Neuronavigated Transcranial Magnetic Stimulation (NrTMS)

TMS is a non-medication treatment that uses a magnet applied to the scalp, inducing a small electrical current to stimulate specific parts of the brain implicated in these conditions. With targeted repetitive stimulation of these areas, TMS can alter the strength of connections between neurons in the brain, leading to changes in brain function, that can be associated with depression.

rTMS is an abbreviation often used for repetitive TMS.

Neuronavigated TMS is rTMS treatment that uses an MRI of the patient’s brain to ensure accurate targeting of the stimulation. Neuronavigated TMS is abbreviated to NrTMS.

Canadian Health Solutions is the only provider of NrTMS in Canada.

TMS was approved as a medical procedure by Health Canada in 2002 for treatment of major depressive disorder (MDD). TMS is also used in the treatment of several other mental and physical conditions.

TMS was approved as a medical procedure by Health Canada in 2002 for treatment of major depressive disorder (MDD).

Once you are referred and confirmed as a good candidate for NrTMS with Canadian Health Solutions, you will first have an MRI done for the purpose of targeting the specific area of your brain for NrTMS treatment. Your MRI is used to target the specific brain region that will be stimulated.

At the first treatment session, the strength of electromagnetic pulse required is determined by placing EMG electrodes over hand muscles. Our software quickly guides the operator to determine the optimized intensity of the TMS dose.​

During each treatment session an electromagnetic coil will be placed on the scalp. When the coil is activated, it will send magnetic pulses a few centimetres under the scalp’s surface to deliver the prescribed treatment to the target location.

A full treatment course usually involves 30 treatment sessions over a six to seven week period. Treatment sessions are typically once daily, five days per week, with each treatment lasting three to 37 minutes.

Treatment programs can vary and are personalized to your situation based on the assessment of the psychiatrist.

NrTMS is generally considered a safe and well-tolerated treatment, and it is not painful for most individuals. Some people may experience mild discomfort or sensations during the treatment.

The most common sensation reported during NrTMS is hearing a tapping or clicking sound, as well as a feeling of tapping or pressure on the scalp. These sensations are typically mild and often described as uncomfortable rather than painful.

You may find the TMS machine pulses or “clicks” are loud. Hearing protection is provided to ensure your comfort and to prevent any possible hearing damage.

NrTMS therapy at Canadian Health Solutions is performed by a multidisciplinary clinical treatment team consisting of a psychiatrist, MD, counsellors and a professionally trained TMS technician. All have specialized training in NrTMS therapy.

While receiving treatments from the Canadian Health Solutions multidisciplinary clinical treatment team, you will remain under the primary care of the physician or psychiatrist who referred you for NrTMS.

There is a one-time set-up procedure and treatment that takes about an hour. After that initial session each treatment will take from three to 37 minutes and depends on the treatment protocol set out by the CHS multidisciplinary clinical treatment team. Treatment is typically applied daily over a six to seven week period.

Other treatment protocols may be recommended by the CHS team.

A physician involved in your care can make a referral if they believe that NrTMS from Canadian Health Solutions may be beneficial for your condition. You will then be assessed to determine if you are a good candidate for NrTMS treatment.

Most individuals who are on medications when they start NrTMS treatments will remain on their medications during treatment.

Each situation is unique and careful consultation between you and your doctors will determine any changes to your medications during and after NrTMS.

After completing the standard 30-session NrTMS treatment course, you will continue to follow up with the clinician who referred you. In some cases, the CHS medical treatment team may recommend ongoing additional NrTMS. We will monitor your response to NrTMS treatments and recommend additional or maintenance treatments. Follow-up will be based on individual needs.

NrTMS is a very simple treatment and doesn’t require any special accommodation before or after a session. Patients may drive to a session, are seated in a comfortable chair for the duration of a session and can drive home or return to work right after a session.

NrTMS has a good response rate compared to other treatments. It has a relatively few side effects and does not require any specific preparation for treatment (people can walk in and walk out after treatment sessions). NrTMS is one of several options available for treatment of major depression (and other conditions).

NrTMS is particularly suited for: (1) individuals who have not had good results with other standard treatments; (2) individuals who have had problems with side effects from other standard treatments; (3) individuals who want to avoid medications or more invasive treatments.

TMS has been proven safe and can be very effective with none of the drug-related side-effects.

NrTMS treatment is generally well-tolerated with only minor side-effects following treatment (such as headache). NrTMS has no known negative effects on cognition and there are normally no restrictions on driving a car to and from a treatment center, for example. After a treatment session, you can return to your daily routine.

Typical side effects:

• Headache: The onset of a headache during or after treatment is the most common side effect reported. Headaches typically occur less frequently after the first week of treatment
• Skin Irritation: There is a small risk of mild scalp irritation at the site of stimulation, but this usually consists of minor redness that will resolve quickly.
• Muscle Twitching: You may feel twitches or tingling in the muscles of your arm, leg or face during the magnetic stimulation. This is a common sensation but not hazardous. The twitches will stop when the magnetic stimulation stops.
• Light-Headedness: Any light-headedness or 'dizzy feelings' will typically goe away when the magnetic stimulation stops

Rare side effects:

• Seizures (convulsions): Although rare, cortical magnetic stimulation runs the risk of inducing seizures. Risks for this side effect will be reviewed when determining if you are a suitable candidate for NrTMS treatments.

A careful screening is conducted prior to any NrTMS treatments to determine if you are a good candidate for NrTMS treatment.

NrTMS therapy cannot be given to anyone with magnetic-sensitive metals implanted in their head or that may be within 30 cm of the treatment coil (examples include cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils, stents, bullet fragments or jewelry).

If you have found antidepressants and other treatments are not working for you, NrTMS therapy from Canadian Health Solutions may be the answer. NrTMS has been proven safe and can be very effective with none of the drug-related side-effects.

Ask your health care provider about whether or not NrTMS is right for you or contact CHS Health & WellBeing Clinics for more information.

Yes, although they will have to wait in a waiting room while the treatment is being done. While you're having your treatment, you can communicate with the technician at any time. They will be present during the entire treatment session.