Brain mapping is the first step of every transcranial magnetic stimulation (TMS) therapy session, helping personalize treatment by locating the specific part of your brain that needs to be stimulated. If you’ve been recommended TMS therapy, you might be curious about brain mapping and wondering what to expect from the process.
In this guide, we’ll explore what brain mapping is, how it works, and why it’s important in personalizing your TMS treatment. Whether you’re considering TMS for yourself or a loved one, understanding the process can help you feel more confident and informed about the journey ahead of you.
What is Transcranial Magnetic Stimulation (TMS)?
TMS is a non-invasive therapy that uses magnetic pulses to stimulate nerve cells in specific regions of the brain that are underactive in people with depression and other mood disorders. The treatment is entirely non-surgical and non-systemic, meaning no incisions or medications are involved, and no other bodily systems or organs are affected. The pulses delivered in treatment are similar to those used in magnetic resonance imaging (MRI) scanners.
TMS therapy is FDA-approved for treating:
- Major depressive disorder (MDD)
- Treatment-resistant depression (TRD)
- Adolescent depression
- Obsessive-compulsive disorder (OCD)
- Migraines
- Nicotine addiction.
It’s also sometimes used ‘off-label’ to help treat other neurological and mental health conditions, such as Parkinson’s disease, fibromyalgia, and post-traumatic stress disorder (PTSD). The therapy is usually recommended when conventional treatments, such as medication or talk therapy, haven’t been effective or cause unwanted side effects.
TMS therapy is sometimes referred to as repetitive transcranial magnetic stimulation, or rTMS. This is because it involves delivering repeated magnetic pulses to the brain. You might also hear of deep transcranial magnetic stimulation, or dTMS. This uses a specialized coil to target deeper and broader parts of the brain.
Learn More: Is TMS Appropriate for Treating Adolescents With Depression?
What happens during a TMS treatment session?
At BestMind Behavioral Health, our TMS sessions take place in our cozy, quiet clinics in Colorado and Oregon. Treatments are usually administered five times a week for a total of 36 sessions over six weeks.
Below, we’ll outline what you can expect from TMS therapy, including your first session and subsequent treatments.
Your first TMS treatment session
The first TMS session is focused on personalizing your treatment by determining the ideal placement of the electromagnetic coil and the right dose of magnetic energy for you. This session involves a process called ‘brain mapping’ and lasts around an hour.
Here’s what to expect from your first TMS therapy session:
- Preparation: You’ll be taken to a treatment room, seated comfortably in a reclining chair, and given earplugs to minimize any noise from the treatment. Your TMS technician will answer any questions you have and make sure you’re relaxed before we begin.
- Placing the coil: The technician will measure your head to find the best position for the magnetic coil. They’ll then place it over your scalp and switch it on and off repeatedly to deliver magnetic pulses. You might hear a series of clicking sounds or feel light tapping on your scalp as the coil is activated.
- Finding the motor cortex: To target the right region of your brain, the TMS technician will adjust the coil’s position until your fingers or hands twitch. This step helps us locate your motor cortex.
- Finding the motor threshold: Once the motor cortex has been found, the technician will vary the strength of the magnetic pulses to find the minimum energy needed to stimulate a motor response. This is called finding your ‘motor threshold’.
After the brain mapping session, we might proceed with your first TMS treatment or schedule it for the following day.
Subsequent TMS sessions
Follow-up TMS treatments are much shorter than brain mapping sessions. Here’s what to expect:
- Preparation: You’ll settle into the reclining chair and be given earplugs to wear. If you have any questions or concerns, your technician will be there to answer them before starting.
- Placing the coil: The electromagnetic coil will be placed over the exact spot identified during your brain mapping session to ensure precise treatment.
- Stimulation: The coil will deliver magnetic pulses to stimulate targeted brain regions. This process helps activate nerve cells and releases neurotransmitters like dopamine and serotonin, which are important for mood regulation.
- Sensation: You may hear a clicking sound and feel light tapping on your scalp. The tapping occurs in short bursts with pauses in between. Some people also feel mild tingling or slight muscle twitches in their face.
- Monitoring: Throughout the session, your TMS technician will monitor how you’re feeling and adjust the intensity of magnetic pulses as required.
After TMS treatments
TMS treatment sessions usually last between 20 and 30 minutes. Once the session is over, you’re free to drive yourself home and continue your daily activities as usual. Some people might experience mild headaches or lightheadedness post-treatment, but these side effects usually subside within a few hours.
Keep Reading: How TMS Helps Military Members & Dependents
What is brain mapping for TMS?
Transcranial magnetic stimulation mapping, also known as brain or cortical mapping, is a procedure that takes place during your first TMS treatment session. This process helps us pinpoint the best location for treatment and the appropriate ‘dose’ or intensity of magnetic pulses for you.
The main goal of brain mapping is to locate the left dorsolateral prefrontal cortex (DLPFC), usually found above the left temple. This part of the brain plays a significant role in mood regulation and is commonly linked to signs of depression. TMS treatments focus on stimulating this region to help relieve symptoms and improve well-being.
What is the process of brain mapping in TMS?
During brain mapping, your TMS technician works to identify the dorsolateral prefrontal cortex (DLPFC), which is the key part of the brain targeted by TMS therapy. To do this, they first need to find the primary motor cortex, a strip of brain tissue that stretches across the top of your head and controls movement in different parts of your body.
The brain mapping session starts with seating you comfortably in a chair and placing a specialized cap on your head. Your TMS technician will take measurements and mark important brain landmarks on the cap. Then, using short magnetic pulses, they’ll stimulate different parts of your motor cortex until they locate the area that controls movement in your right thumb. When they’ve found the right spot, you’ll feel a twitch in your thumb or fingers.
Once the motor cortex and ideal stimulation level are identified, the TMS technician will look for your DLPFC and mark it out on your cap. You’ll wear this same cap during each subsequent session to make sure the magnetic coil consistently targets the right region of your brain.
Sometimes, the brain mapping process might be repeated during your treatment series to reassess the ideal location and maintain accuracy.
See More: Using TMS Therapy For Fibromyalgia
How does brain mapping work in TMS?
Brain mapping for TMS relies on advanced 3D positioning technology. You’ll have a special tracking device placed on your forehead that helps your TMS technician visualize the position of your brain in space. This ensures the right treatment area is being targeted.
To make sure your brain is responding to the magnetic stimulation, small electromyography (EMG) electrodes are placed on your thumb. These electrodes monitor muscle activity and detect the minimum amount of stimulation needed to make your thumb twitch, helping determine the ideal stimulation dose.
How long does brain mapping take?
A brain mapping session usually lasts around an hour, although it can take more or less time depending on how quickly the motor cortex is identified. In some cases, the motor cortex might not be located in one session and you may have to return for a follow-up mapping session.
If this happens, please don’t be discouraged. It’s not uncommon, and it doesn’t mean TMS therapy won’t work for you. The process takes time to ensure the treatment is as effective as possible.
What happens after TMS brain mapping?
Once brain mapping is complete and the ideal treatment location is identified, your TMS sessions can begin. This might happen on the same day or at your next appointment. Follow-up sessions are much shorter and usually last about 20 to 30 minutes.
In most cases, we recommend a total of 36 TMS treatments over the course of several weeks. The exact number you need, however, depends on your individual condition and response to the therapy.
What is the dorsolateral prefrontal cortex?
The dorsolateral prefrontal cortex (DLPFC) is the region of the brain that TMS therapy targets. This area plays an important role in cognitive functions like short-term memory, emotional regulation, and decision-making.
The DLPFC is often underactive in people with depression, contributing to the expression of depressive symptoms. It’s also closely connected to other parts of the brain, such as the limbic system, which governs behavioral and emotional responses. Because depression can affect multiple brain regions, stimulating the DLPFC helps create positive changes that can relieve depressive symptoms over time.
What are the side effects of TMS?
TMS therapy is a safe, non-invasive, and non-systemic treatment that most people tolerate very well. It’s painless for the majority of patients, but like any treatment, there can be some mild to moderate side effects. These are usually short-lived and tend to resolve on their own within a few hours. They also tend to disappear as your body adjusts to the sessions.
Below are some potential side effects of TMS:
- Mild headaches
- Lightheadedness
- Neck or scalp discomfort
- Tingling sensations
- Twitching of facial muscles
- Fatigue or sleepiness
- In extremely rare cases, seizures.
Unlike other forms of brain stimulation, like vagus nerve stimulation or deep brain stimulation, TMS therapy doesn’t require surgery or implanting electrodes. And unlike electroconvulsive therapy (ECT), TMS doesn’t cause memory loss or require anesthesia.
If you experience side effects during TMS therapy, our team can adjust the level of stimulation to help reduce symptoms. Don’t hesitate to reach out to our team if you need more clarification about the potential side effects of TMS therapy.
How to prepare for TMS therapy
Before starting TMS therapy, you may be asked to undergo a few assessments to make sure the treatment is safe and appropriate for you. These might include:
- A physical exam, and possibly lab tests
- A mental health evaluation to discuss your symptoms and mental health history.
These evaluations help us understand whether TMS therapy is the best treatment option for you. During a TMS consultation, be sure to let us know if:
- You’re pregnant or planning to become pregnant
- You have metal or implanted medical devices.
TMS involves a strong magnetic field, so it’s important to mention if you have any metal implants or devices. Sometimes, TMS can still be possible with these devices, but not in all cases. Be sure to let us know if you have any of the following:
- Aneurysm clips or coils
- Heart, neck, or brain stents
- Implanted stimulators (e.g. vagus nerve or deep brain)
- Pacemakers or medication pumps
- Cochlear hearing implants
- Electrodes
- Bullet fragments, shrapnel, or other metal objects.
We should also know if:
- You’re taking any medications, be they prescriptions, over-the-counter, or herbal
- You have a personal or family history of seizures or epilepsy
- You have a history of conditions like bipolar disorder, psychosis, or substance use issues
- You’ve experienced brain damage due to illness or injury, such as a stroke, brain tumor, or traumatic brain injury
- You suffer from frequent or severe headaches
- You’ve had TMS therapy in the past, and whether it was helpful in treating your symptoms.
All of this information helps us ensure a safe and personalized treatment plan that addresses your unique health needs and circumstances.
Continue Reading: Who Qualifies for TMS Therapy? (TMS Requirements)
Summary: Brain mapping for TMS therapy
By now, you should have a clearer understanding of what brain mapping is and the role it plays in personalizing your TMS treatment. If you’re interested in exploring TMS therapy, either for yourself or a loved one, our team at BestMind Behavioral Health are ready to provide compassionate care and personalized treatment plans.
We offer TMS therapy for a range of conditions, including treatment-resistant depression, adolescent depression, anxiety, OCD, and more – contact us to discuss this innovative treatment and how we can support you today.
