Accelerated TMS Therapy
Now offering Accelerated TMS – five day TMS therapy
Since 2008 with the FDA approval of TMS therapy, patients undergo treatment over a six week period and then usually taper the following three weeks. Now the FDA has cleared an accelerated protocol that delivers 50 treatments during five days.
This protocol was developed at Stanford and data published in the American Journal of Psychiatry in 2021 Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial .In this study nearly 80% of treated patients achieved remission from depression compared to 13% that received sham (placebo) treatment .
What was the schedule?
This treatment protocol has patients receiving a 9 min treatment once per hour during the day with a 50 min rest between sessions for five days .The TMS system utilized a Magventure Stimulator combined with a Cool B-65 coil.
Pulses were delivered using intermittent Theta Burst (iTBS) . MagVenture was granted FDA clearance for this second generation TMS type in 2018.
Is Accelerated TMS safe?
Very few side effects occurred during the study. Some patients noted slight fatigue and the frequency of headache was slightly higher compared with the sham placebo TMS group.
Pros of Accelerated Treatment
Certainly treatment that is completed in five days offers an advantage over traditional six week plus tapering phase of traditional TMS therapy. The high remission rate with multiple treatments per day also suggests this treatment may be more effective than once daily TMS.
Cons of Accelerated Treatment
This treatment is not yet covered by insurance companies and represents a higher out of pocket cost. The durability of the treatment has not been as well-established as traditional once daily treatment. It could be that patients may need TMS treatment reintroduction more frequently in the future to maintain response.
TMS Huntsville protocol for Accelerated TMS
At TMS Huntsville, we are utilizing the same Magventure stimulator and Cool B-65 coil and can provide intermittent theta burst stimulation like the original study. The only difference would be the placement of the coil on the scalp. We utilize anatomical landmarks on the skull to approximate the coil position. This approach has been utilized for the last several years with great success over a wide variety of patient types.
In the Stanford study, patients underwent structural and functional MRI studies before treatment. During treatment , neuronavigated coil positioning allowed the researchers to choose a position that could enhance treatment response.
Magnus Medical was given the FDA clearance for the SAINT protocol but currently Magnus neuronavigation mapping systems are not available for individual psychiatry practices . These systems may become available in limited supply in 2023.
Dr Hayden at TMS Huntsville is able to provide a one week accelerated protocol that utilizes the same TMS system except for the neuronavigation component.
More research is needed to determine which aspects of the SAINT protocol have the most impact on response but it is reassuring that protocols utilizing more than one treatment per day have shown advantages in multiple studies over the last several years.