# TMS (Transcranial Magnetic Stimulation)



## aloof (Nov 18, 2008)

Well my doc now has the TMS machine in his office. He is offering the treatment half price for the first 3 people...still comes to $4500. I called my health insurance company and although it is FDA approved, it is still considered "investigational" thus no coverage. Also there was a study completed in April using TMS on DPD subjects. It was done at the New York State Psychiatric Institute, however no results have been posted. Be nice to know and i am planning to make a call to the doctor who headed the study. Interestingly when i had an MRI done of my head/neck recently my mood felt temporarily "lifted" afterward. Of course the TMS energy is much more focused and for longer periods of time. The course of treatment is 30 mins a day, 5 days a week for 3-4 weeks.


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## wael (Sep 5, 2008)

I had contact with the trial coordinator of the TMS study in New York. He is writing the manuscript right now! He thinks that the results are being published in spring 2010. So in 6 months or something we will know more!
You are talking about 15 up till 20 interventions for 4500 dollar Here in the Netherlands it costs 110 euro per session, so 20 sessions will cost you 2200 euro. But we are waiting for the results of the New York study, before I can begin(or not) with this intervention.


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## aloof (Nov 18, 2008)

wael said:


> I had contact with the trial coordinator of the TMS study in New York. He is writing the manuscript right now! He thinks that the results are being published in spring 2010. So in 6 months or something we will know more!
> You are talking about 15 up till 20 interventions for 4500 dollar Here in the Netherlands it costs 110 euro per session, so 20 sessions will cost you 2200 euro. But we are waiting for the results of the New York study, before I can begin(or not) with this intervention.


 wow good to hear. be nice to know something before next spring though....i would like to give this a try like now if the results of the study were positive.


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## S O L A R I S (Dec 24, 2009)

I did one session of repetitive transcranial magnetic stimulation. Currently there are two vendors. Nurostar in north america & Magstim internationally based in london. I called their offices and got a list of clinics/hospitals theyve sold it to.

I went to the private clinic which has it, theres only one in the country. I lucked out. The psychiatrist didnt really know what the hell DP was. He was confused and suggested CBT. I gave him the research done, and told him upfront that I dont need meds, more talking, I just want to use the machine as a test try. It cost about 75 US dollars a 20 minute session. Thats a good price, I called a few clinics in Los angeles, and they charge 450 US dollars a session. But there are only a couple of tms vendors worldwide, so you cant be skeptic about what these clinics are using.

Throughout the session it felt wierd but good. its like you can feel your neurons move abouts. After the treatment, i didnt know if it was placebo or what. but i did feel euphoric. less brain fog in a sense. only slightly ofcourse. i just did one session but i will be going back next week to undergo an intensive 2 week "get rid of DP" marathon. im cojoining it with acupuncture, wellbutrin, herbal beta blockers, chinese herbs, and tommygunz's recipe. im taking wellbutrin to help with stop smoking, but I wouldnt mind switching to an SSRI. I am also trying to increase my dopamine levels - maybe that will help? so in that corner I will be eating brown bananas, they look gross. but apparently they are very rich in dopamine.

anyways, i ventured off topic. TMS, its good, but i feel it works best for depression. But hopefully with a variety of things. it sure will help.


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## wael (Sep 5, 2008)

Nice to hear from somebody who is actually being treated with rTMS. I will wait for the results of the NY study, which perhaps allows for a better understanding regarding the intensity of stimulation, coil orientation and frequency of stimulation. Which part of your brain is subject to (de)stimulation? Keep in touch and post your results. I would advice you to keep as much other variables (medications etc) stable, so you can better address the possible causal effects of the rTMS. But that just from a more scientific standpoint. Keep up the good work and good luck!


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## Rebekah (May 16, 2009)

I was just on the clinicaltrialsdotgov (can't post links) and they are actively recruiting for the TMS for DP trials. Put "depersonalization disorder" in their search and you should be able to bring up the details. It's in NY, USA. It seems they've completed some studies and are doing others now. I don't think I will trust this treatment. Just don't feel right about any use of magnetic therapy on the body.


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## S O L A R I S (Dec 24, 2009)

Wael,

It is actually placed on the pre-frontal cortex, similar to the NY study. The coil is placed on the left side of your brain and rotates/moves a few cm here and there. I do agree having a stable dose of medication is best approach. I have decided to quit antidepressants because effexor stopped working for me and im not too eager to try something else. Im going on wellbutrin/zyban to aid in smoking cessation and since its an anti depressant, im getting two birds one stone.

The only negative aspect of Magstin and Neurostar's TMS is that the coil type only penetrates up to 2 cm into the brain. They assume that a snow ball effect will stimulate neurons deeper in the brain.

There is a new system designed by Brainsway based in Israel/Italy which is a deep TMS. it penetrated up to 8 cm into the brain, hence really stimulating parts of the brain which should be - like the amgydala. I sent the Italy office an e-mail and will let everyone know what happens.

I might be overdoing it, but I found this russian manufacturer of magnetic systems for various industries. Their healthcare products include an item called magnetic cap, which is like a head piece you wear with small magnetics placed throughout. I placed an order for that and will let you know how it goes.

At first I thought all this was so Science fiction ! I love where the medical field is going with this. Ill keep everyone posted!


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## wael (Sep 5, 2008)

"Just don't feel right about any use of magnetic therapy on the body"

rTMS is considered as a save intervention, although they need more research considering certain combinations of stimulation frequency and intensity in order to make it more effectiveness and saver. But the contemporary literature is growing! They need more sham-controlled studies etc.

I rather use a magnetic coil which possibly can intervene with the small parts that are responsible for these feeling, then pharmaceutical drugs which induces all kind of changes in the whole brain. Not that im against drugs, i use clonazepam and sertraline, but it only make it manageable for me and has quite some side-effect because it is not possible with a pill to pinpoint a part that needs more serotonine/dopamine etc or other mechanisms.

@solaris3618

How do you know that the NY study concentrates on the pre-frontal cortex? I only found a case study. The study of Simeon with the pet-scans stated that there was significantly higher metabolism in parietal Brodmann?s areas 7B and 39 and left occipital Brodmann?s area 19 of DP patients. Thus the occipital lobe (Visual processing center), which would make more sense considering the common symptoms Dp'ers have. But im far from a Neuro scientist so this is just amateurish deduction.


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## S O L A R I S (Dec 24, 2009)

wael,

I might have spoken too soon on the pre-frontal cortex / NY study. I did a hefty amount of browsing and research and listed this information down, i dont recall exactly from where. In that case dont take my words in concrete form. I called the NY.columbia clinic and the person in charge is on a 3 months vacation, so im not sure how to get more detailed info on that study.

I love it that you brought this up, I will research this weekend and msg you if i need more help. I will talk to my psychiatrist more about it next week, and we might experiment if he is comfortable. But im intruiged to know if TMS could be used anywhere throughout the brain, or if there are restrictions on certain parts of the brain.


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## wael (Sep 5, 2008)

solaris3618,

How did your (q)eeg looked like? Perhaps this is an interesting link:

http://www.tigis.cz/PSYCHIAT/psychsupp3 ... opecek.htm

There you can see, (case study), that they found almost the same over-metabolism in some parts of the brain as in study of Simeon (2000). Furthermore it seemed that the Eeg detected the same abnormalities as a Pet scan.

*Case 3: Patient with chronic depersonalization and derealization syndrome
*
A 36 year old man who has suffered from depersonalization-derealization syndrome (ICD-10) for the last 20 years was assessed by the use of 18FDG PET (Figure 6). An extensive case study of this patient was described recently (Kope?ek et al., 2004). This patient was also assessed by QEEG LORETA (Figure 7, 8). We found agreement between both methods of functional brain imaging, which detected abnormality in the right superior temporal gyrus/inferior parietal gyrus (BA 40) and the right superior parietal gyrus (BA 7). Only 18FDG PET detected increased glucose metabolism in the left fusiform gyrus in the occipital lobe (BA 19) and only LORETA showed abnormality in the right fusiform gyrus (BA 20). The right superior temporal gyrus/inferior parietal gyrus (BA 40) abnormality detected in our study by PET and LORETA is adjacent to BA 39 and may only differ from Simeon?s et al. (2000) finding due to the spatial resolution of the PET method or due to inter-individual variability. BA 40 represents a multimodal association area and is implicated in somatosensory-visual-auditory integration, which could be disturbed in depersonalization-derealization syndrome. Functional disturbances in BA 39/40 could lead to autoscopy or out-of-body experiences (Blanke et al., 2004) that have a partially similar phenomenology as depersonalization. We detected an increased metabolism in the patient with depersonalization-derealization syndrome in the right parietal area BA 7 using PET, which is a similar result as found by Simeon et al. (2000) and a corresponding increase of beta3 current densities in BA6 and BA7 with LORETA. BA 7 represents the somatosensory association area, an area in which dysfunction could lead to symptoms of body alienation (Sierra et al, 2002). Simeon et al. (2000) found a positive correlation between metabolic activity in area 7B and the dissociation and depersonalization scores which suggests that dysfunction of this area could be responsible for the quality of the depersonalization.

The partial agreement between both methods of detecting functional brain abnormalities suggests that they can visualize similar brain process. The differences could be due to the different control groups in the LORETA and PET analysis.

good luck.


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## Absentis (Jul 10, 2007)

I don't know anything about TMS and DPD, but I had the opportunity to watch its effects in person. I went with a researcher to a clinic and we tried to replicate the results of what a person we're going to study can voluntarily induce. (We found a subject who can consciously induce a rare phenomena, and since that same phenomena has been experimentally induced with TMS in the past, we thought we'd fool around with it on ourselves.) It didn't work, but we took footage of its effects on speech and motor functioning.

It's really cool science fictiony stuff that I'm still amazed exists.


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## S O L A R I S (Dec 24, 2009)

I just came back from my doctor.

I gave him the research done about PET brain scans, and suggested that we might orient the coils to the right superior temporary gyrus - as it is deemed to be dysfunctional from the studies. He said that he was not comfortable targeting that section because all is still speculation, and that the FDA only approved the prefrontal cortex. I swear to god i feel he thinks im mad, and do now know what i am going through.

So anyways, i did another TMS session, and will continue to do so for the next few days. I feel ok after each session, but well see if there is any efficacy in the coming days. He puts me in a room by myself, so im tempted to move the coil to the right side of my brain lol. oh god, why is NO one listening to us!!! I really want to know if its safe to target TMS machines to other parts than the prefrontal cortex.

He prescribed me zoloft and respirdal. ugh..... ill take the zoloft tonight.


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## wael (Sep 5, 2008)

I would suggest to wait untill the study in NY is finished. Especially when you are taking new meds. It's impossible to determine what is effecting what. But i understand that you want to do something.


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## Absentis (Jul 10, 2007)

solaris3618 said:


> Suggested that we might orient the coils to the right superior temporary gyrus - as it is deemed to be dysfunctional from the studies. He said that he was not comfortable targeting that section because all is still speculation, and that the FDA only approved the prefrontal cortex.


Don't do this. It's a bad idea. Scratch that. It's a terrible idea.

Yes, dissociation might be cause by dysfunction in the superior temporal (not temporary, it's not going anywhere) gyrus, and applying TMS to that area could make it worse. That area of your brain is involved in high-level processing as an associative area; this means that part of the brain helps put different sensory modalities into a coherent experience. If you aim the coils to target that area, you could make things a lot worse.

TMS doesn't work by targeting an area and magically "making it better". It directly impacts neural activity, and please, for the love of zeus, don't move the coils!


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## S O L A R I S (Dec 24, 2009)

Haha...I LOVE YOU ABSENTIS!! Thanks for the advice....

No I have not moved the coils, I figure it's too risky and I was a bit irrational by asking the doctor to do that. But I think that in the future other areas might be targeted, i dont know. Theres this other technique by a company called Brainsway, called Deep TMS, where you basically wear a helmet that stimulates your entire brain! I dont know for sure about its mechanism, but Im all for this new technology.

I'll stick to prefrontal cortex for now though


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