The rTMS treatment process

Breakwater Neuro is a pioneering community provider of repetitive transcranial magnetic stimulation (rTMS), a non-invasive outpatient medical treatment that uses magnetic energy to stimulate the brain.

1. Referral

Because rTMS is a medical treatment, it requires a referral from a primary care provider (your family doctor or nurse practitioner). We supply your provider with a referral form, so he or she can send us the referral to get the process started.

2. Screening

We ask you to complete online questionnaires about your symptoms and medical history.

3. Assessment

We book you to see our psychiatrist, who will assess you to determine if rTMS would be safe and potentially effective for you.

4. Your motor threshold appointment

If the treatment is suitable for you, we’ll then bring you in to collect some key baseline data, including recording a sample of your EEG and having you finish a few pre-treatment questionnaires and cognitive tests.

During the motor threshold appointment we also take some measurements of your scalp and establish the needed dose of magnetic energy. This appointment may last up to one hour.

5. Your treatment plan

You and your technician will then develop a Monday-to-Friday schedule for treatment. For rTMS treatment to be most effective, you must be able to attend all of your sessions as scheduled, so it will be important to plan carefully for when you’ll start the treatment sessions.

6. Treatment sessions

Treatment is done once daily (excluding weekends), for up to 30 sessions (up to six weeks).

Depending on your protocol, individual sessions last anywhere from 4 to 45 minutes.

7. Follow-up appointments

Around the 15- to 20-session mark, you’ll have a follow-up appointment with our psychiatrist, who will assess your progress. If there has been a partial response, we’ll provide more sessions aimed at reducing your symptoms further, to a maximum of 30.

Another follow-up appointment will occur after your last session, in which you and the psychiatrist will review the treatment together.

How we determine your motor threshold

Our psychiatrist and technician will work together to find your individual “motor threshold,” which we use to tailor the treatment specifically to you by adjusting the magnetic energy administered to fit with your brain’s own level of excitability.

  • You’ll be asked to sit in a chair with your hands on your lap, palms up and relaxed.
  • The electromagnetic coil will be moved around on your scalp until it’s positioned over the part of your brain that controls muscle movements in the hand on the opposite side of your body.
    • We’ll know we’ve arrived in that spot when your fingers or thumb twitch visibly in response to brief magnetic pulses delivered through the coil.
  • Pulses of different intensities will be delivered to that location while the psychiatrist and technician observe your hand, watching for the twitching of your fingers or thumb.
    • Their goal is to find the lowest amount of energy that reliably produces a twitch. This is your “motor threshold.”
  • The technician will write this value down, then use it to set the stimulator settings for your subsequent treatment sessions.
  • The technician will also use a measuring tape and washable marker to measure a few landmarks on your scalp and locate your individual treatment site.
    • Once the treatment site is determined, a small dot will be made there with henna, which makes a lasting (but non-permanent) mark that allows us to place the coil consistently from treatment session to treatment session.
    • After we’ve applied the henna, you can wash off all the other marks we’ve made.

What you can expect during an rTMS treatment session

  • On each day of treatment, you’ll receive forms to complete and/or be asked a few questions to check on your symptom status.
  • The technician will bring you into the treatment room, where you can sit comfortably.
  • You’ll be given a set of earplugs to be worn during treatment, because the stimulator can be loud.
  • A small line will be drawn on your forehead with washable marker to guide where the electromagnetic coil should be placed to hit the treatment site consistently and accurately.
  • The technician will position the coil on your scalp and start the treatment protocol.
  • You’ll feel the magnetic pulses like a patterned tapping sensation on your head. You may also notice some contraction of the muscles in your jaw or forehead, in rhythm with the pulses. There is no need for an anesthetic – you’ll be awake and alert and able to relax or chat with the technician throughout your session.
  • Once the treatment is complete, the technician will store your earplugs and ask a few questions about how you’re feeling.
  • After your session, you can simply go about your day as you normally would.

still have questions?

Check out our FAQs on rTMS and don’t hesitate to reach out if you’d like to speak with a member of our team about how rTMS might work for you.