TMS Consent

The Center for Brain Stimulation, PC

My doctor has recommended that I receive treatment with Transcranial Magnetic Stimulation (TMS). The nature of this treatment, including the risks and benefits that I may experience, has been fully described to me by Dr. Albert, and I give my consent to be treated with TMS.
I will receive TMS to treat my psychiatric condition. I understand that there may be other alternative treatments for my condition which may include medications, psychotherapy, and ECT. Whether TMS or an alternative treatment is most appropriate for me depends on my prior experience with these treatments, the nature of my psychiatric condition, and other considerations. Why TMS has been recommended for my specific case has been explained to me.
To administer the TMS treatment, the doctor or a member of their staff will position the magnetic coil on my head and I will hear a clicking sound and feel a tapping sensation on my scalp. The doctor will adjust the TMS system so that the device will give just enough energy to send electromagnetic pulses into my brain, so that my hand or legs twitch. The amount of energy required to make my hand or legs twitch is called the “motor threshold.” Everyone has a different motor threshold and the treatments are given at an energy level that is based on a percentage of my individual motor threshold. How often my motor threshold will be reevaluated will be determined by my doctor.

Once motor threshold is determined, the magnetic coil will be positioned over the treatment area and I will receive the treatment as a series of “pulses” that last up to 4 seconds, with a rest period between each series. The whole treatment will take 10-20 minutes, but can vary depending on your treatment parameters. I understand that this treatment does not involve any anesthesia or sedation and that I will remain awake and alert during the treatment. The number of treatments will depend on my psychiatric condition, how quickly I respond to the treatment, and the medical judgment of my psychiatrist. I will likely receive these treatments 5 times per week for 6 weeks or more (30+ treatments). The treatment is designed to relieve my current symptoms of depression.

During the treatment, I may experience tapping or painful sensations at the treatment site while the magnetic coil is turned on. These types of sensations were reported by about one third of the patients who participated in research studies. I understand that I should inform the doctor or his staff if the sensation is too painful to tolerate. The doctor may then adjust the dose or make changes to the coil position to help make the procedure more comfortable for me. I also understand that headaches were reported in half of the patients who participated in clinical trials for TMS. I understand that discomfort and headaches got better over time in the research studies and that I may take common over-the-counter pain medications such as acetaminophen if a headache occurs.

RISK: TMS should not be used by anyone who has magnetic-sensitive metal in their head or within 12 inches of the TMS coil. Failure to follow this restriction could result in serious injury or death.

Objects that may have this kind of metal include:

  • Aneurysm clips or coils
  • Cerebral Stents
  • Implanted stimulators
  • Electrodes to monitor your brain activity
  • Ferromagnetic implants in your ears or eyes
  • Bullet fragments
  • Other metal devices or objects implanted in the head

TMS is not effective for all patients with depression. Any signs or symptoms of worsening depression should be reported to your doctor. You may want to ask a family member or caregiver to monitor your symptoms to help you spot any signs of worsening depression.

Seizures (sometimes called convulsions or fits) have been reported with the use of TMS devices. I will let my doctor know if I have a seizure disorder or had a seizure in the past.

Because the TMS produces a loud click with each magnetic pulse, I may wear ear plugs as needed to make the procedure more comfortable.

I understand that most patients who benefit from TMS experience results by the fifth week of treatment. Some patients may experience results in less time while others may take longer.

I understand that I should feel free to ask questions about TMS at any time before, during, or after receiving treatment and can call (910) 294-0410 to speak with the doctor or a member of his staff, but may need to schedule an appointment to do so. I also understand that my decision to agree to TMS is being made on a voluntary basis and that I may withdraw my consent and have treatment stopped at any time.

If I need to miss my scheduled treatment, I will let the office know at least 24 hours in advance. Due to scheduling constraints, if I am more than 5 minutes late for a treatment, it may have to be skipped or rescheduled at the discretion of the TMS coordinator.

The nature, proposed and possible consequences, possible alternative methods of treatment, the risks involved and possibility of complications have been fully explained to me. No guarantees or assurances have been made or given by anyone as to the results that may be obtained.

I, the undersigned, have had this form explained to me and fully understand the contents of this authorization.

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