–5.21 (P = 0.040). The HAM-D17 was lowered by 59% in the H1-coil, 41% in the 8-coil (P = 0.048), and 17% in the control group (P < 0.001 vs H1-coil; P = 0.003 vs 8-coil).
  • You will be taken to our dedicated treatment room by your nurse or therapist and seated in a comfortable chair. Any paperwork will be completed
  • Before your first treatment begins, your nurse will need to determine the precise location to put the H-Coil on your head and calculate the optimum intensity of magnetic energy for you
  • The electromagnetic coil is switched on and off repeatedly to produce stimulating pulses
  • This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You will also feel a tapping sensation on your forehead
  • During the course of treatment, the amount of stimulation will be changed depending on your response
  • Each treatment will last about 20 minutes and throughout you will remain awake and alert. You should allow about half an hour for your appointment
  • You should be able to resume your daily activities right after your session
What are the results of rTMS?

Remission after 5 weeks with dTMS (deep TMS

A multi-centre study of 212-patients receiving rTMS to treat depression using the H-Coil versus ‘sham’ (placebo) treatment. (Ref:Levkovitz Y., et al World Psychiatry 2015;14:64–73)

When is rTMS not suitable?
  • For those with co-morbid neurological disorders, history of epilepsy, and/or neurosurgery
  • For those who have metal plates in the head / brain, the presence of pacemakers or other electronic implants, inner ear implants, metal or magnetic objects in the brain and medication pumps
  • For people with alcohol and / or drug dependency
  • Age below 18 years
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