TMS Treatment Protocols
Parameters for the four treatment protocols built into Brain Ultimate TMS
About TMS Protocols
Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique. The four protocols below are built into the Brain Ultimate TMS system. They should be administered by trained healthcare professionals following proper patient assessment and motor threshold determination.
Built-In Treatment Protocols
Standard MDD Protocol
BUILT INThis 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.
| Parameter | Value |
|---|---|
| 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 | 18:26 |
| Total pulses | 3000 |
Clinical Notes
- Shorter duration may improve patient comfort and compliance.
- Administered over the left dorsolateral prefrontal cortex (DLPFC).
Extended MDD Protocol
BUILT INThis 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.
| Parameter | Value |
|---|---|
| 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 |
| Total time | 36:56 |
| Area of brain | Left Dorsolateral Prefrontal Cortex |
Clinical Notes
- Consider for patients who report discomfort with the Standard MDD Protocol.
iTBS Protocol
BUILT INIntermittent Theta Burst Stimulation (iTBS) delivers bursts of high-frequency stimulation in a pattern that mimics natural brain rhythms. This protocol reduces session time to just over three minutes.
| Parameter | Value |
|---|---|
| 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 | 03:12 |
Clinical Notes
- iTBS delivers 50Hz triplet bursts (3 pulses per burst) repeated at 5Hz.
- The short session time (3:12) improves clinical workflow and patient throughput.
- May improve treatment adherence due to shorter sessions.
OCD Protocol
BUILT INThis protocol uses a different set of stimulation parameters and targets the medial prefrontal cortex/anterior cingulate cortex rather than the left DLPFC used by the MDD protocols.
| Parameter | Value |
|---|---|
| Protocol | OCD 1 |
| Magnetic field intensity (% of MT) | 100% |
| Frequency | 20 Hz |
| Burst pulses | 1 |
| Cycle time | 50 ms |
| Pulses in train | 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 the MDD protocols).
- Higher frequency (20 Hz) compared to the MDD protocols (10 Hz).
All Protocols — Quick Comparison
| Parameter | Standard MDD | Extended MDD | iTBS | OCD |
|---|---|---|---|---|
| Motor Threshold | 120% | 120% | 120% | 100% |
| Frequency | 10 Hz | 10 Hz | 50 Hz (burst) | 20 Hz |
| Total Pulses | 3,000 | 3,000 | 600 | 2,000 |
| Trains | 75 | 75 | 20 | 50 |
| Pulses per Train | 40 | 40 | 30 | 40 |
| Inter-train Interval | 11 s | 26 s | 8 s | 20 s |
| Total Duration | 18:26 | 36:56 | 3:12 | 18:00 |
| Target Region | L-DLPFC | L-DLPFC | L-DLPFC | mPFC/ACC |