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TMS Update

I’ve been getting TMS treatments for the last several weeks. So far, it has not been helpful for me, and it seems to have worsened my insomnia. I’m extending my treatment past the planned-for 36 sessions in case I’m just a late responder, but I’m struggling to be optimistic.

I mentioned in my first post about what TMS is like that I’m doing the 10 Hz protocol. Seeing no improvement after a few weeks of treatment, we added a priming protocol called intermittent theta-burst stimulation (iTBS) to my usual treatment. This means that the coil is placed in the same spot as it normally is for me, and pulses are delivered at a different frequency and pattern for 2 minutes prior to my usual treatment.

The idea (as much as I understand it) is that the priming pulses enhance my neurons’ response to rTMS, either by preparing postsynaptic neurons to fire by affecting voltage-gated ion channels or lowering the activation threshold at which a signal can be passed on to the next neuron.

It feels very different; the 10 Hz pulses feel like a woodpecker drilling into my head, but the priming pulses (which are delivered at a lower intensity than the regular pulses) remind me of how those springy door stops fly back and forth when you pull them to the side and let go. In the beginning, it feels more like having a rubber band snapped on my head many times per second than being pecked by a woodpecker. As it increases in intensity, it loses some of its sting and becomes more similar to the dull-but-concentrated knocking that rTMS creates.

Overall, I find that iTBS feels more robotic than rTMS, probably because the pulses are delivered in multiple bursts per second. I think the rhythm of it seems less natural than a single burst pattern. Unfortunately, I haven’t noticed much difference with the priming protocol in place.

Next, we added a right-sided protocol. Treating both sides of the head may or may not improve TMS outcomes, but we figured why not try it if the left side alone wasn’t working? The pulses are delivered in the same place as they are in my usual left-sided treatments but on the other side of my head. It’s slow – only 1 Hz, meaning there is one pulse per second. The treatment goes for 15 minutes.

It reminds me of a metronome, and it can become mesmerizing if the conversation in the room stops. There is a light on the TV across from the chair that blinks at a rate slightly slower than the TMS pulses, which is somewhat maddening. Why would TV manufacturers not ensure that their lights blink exactly once per second? Couldn’t they have foreseen that a minuscule proportion of their products’ users would be in precisely my situation? Big oversight on their part not to consider this incredibly niche but potentially loyal corner of the market.

It’s interesting how accustomed I’ve gotten to the treatments on the left side of my head. Adding the right-sided treatment was surprisingly uncomfortable, even at a much lower intensity than my left-sided treatments. Just like with my usual treatments, we increase the intensity of the right-sided pulses within a certain range each time, so it starts out easy and becomes more uncomfortable as we go. That said, it’s gotten less painful with each appointment, and I can always opt to stay at a lower intensity if it’s too much.

I’m still feeling discouraged, but I decided to do some extra treatments to make sure I’m giving it as much of a chance to work as possible. I am, however, concerned about how I’ll feel if I have to accept that it didn’t work for me. Around 30% of people don’t respond to rTMS, which is slightly comforting. At least I can be pretty sure it’s not something I did wrong.

2 thoughts on “TMS Update

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