How many sessions will I need?
Research suggests that a treatment programme of 20 sessions offers the greatest benefit. We offer our patients two sessions per day, with an hour in between, allowing us to achieve this total in 10 days. We understand that people have busy schedules, so we do offer some flexibility within this, and will work with you to find a plan that suits your life.
Is rTMS safe?
RTMS has been used for over 25 years, and has a very good safety record. Although “brain stimulation” may sound scary, the treatment is actually completely non-invasive and pain free. Many of our patients even report the sessions to be relaxing and enjoyable.
Your safety is our main priority, and a trained member of staff will be on hand throughout every session in the extremely unlikely event that you required assistance. For context, our colleagues at the London Psychiatry Centre have not reported any severe adverse events in over eight years of rTMS treatments.
Are there any side effects?
One of the greatest strengths of rTMS is that, for most people, it does not cause any side-effects at all. However, around 10% of people do report headaches after the sessions, although these are usually mild and respond well to over the counter painkillers. Other people report neck stiffness or sensitivity over the treatment site, although these are less common. The most serious side-effect of rTMS is seizure, although this is extremely rare (0.003%) and is usually reported in people who have an increased risk (epilepsy etc). We screen all patients before treatment to ensure that they are appropriate for rTMS.
Will it work for everyone?
Research suggests that rTMS is effective for the majority of people with fibromyalgia However, as with all medical interventions, it appears that it does not work for everyone. Most people who are going to respond well will do so within the first 5-10 sessions, and with this in mind we offer a flexible weekly payment plan which gives you the option to stop treatment if you are not feeling the benefit.
How long does the effect last?
In 2020, a team of researchers investigated the effects of rTMS in fibromyalgia, including a six-month follow up as part of their study. What they found was that the benefits of the treatment were still being felt by the participants at the end of this period, suggesting that the effect does last for at least this long for most people. More research needs to be done to discover how long the effect lasts beyond this point, but research into rTMS for depression suggests that this may vary from person to person.
Research also supports the use of monthly “maintenance” booster sessions of rTMS, which some people find beneficial as it helps to ensure the continued effect of the treatment.
What happens during the treatment?
Before your first session you will have a consultation with one of our rTMS specialists who will explain the procedure in full, and give you the opportunity to ask any questions that you may have. The specialist will place a cloth cap over your head and use a tape measure to take a number of measurements, this is to ensure that the treatment is precisely applied to the correct part of your head.
Once this step has been completed, the specialist will use the insulated magnetic coil of the TMS machine to determine your motor threshold, by delivering a series of pulses to a specific part of your head, until a small twitch is produced in your hand. The aim of this is to determine the correct level of stimulation that you will require for your treatment, as this is different for everybody.
Now that your motor threshold has been determined, the treatment can begin. You will lie down on a treatment table and the machine will be placed over a region of your brain called the Dorsolateral Pre-Frontal Cortex (DLPFC), that research shows is important for processing pain and sensory input. The machine will then deliver a series of pulses to this area at one-second intervals.
No anaesthetic is necessary, so you will be awake throughout the session, and a member of staff will be on hand should you require any assistance.
Do I need to do anything before the session?
Preparation for rTMS treatment is minimal, due to the non-invasive nature of the procedure. We encourage patients to stay well hydrated before and after sessions, and to avoid too much caffeine, as this can affect the sensitivity of the nervous system. We also suggest that patients take some time to relax after each day of treatment, and avoid anything which may be too mentally strenuous.
What can I do between sessions?
The recommendation is to leave at least 50 minutes between sessions, giving you a chance to relax. The London Clinic boasts an impressive therapies department, so why not use the opportunity to treat yourself to some hydrotherapy, massage, reflexology or aromatherapy. Alternatively, if the weather is nice, you may wish to take a short walk to the beautiful Regent’s Park, or simply visit one of Marylebone’s many excellent restaurants and cafes.
Will I be able to drive afterwards?
The majority of people walk out of an rTMS session feeling fine, and there is no suggestion in the research that driving afterwards is not safe. However, on your first visit it may be sensible to make alternative arrangements in case you happen to react more strongly than most.
Is it suitable for everyone?
RTMS is a very safe and well tolerated treatment, however there are a small number of people for whom it is not appropriate. We are currently unable to offer rTMS to anybody with cochlear implants or any other metalwork in their skull, as the magnetic pulses can interfere with these. We also do not offer rTMS to people with epilepsy or people with mental health disorders which have not been stabilised. Please do contact us if you are unsure about whether or not you will be suitable.
Will my insurance cover rTMS?
Due to the fact that rTMS is a new therapy for fibromyalgia it is not yet covered by most insurance companies. However, if you also have a diagnosis of depression it may be possible to claim for this, as rTMS is on the NICE guidelines as a recommended treatment option.
Your initial consultation with Dr Barrett, as well as any further testing that may be necessary, should all be covered by insurance as standard.
Will it still work if I can’t make six sessions per week?
We understand that people have busy lives, and we will always endeavour to find a programme that works for you. However, research suggests that a more intensive treatment plan confers the greatest benefit, so spreading out appointments too much is not recommended.
What payment options do you offer?
Many rTMS centres ask for full payment for 20 sessions upfront. At rTMS London we prefer to instead ask for payments one week at a time, allowing people who feel as though they are not responding to the treatment to have the flexibility to withdraw if they wish.
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