What is evaluated before starting rTMS treatment?
Medical history, previous treatments, implants, seizure risk, and treatment goals are all part of the initial evaluation.
Repetitive transcranial magnetic stimulation (rTMS) begins before the equipment is even switched on. The initial evaluation makes it possible to determine whether the technique is appropriate, choose a protocol, and identify any conditions that call for caution.
The reason for the consultation
The first step is to understand what problem needs to be addressed. In a person with depression, for example, current symptoms are reviewed, along with their duration, severity, and impact on daily life.
The clinician also reconstructs the person's history: previous episodes, relapses, hospitalizations, and recent changes. This history helps distinguish treatment-resistant depression from other situations that may call for different strategies.
Past and current treatments
It helps to bring a list of medications, psychotherapies, and other treatments used. For each one, it is useful to note the dose, the length of time, the response, and any side effects experienced.
The clinician also needs to know about current treatments. The decision to continue, adjust, or combine them belongs to the treating team and should not be made on one's own.
Medical and neurological history
The evaluation includes a history of seizures, epilepsy, head trauma, and neurological conditions. Migraines, hearing problems, cardiac conditions, and other relevant conditions may also be reviewed.
This information should be complete even if the patient thinks a particular detail is unrelated. The clinician will be able to determine what may affect the treatment.
Implants and metal objects
It is essential to report any implanted devices or metal objects, especially in the head and neck. This includes cochlear implants, clips, electrodes, stimulators, metal fragments, and certain medical devices.
Dental fillings and appliances are usually assessed differently, but they should still be mentioned. The team needs to know the material involved and its location.
Evaluating the current state
Interviews and rating scales can be used to measure symptoms of depression, anxiety, and functioning. These tools provide a baseline that later makes it possible to track changes.
They do not replace clinical conversation. They complement clinical observation and help record progress systematically.
Determining the motor threshold
Before or at the start of the sessions, a calibration is performed. The team looks for a motor response and uses that measurement to adjust the stimulation intensity for that individual.
Depending on the protocol, the target location may be determined using anatomical landmarks or with the support of imaging and neuronavigation.
Goals and expectations
The evaluation should also clarify what is expected to improve and how that will be measured. Mood, sleep, concentration, functioning, and quality of life can all be part of the goals.
A good consultation leaves room to ask about duration, sensations, possible side effects, alternatives, and follow-up. That conversation turns the initial evaluation into the first step of an informed decision.
“New Hope for Treatment-Resistant Depression Without Medication” describes this preparation and walks through the full course of an rTMS session.
