Transcranial Magnetic Stimulation (TMS)
TMS uses focused magnetic pulses to change activity in targeted areas of the brain, without surgery, sedation or systemic medication. We do not provide TMS in our offices. We collaborate with our network of trusted service providers and make referrals to local TMS centers to coordinate care, with Dr. Sean Orr evaluating whether TMS fits and staying involved as your neurologist.
Available at our St. Marys, Georgia clinic.
How TMS Works
A coil placed against the scalp generates a brief, focused magnetic pulse, typically lasting less than one millisecond. The magnetic field passes through the skull and induces a small electrical current in the cortex underneath, which makes the neurons in that area fire.
The effect depends on how the pulses are delivered. High-frequency repetitive TMS (rTMS), at 10 to 20 hertz, increases activity in the stimulated region. Low-frequency stimulation at 1 hertz decreases it. That lets a clinician turn up an underactive circuit or quiet an overactive one.
The trial that led to FDA clearance for treatment-resistant depression was published by O’Reardon et al. in Biological Psychiatry (2007, n=301). It delivered 10 Hz rTMS to the left dorsolateral prefrontal cortex over four to six weeks and showed significantly greater improvement than sham stimulation. George et al. (Archives of General Psychiatry, 2010) confirmed the benefit in a separate sham-controlled trial.
Theta burst stimulation is a faster alternative. It delivers patterned bursts of pulses and completes a session in about three minutes rather than the 19 to 37 minutes of conventional protocols. The THREE-D trial (Blumberger et al., The Lancet, 2018, n=414) found it non-inferior to standard 10 Hz rTMS for depression.
What TMS Is Used For
TMS is FDA-cleared for treatment-resistant major depressive disorder, obsessive-compulsive disorder and smoking cessation, using specific devices and protocols.
Researchers are also studying TMS for chronic neuropathic pain, anxiety, and attention and memory problems after brain injury. Those uses are not FDA-cleared indications, and the evidence varies by condition. Dr. Orr will tell you plainly where the evidence stands for your situation.
How Our TMS Referral Works
Neurological consultation with Dr. Orr
Dr. Orr reviews your history, symptoms, medications and any brain imaging. He confirms the diagnosis, screens for reasons TMS could be unsafe, and considers whether other causes of your symptoms need attention first. If TMS is a reasonable option, he explains why and what to expect.
Referral to a trusted local TMS center
We refer you to a TMS center in our network of trusted service providers and, with your permission, send the records and clinical summary the center needs. The TMS center performs its own intake, motor threshold mapping and treatment course.
Coordinated care while you are in treatment
Dr. Orr stays involved as your neurologist. He can follow your progress, repeat cognitive testing when it is useful, and fit TMS into the rest of your plan, such as NeuroCoaching with Dr. Edwards or other services at our St. Marys office.
Frequently Asked Questions
Does The Neurogenesis Project provide TMS?+
Not in our offices. We refer patients to trusted local TMS centers and coordinate care, with Dr. Orr staying involved as your neurologist.
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We do not provide TMS in our offices. We collaborate with our network of trusted service providers and make referrals to local TMS centers to coordinate care. Dr. Orr evaluates whether TMS is a reasonable option for you, sends the TMS center the records it needs with your permission, and stays involved as your neurologist while you go through treatment.
Why see a neurologist before starting TMS?+
To confirm the diagnosis, review imaging, and screen for reasons TMS could be unsafe, such as certain metal implants or a seizure history.
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TMS is not right for everyone. Ferromagnetic implants near the head, some implanted devices such as deep brain stimulators, and a history of seizures can make it unsafe or call for a different approach. A neurological evaluation confirms the diagnosis, reviews any brain imaging, and screens for these issues before you commit to a course of treatment. It also lets Dr. Orr look for other causes of your symptoms that should be treated first or alongside TMS.
What does a TMS session feel like?+
You feel a tapping sensation on your scalp and hear a clicking sound. There is no sedation or downtime.
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You sit in a reclined chair while a magnetic coil rests against your scalp. When the device fires, you feel a tapping sensation at the coil site and hear a clicking sound. Some people notice mild scalp discomfort during the first few sessions, which usually fades as treatment continues. There is no sedation and no recovery period, and most people drive themselves to and from sessions.
How many TMS sessions are typical?+
Usually about 30 sessions over six weeks. The TMS center sets the exact protocol.
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The standard protocol for major depressive disorder is about 30 sessions over six weeks, five days a week. Theta burst stimulation can deliver a session in roughly three minutes instead of the 19 to 37 minutes of conventional protocols. The TMS center sets the specific protocol and schedule.
Is TMS FDA-cleared?+
Yes, for treatment-resistant depression, OCD and smoking cessation. Other uses are still being studied.
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Yes, for specific uses. The FDA cleared repetitive TMS for treatment-resistant major depressive disorder in 2008, for obsessive-compulsive disorder in 2018 and for smoking cessation in 2020. Clearances apply to particular devices and protocols. Uses such as chronic pain, anxiety and recovery after brain injury are still being studied and are not FDA-cleared indications.
What are the risks of TMS?+
Scalp discomfort and headache are the most common side effects. Seizure is rare when safety guidelines are followed.
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TMS has a well-established safety record. The most common side effects are scalp discomfort at the stimulation site and headache, which usually ease within the first week or two. The most serious risk is a seizure, which is rare (well under 1 in 1,000 patients) when international safety guidelines are followed.
Does insurance cover TMS?+
Coverage for the TMS course is handled by the TMS center. Your consultation with Dr. Orr is direct care, and we provide a superbill.
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Many plans cover TMS for treatment-resistant depression after a person has tried antidepressant medication without enough benefit. Coverage for the TMS course is handled by the TMS center, which does its own billing. The Neurogenesis Project is a direct-care practice and does not bill insurance. For your consultation with Dr. Orr, we provide a superbill you can submit to your plan for possible out-of-network reimbursement.
What does it cost?+
The TMS center sets its own pricing. A consultation with Dr. Orr is $250 for a full hour.
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Pricing for the TMS course is set by the TMS center you are referred to. A consultation with Dr. Orr is $250 for a full hour, paid when you book.
Find Out Whether TMS Is Right for You
Start with a one-hour consultation with Dr. Orr. If TMS makes sense, we will refer you to a trusted local TMS center and coordinate your care from there.