About TMS Protocols

Transcranial Magnetic Stimulation (TMS) is an FDA-cleared non-invasive neuromodulation technique for treating Major Depressive Disorder (MDD). The following protocols have demonstrated efficacy in clinical trials and are optimized for use with the Brain Ultimate TMS system. These protocols should be administered by trained healthcare professionals following proper patient assessment and motor threshold determination.

FDA-Approved Protocols

19-minute Protocol

FDA-Cleared

This protocol is performed at 120% of motor threshold. The train(s) consist of 40 pulses: 10 pulses a second for a total of 4 seconds, followed by a break of 11.0 seconds. This is repeated 75 times. The total duration is 18 minutes 26 seconds, and the total number of pulses is 3000.

120%
Motor Threshold
10 Hz
Frequency
3000
Total Pulses
~19 min
Duration
Parameters Values
Stimulation type Biphasic
Stimulus amplitude (% of MT) 120
Pulse frequency in train (Hz) 10
Pulses in train 40
Number of trains 75
Intertrain interval(s) 11.0
Total time 00:18:26
Total pulses 3000

Clinical Notes

  • This protocol is optimized for efficient treatment delivery while maintaining clinical efficacy.
  • The shorter duration may improve patient comfort and compliance.
  • Typically administered over the left dorsolateral prefrontal cortex (DLPFC).
  • Standard course is 5 sessions per week for 4-6 weeks (20-30 sessions total).

37-minute Protocol

FDA-Cleared

This protocol uses a longer inter-train interval for enhanced patient tolerance. It delivers the same total pulses (3000) but over a longer duration, which may be preferable for some patients.

120%
Motor Threshold
10 Hz
Frequency
3000
Total Pulses
~37 min
Duration
Parameters Values
Magnetic field intensity 120% of the MT
Frequency 10 Hz
Train duration 4 sec
Inter-train interval 26 sec
Number of trains 75
Magnetic pulses per session 3000
Treatment session duration ~37.0 min
Sessions/wk 5
Treatment schedule 5 daily sessions for 6 weeks
Area of brain to be stimulated Left Dorsolateral Prefrontal Cortex

Clinical Notes

  • The efficacy of this protocol is comparable to the 19-minute protocol in clinical trials.
  • Consider this protocol for patients who report discomfort with the shorter protocol.

iTBS Protocol

NEWLY FDA-CLEARED

Intermittent Theta Burst Stimulation (iTBS) delivers bursts of high-frequency stimulation in a pattern that mimics natural brain rhythms. This accelerated protocol significantly reduces treatment time to just over 3 minutes while maintaining efficacy for depression treatment.

120%
Motor Threshold
50 Hz
Burst Frequency
600
Total Pulses
3:12
Duration
Parameters Values
Location Left Dorsolateral Prefrontal Cortex
Treatment level (% of MT) 120%
Pulse frequency within burst 50 Hz
Pulses per burst 3
Burst cycle time 200 ms
Number of bursts per train 10
Intra-sequence interval (ISI) 2.00 s
Inter-train interval (ITI) 8 s
Number of trains 20
Total pulses 600
Total time 3 min 12 sec

Clinical Notes

  • iTBS delivers 50Hz triplet bursts (3 pulses per burst) repeated at 5Hz.
  • The accelerated treatment time (3:12) significantly improves clinical workflow and patient throughput.
  • Research suggests comparable efficacy to standard 37-minute protocols despite the reduced treatment time.
  • May improve treatment adherence due to shorter sessions.

OCD Protocol

NEWLY FDA-CLEARED

This protocol is specifically designed for the treatment of Obsessive-Compulsive Disorder (OCD). It uses a different set of stimulation parameters and typically targets different brain regions compared to depression protocols.

100%
Motor Threshold
20 Hz
Frequency
2000
Total Pulses
18 min
Duration
Parameters Values
Protocol OCD 1
Magnetic field intensity (% of MT) 100%
Frequency 20 Hz
Burst pulses 1
Cycle time 50 ms
Number of pulses 40
Intra-sequence interval (ISI) 2.00 s
Inter-train interval (ITI) 20 s
Number of trains 50
Total pulses 2000
Total time 18:00

Clinical Notes

  • Lower motor threshold (100% vs 120% used in depression protocols).
  • Higher frequency (20 Hz) compared to standard depression protocols (10 Hz).