When it was realized that magnetic stimulation of the cerebral cortex (transcranial magnetic stimulation - TMS) provided an effect close to electrical stimulation, the first TMS device was developed (1985) and its use for research purposes began (Anthony Barker et al.) It was observed that the application of TMS to the left dorsolateral prefrontal cortex (DLPFC) normalized cortical blood flow, glucose and oxygen consumption, which had slowed down due to depression, and produced an antidepressant effect. After repeated studies, TMS received FDA approval in 2008 to be used in the treatment of depression.
In 2007, Roth et al. developed and started using the Hesed coil (H-coil), which will affect deeper brain structures. Patented in 2002 by the NIH, this coil resembles a motorcycle helmet in shape. It is worn on the head after various measurements/adjustments are made before the application. The application using the H-coil is called "Deep TMS". Deep TMS promises great hope to humanity with groundbreaking innovative studies in the field of brain health.
Over the years, the Hesed coil has been developed to stimulate different brain structures and is now used in 3 different models: H-1, H-4, H-7 .
The application of Deep TMS has received the European CE mark in parallel with its proven efficacy in alleviating various psychiatric-cognitive symptoms. These include MDD, OCD, smoking cessation, Alzheimer's Disease (AD), autism, bipolar disorder, chronic pain, multiple sclerosis (MS), Parkinson's Disease, rehabilitation after stroke, post-traumatic stress disorder (PTSD) and negative symptoms.
Following the TMS device, the Deep TMS H-1 model was approved by the FDA in 2013 for the treatment of Major Depressive Disorder (MDD) who have failed to achieve adequate improvement from antidepressant treatment.
The Deep TMS H-7 was also approved by the FDA in 2018 for the treatment of Obsessive-Compulsive Disorder (OCD).
In 2020, Deep TMS became the first system approved to help adults quit smoking.
Finally, the indications for the technology were expanded to include the treatment of depressive episodes and the reduction of accompanying anxiety symptoms, receiving FDA approval to treat anxious depression in 2021.
Deep TMS and Major Depression
Major Depressive Disorder (MDD) and Depression with Anxiety - H1 Coil:
Major depression is a brain disorder that severely disrupts an individual's life. In addition to medication and psycho-social interventions, Deep TMS is a method applied especially for patients who are resistant to treatment, allergic to medication, complain of side effects of medication, have liver-kidney problems, pregnant and puerperant patients.
Anxiety disorder refers to a condition in which the anxiety felt is so severe that it prevents the effort to be made to meet the need. For example, a person who needs to succeed in an exam may not be able to answer the questions due to excessive anxiety.
The H1 Coil stimulates the bilateral prefrontal cortex, particularly the left dorsolateral prefrontal cortex. In addition to numerous published, double-blind, randomized controlled trials confirming the efficacy of Deep TMS on depression, clinical data from more than 1000 patients in real practice settings have shown intriguing results. Of the patients who completed 30 sessions, approximately 4 out of 5 achieved a clinical response and approximately 2 out of 3 showed improvement in depression.
The brain regions observed after deep TMS include the left anterior cingulate cortex, left insula, left superior temporal gyrus and right angular gyrus. There was a correlation between the increase in volume in these regions and the decrease in depression. Unlike standard TMS, deep TMS may be more effective in the treatment of major depression by providing a deeper and wider effect on the brain reward center (nucleus acumbens) and anterior tegmentum area.
Deep TMS and Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is a disorder characterized by intense disturbing thoughts and repetitive behaviors. According to neurobiological modeling, OCD is associated with the motor area, cortico-striato-thalamo-cortical pathways, prefrontal cortex and orbifrontal cortex.
H7 Coil
Deep TMS targets the middle prefrontal cortex and anterior cingulate cortex in the treatment of OCD and the H7 Coil was developed to stimulate these areas. Deep stimulation of these areas contributes to the integration of emotional and cognitive processes. The patient's control, attention, planning and short-term memory functions may improve. Large-scale studies and clinical applications showing strong response rates show that over 50% of OCD patients who complete 29 sessions can achieve a lasting response.
Deep TMS and Smoking Addiction - H4 Coil
H4 Coil stimulates bilateral insula and prefrontal cortex. In a large-scale, double-blind, multi-center, randomized controlled study, approximately 1 in 3 patients who completed 18 sessions managed to stay away from smoking for 4 weeks or longer, and 2 out of 3 patients who quit smoking at the end of the treatment continued to quit smoking for at least three more months.
It has also been observed that Deep TMS can achieve successful results in the treatment of diseases such as Alzheimer's, Bipolar Mood Disorder (Manic Depression), Post Traumatic Stress Disorder (PTSD), Autism, Panic Disorder, Tourette Syndrome (Tics), Asperger's Syndrome, Schizophrenia.
Differences Between Deep TMS and Classical TMS
As can be seen, the heads used to adapt the brain region of the person in Deep TMS applications have a different structure. These heads are called "H Headgear". The H-Headgear is designed as a flexible helmet to provide a constant, consistent contact with the person's scalp during the treatment. Unlike other conventional TMS systems, the H Helmet is fixed to the person's head. This reduces the potential for the coil to move during Deep TMS treatment. The headgear design and the resulting advantages and differences are detailed below.