TMS Treatment Protocols
FDA-cleared protocols for depression and OCD treatment using Brain Ultimate TMS
About TMS Protocols
Transcranial Magnetic Stimulation (TMS) is an FDA-cleared non-invasive neuromodulation technique. 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-Cleared Protocols
19-Minute Protocol
FDA CLEAREDThis 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 | 00:18:26 |
| Total pulses | 3000 |
Clinical Notes
- Optimized for efficient treatment delivery while maintaining clinical efficacy.
- Shorter duration may improve patient comfort and compliance.
- Administered over the left dorsolateral prefrontal cortex (DLPFC).
- Standard course: 5 sessions/week for 4–6 weeks (20–30 sessions total).
37-Minute Protocol
FDA CLEAREDThis 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 |
| Treatment session duration | ~37.0 min |
| Sessions/wk | 5 |
| Treatment schedule | 5 daily sessions for 6 weeks |
| Area of brain | Left Dorsolateral Prefrontal Cortex |
Clinical Notes
- Efficacy comparable to 19-minute protocol in clinical trials.
- Consider for patients who report discomfort with the shorter protocol.
iTBS Protocol
FDA CLEAREDIntermittent 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.
| 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 | 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
FDA CLEAREDThis protocol is specifically designed for Obsessive-Compulsive Disorder (OCD). It uses a different set of stimulation parameters and targets the medial prefrontal cortex/anterior cingulate cortex rather than the DLPFC used in depression protocols.
| Parameter | Value |
|---|---|
| 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).
All Protocols — Quick Comparison
| Parameter | 19-min MDD | 37-min MDD | iTBS | OCD |
|---|---|---|---|---|
| FDA Status | Cleared | Cleared | Cleared | Cleared |
| 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 | ~37 min | 3:12 | 18:00 |
| Target Region | L-DLPFC | L-DLPFC | L-DLPFC | mPFC/ACC |
| Sessions/Week | 5 | 5 | 5 | — |
| Treatment Course | 4–6 weeks | 6 weeks | — | — |