The procedure

How is rTMS administered?

The first visit will consist of an initial intake consultation with a MUHC medical who will discuss and confirm that this procedure is appropriate for the physician/psychiatrist patient. The entire procedure is explained and questions are answered.

rTMS Therapy

  • rTMS is an outpatient procedure = no hospitalization, no anaesthetics and non-invasive.
  • rTMS therapy is therefore administered in a clinical setting by a trained technician under the supervision of a medical doctor.
  • During the treatment session, patients are fully conscious.
  • The intensity of the stimulus that will be delivered is determined by inducing a motor-evoked potential (i.e. causing a movement or twitch to occur) in the abductor pollicis brevis, or the thumb muscle.
  • A tingling or tapping sensation on the head may be felt, or scalp muscles may feel a little tense, during and after the procedure. This is normal and may result in a minor headache.
  • Most patients describe this as a "mild tapping sensation". Patients are also asked to wear earplugs in order to reduce the clicking noise made by the machine.


Who will be involved in the treatment?

A medical practitioner, involved throughout the rTMS therapy procedure, will complete the preprocedure consultation, and be available for questions during treatment. An rTMS technician will administer the rTMS treatment sessions.

All doctors and medical technicians working at the MUHC Neuromodulation Unit have followed a course on all aspects of rTMS therapy. While our doctors and rTMS technicians are highly qualified and well-trained, the outcome of rTMS therapy for a given patient also depends upon individual factors. We recommend patients continue to consult with their referring physician.How long will the initial medical consultation take?

How long will the initial medical consultation take?

During the initial consultation, a doctor will review the medical and psychiatric history, including discussion of any previous treatments completed and medication history. The initial consultation acts as a second screening device, in addition to the referral form, to ensure the suitability of each candidate for rTMS therapy. The initial consultation will take about one hour.

How often will patients receive rTMS therapy?

Generally, rTMS therapy consists of two stages:

  1. Acute therapy: involves 20-30 consecutive treatment sessions over a FOUR to SIX-week period.
  2. Maintenance therapy: may be required every 6-12 months, depending on results. 

A trained medical staff member will determine the need for maintenance therapy following the first set of acute treatment sessions.

How long is each rTMS treatment session?

A trained MUHC rTMS technician administers each treatment session. On the first day of treatment, a technician explains the procedure in detail and informs the patient as to what to expect during the first session. Each subsequent rTMS treatment session lasts approximately half an hour.

What are the risks?

While there are some risks associated with having rTMS therapy, they are minimal.

A potential side effect of rTMS therapy is a mild headache, resulting from muscle stimulation on the scalp. This is experienced by only 1 in 10 patients. Typically, the headache will pass with a few hours or with a dose of Tylenol. The ear plugs will minimize the noise during the procedure. With proper pre-procedural screening, the risk of any serious side-effect such as a seizure becomes extremely rare.


Who is a Candidate?

In order to ensure patient safety, the following general requirements will need to be met prior to receiving rTMS therapy:

  • Have a diagnosis by a psychiatrist or physician*
  • No implanted ferromagnetic items (i.e. pacemaker)
  • No previous history of epilepsy
  • No foreign metal bodies or metallic/magnetic implants in the head

Please note: rTMS is not suitable for the treatment of personality disorders.