"Best" TMS Device?

[FlowRate]

Hi All,

We're looking at potentially starting a TMS service line. I'm working through various resources to try and learn more about the differences in price and features between different devices. That said, I would greatly appreciate if anyone has some recommendations from their own experience or research.

Thanks!

A good source for a higher level overview that I found: The complex landscape of TMS devices: A brief overview - PMC.

---

Members don't see this ad.

 

[mistafab]

Which indications will you all be using it for?

I've had experience with neurostar and brainsway. Currently we do rtTMS but it requires the FMRI. Previously we just did the headcap landmark-type interventions. Had good experiences with both but the fMRI guided rtTMS has definitely been higher level in terms of %response/remission.

I've had no experience with the tms for nicotine use disorder, but was really interested in seeing that.

 

[splik]

Magventure is the one that is most commonly used by the reputable practices around here (including the academic centers and Kaiser). Some of them also have Brainsway as well.

 

[FlowRate]

Which indications will you all be using it for?

I've had experience with neurostar and brainsway. Currently we do rtTMS but it requires the FMRI. Previously we just did the headcap landmark-type interventions. Had good experiences with both but the fMRI guided rtTMS has definitely been higher level in terms of %response/remission.

I've had no experience with the tms for nicotine use disorder, but was really interested in seeing that.

That's really interesting. Are you doing research or are people paying out of pocket for fMRI? (I'm assuming insurance doesn't cover fMRI.)

Would primarily be for MDD although would like the option to try other indications as they become more evidence-based/FDA-approved/insurance covered.

Magventure is the one that is most commonly used by the reputable practices around here (including the academic centers and Kaiser). Some of them also have Brainsway as well.

Thanks. I imagine people usually opt for the devices that are TBS capable?

 

[Stagg737]

That's really interesting. Are you doing research or are people paying out of pocket for fMRI? (I'm assuming insurance doesn't cover fMRI.)

Would primarily be for MDD although would like the option to try other indications as they become more evidence-based/FDA-approved/insurance covered.

Thanks. I imagine people usually opt for the devices that are TBS capable?

Our academic center uses Brainsway for mostly MDD (occasionally OCD). I don't currently do TMS, but am trying to get into it in the next few months, so curious about others' thoughts on devices as well.

 

[mistafab]

That's really interesting. Are you doing research or are people paying out of pocket for fMRI? (I'm assuming insurance doesn't cover fMRI.)

Would primarily be for MDD although would like the option to try other indications as they become more evidence-based/FDA-approved/insurance covered.

Thanks. I imagine people usually opt for the devices that are TBS capable?

Currently it is cash only for treatment. The data is so compelling for MDD (even TRD) though that I don't think insurance will be able to block the fMRI -> rtTMS pathway for long.

 

[psydocc]

From a practical standpoint, any FDA approved machine will work for an insurance based practice using the machine for regular MDD protocol. "Best" would utilize fMRI but that isn't covered by insurance. Some might feel that faster (SAINT/TBS) is better, but again that wouldn't be covered by insurance. I have no doubt that newer/better protocols will become FDA approved in the future, but by the time that happens it will likely be the end of life expectancy for a machine that you buy now anyways. I'd avoid any pay per click offers (neurostar does this I think?)

 

[Merovinge]

Has there been anymore f/u to the SAINT style TMS efficacy.

 

[mistafab]

Has there been anymore f/u to the SAINT style TMS efficacy.

From the very limited sites doing it (including where I am), the data seems to be supportive of the original data. I think there is ongoing debate and exploration regarding what to do regarding maintenance afterwards.

 

[Merovinge]

From the very limited sites doing it (including where I am), the data seems to be supportive of the original data. I think there is ongoing debate and exploration regarding what to do regarding maintenance afterwards.

Pardon my ignorance but what is keeping this from more widespread use? That would be the largest breakthrough in the treatment of depression across the history of mankind. Is it due to patents or some other force limiting the widespread studies/adoption?

 

[mistafab]

Pardon my ignorance but what is keeping this from more widespread use? That would be the largest breakthrough in the treatment of depression across the history of mankind. Is it due to patents or some other force limiting the widespread studies/adoption?

It is (currently) extraordinarily expensive, and not covered by insurance. It requires the FMRI which many places just dont have access to. It requires a psychiatrist involved to personally read the FMRI to calibrate the machine. It takes a week straight of treatments which take most the day, which requires staff and supportive relationships to be available for this.

Based off my biased, skeptical perspective - insurance will put off approving this for as long as humanely possible.

 

[Merovinge]

It is (currently) extraordinarily expensive, and not covered by insurance. It requires the FMRI which many places just dont have access to. It requires a psychiatrist involved to personally read the FMRI to calibrate the machine. It takes a week straight of treatments which take most the day, which requires staff and supportive relationships to be available for this.

Based off my biased, skeptical perspective - insurance will put off approving this for as long as humanely possible.

That's really helpful for my understanding. Is there a real pathway for reducing the extraordinary costs? I recall how much fMRI was running 10 years ago and it was absurd, I presume this has come down some but then requiring so much coil time as well...