Last week, February 21 – 23, 2019, I attended the Clinical TMS Society‘s annual meeting held in vibrant Vancouver, Canada. For the sixth year, this conference bought together TMS providers and researchers from across the globe to discuss the pulse of the industry, discoveries, and what’s on the horizon for Transcranial Magnetic Stimulation (TMS) technology as the therapy continues to be a safe and effective treatment for depression.
The three-day conference boasted more than 540 attendees and offered 30+ presentations, panel discussions and workshop breakout sessions—all packed with top-notch data and impactful stories of research success and patient progress.
As a member of the Society and a veteran guest of this meeting, I wanted to share some conference highlights and insights that focus on the development of the field and future possibilities.
Anthony Trevor Barker, Ph.D., opened the meeting with his presentation, An A to Z of Transcranial Magnetic Stimulation – from Blue Skies Research to Clinical Tools, which reflected on his TMS journey. In 1985 he developed a transcranial magnetic stimulator, which caused quite a stir in London when he first stimulated the human cortex with non-invasive magnetic energy. This experiment led to an article in The Lancet and worldwide recognition. Dr. Barker indicated there are now 1,500+ publications referring to TMS, and in 2018 there were 24 new publications each week.
Michael Fox, M.D., Ph.D., followed the TMS track with his presentation, Using the Human Brain Connectome to Optimize TMS Targets, which stressed the importance of finding the optimal treatment site. He suggested that clinicians may be looking for symptom-specific targets rather than diagnosis-specific targets as there may be subgroups within the diagnosis of major depressive disorder. Shan H. Siddiqi, M.D. complimented Dr. Fox’s presentation with his clinical poster that focused on symptom-specific targets for “circuit-based” neuromodulation, confirming that until a 100% response rate is achieved, clinicians need to find ways to improve treatments.
Transitioning the afternoon with his presentation, Improving the Quality of Care: Motor Threshold and Seizure Risks, Daniel Press, M.D., talked about the low risk of seizure activity with TMS. He shared that a survey of members of the Society revealed a rate of 1/29,000 with variability among TMS system and that the standards committee does recommend having a seizure protocol and response plan. Dr. Press noted that providers should always talk to their patients about the low-risk factor for seizures.
Well-known for helping TMS overcome early research hurdles to being an accepted treatment path, Mark George, M.D., kicked off day two of the conference. Dr. George pointed out the natural growing pains of the field, and how it is a learning process that encompasses clinical experience and research. This learning process will reveal more information and knowledge, which will lead to more effective treatments.
Closing out the afternoon, Dr. Press moderated a discussion centered on the clinical performance of theta burst stimulation for depression, with panelists Daniel Blumberger, M.D., Johnny O’Reardon, M.D., Andrew Leuchter, M.D., and Ken Goolsby, M.D. While there is not as much research about this type of TMS, theta burst stimulation has regulatory acceptance, and the question is how to integrate it into clinical practice.
On the final day of the conference, Martijn Arns, Ph.D. focused on precision, discussing neuro-cardiac guided TMS. This approach is where clinicians take advantage of observing a transient cardiac deceleration of the heart rate when a specific part of the brain is stimulated and may highlight a better site of stimulation for TMS treatment of depression.
Switching to a wider view of TMS, Linda L. Carpenter, M.D, spoke on the effects of combining TMS with other brain activities to enhance therapeutic outcomes. She indicated clinicians should think of TMS as an “interaction between external stimulus and the underlying state of the stimulated region or network” with a goal of controlling neural activity in the targeted region/network to improve outcomes.
As the conference came to an end, Jonathan Downar, M.D., Ph.D. closed by highlighting 34 years of growth, discussing what’s happening in the field now and what’s to be expected ahead. Realizing that not all patients are the same, and many have different response timelines, clinicians need to have flexibility when treating patients to ensure the best possible outcome.
The Clinical TMS Society annual meeting is always an empowering experience, as it is encouraging to see the evidence behind what we do as clinicians, researchers, and advocates of TMS therapy. Collectively, we share our knowledge and commitment to research-driven progress and the future of TMS—with the ultimate goal of helping people alleviate depression, and achieve a happier and healthier life.