How Effective is dTMS (Deep Transcranial Magnetic Stimulation) for Obsessive Compulsive Disorder (OCD) and Smoking Cessation?

Obsessive Compulsive Disorder is functionally debilitating condition. This disorder is characterized by recurrent intrusive thoughts and myriad compensatory behaviors including repetitive hand washing, checking, and counting, among many others. The obsessive thinking and compulsive rituals of OCD often
do not respond sufficiently to conventional medical treatments with serotonin-based medications. This dire need for a better solution led to the FDA approval of Brainsway H7 TMS coil for OCD in 2018.

Tobacco related deaths have exceeded 6 million a year with over half a trillion dollars of economic damage, according to the World Health Organization (WHO). This is why smoking is considered one of the most prevalent and destructive addictions in human history. Yet another dire need has led to the development of the Brainsway H4 TMS coil for smoking cessation, which received FDA approval in 2020. The Brainsway H7 & H7 coils have taken the immensely successful H coil technology to the next level by reaching deeper areas of the Human brain.

Q: How Does OCD Treatment With Deep TMS Work?
A dysfunction involving the cortical-striatal-thalamic-cortical circuit has been implicated in OCD. Certain areas of the brain are hyperactivated at rest and further hyperactivated when provoked by an OCD trigger. The Brainsway H7 coil has deep penetration that can reach the Medial Pre-Frontal Cortex (MPFC) and the Anterior Cingulate Cortex (ACC). High frequency stimulation of these two areas of the brain was shown to significantly reduce OCD symptoms.

Q: How Does TMS for Smoking Cessation Work
Nicotine induces neuroadaptations in the brain that alters dopamine levels and cortical excitability. These long-lasting changes in the brain increase cravings for cigarettes that are especially notable every time someone tries to quit. Neural circuits coming from the Ventral Tegmental Area into the reward-related areas of the brain are stimulated by nicotine and eventually lead to addiction. High frequency TMS focused on the Lateral Pre-Frontal Cortex (LPFC) and the Insula reduces nicotine addiction with high and long lasting abstinence rates in treatment resistant smokers.

Q: How Is A Treatment Session With The H7 Or H4 Administered?
Both the H7 and the H4, just like any other TMS treatment, require a mapping session to determine both the treatment location and the “dose” of TMS. The dose or intensity of the magnetic pulse is based off of a specific percentage of an individual’s motor threshold. The motor threshold is the amount of stimulation that is just enough to provoke movement of a target muscle group (depending on the coil) 50% of the time. Once the dose and the treatment location have been determined, the TMS can be administered. For both the treatment of OCD and of smoking cessation, a “provocation” is done prior to administering TMS. A “provocation” is the use of a cue that will provoke intensification of the OCD symptoms or cravings to smoke a cigarette. This activates the neural circuits involved in each of these conditions. The TMS is then administered to affect the target areas, which after multiple sessions will reduce the intensity of the OCD or cravings to smoke. Both the H7 and the H4 involve a series of successive treatments to achieve the desired result.

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