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I think that for this article, it makes sense to have a brief description of what the device is and how it is used at the top of the article, to orient the reader. This is pretty arcane technology, not like a pill you take, So I moved that section to the top. In this dif, Doc James moved it to after the medical use section. Doc do you see my reasoning for moving this up? Thanks! Jytdog ( talk) 14:27, 2 January 2015 (UTC)
Since when is there an FDA approved therapy and what kind of stimulation is used in both (MDD, migraine) cases? -- Amtiss, SNAFU ? 21:09, 13 February 2015 (UTC)
Dear User:Doc James, User:Jytdog
I'd like to suggest two edits edits to the page; please note that these edits were requested by Neuronetics. I've tried to maintain a neutral point of view; please let me know if you have any objections. The required references are provided in line for these edits.
Thanks for your inputs!
Protein3EFN ( talk) 11:29, 27 February 2015 (UTC)
1) Medicare Section
Current Text:
There is no national policy for Medicare coverage of TMS in the United States. Policies vary according to local coverage determinations (LCDs) that Medicare administrative contractors (MACs) for the Centers for Medicare and Medicaid Services (CMS) make for geographical areas over which they have jurisdiction. CMS presently has ten to fifteen MAC jurisdictions that each cover several U.S. states.
LCDs for individual MAC jurisdictions can change over time. For example:
In early 2012, the efforts of TMS treatment advocates resulted in the establishment by a MAC with jurisdiction over New England of the first Medicare coverage policy for TMS in the United States. However, a new MAC for the same jurisdiction subsequently determined that Medicare would not cover services for TMS performed in New England on or after October 25, 2013. In August 2012, the MAC whose jurisdiction covered Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma and New Mexico determined that, based on limitations in the published literature there was insufficient evidence to cover the treatment, but the same MAC subsequently determined that Medicare would cover TMS for the treatment of depression for services performed within the MAC's jurisdiction on or after December 5, 2013. In December 2012, Medicare began covering TMS for the treatment of depression in Tennessee, Alabama and Georgia. CMS maintains a searchable database that enables users to find current Medicare LCDs for TMS for individual U.S. states.
Proposed Text:
Medicare policies vary according to local coverage determinations (LCDs) that Medicare administrative contractors (MACs) for the Centers for Medicare and Medicaid Services (CMS) make for geographical areas over which they have jurisdiction. CMS is currently engaged in a MAC consolidation strategy, moving from 15 A/B MAC jurisdictions to 10 A/B MAC jurisdictions. [1]
The majority of the Medicare contractors cover TMS therapy for the treatment of depression, including:
CMS maintains a searchable database that enables users to find current Medicare LCDs for TMS for individual U.S. states. [2]
2) Commercial health insurance section
Current Text:
In 2013, several commercial health insurance plans in the United States, including Anthem, Health Net, and Blue Cross Blue Shield of Nebraska and of Rhode Island, covered TMS for the treatment of depression for the first time. In contrast, UnitedHealthcare issued a medical policy for TMS in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.
Proposed Text:
Since 2010, commercial health insurance plans in the United States including Priority Health, Federal Employee Health Plan, Tufts, Health New England, Health Net, Anthem, EmblemHealth, Premera, MVP, Harvard Pilgrim, The National Association of Letter Carriers, and Washington State have begun covering TMS for the treatment of depression. [3] In addition, several Blue Cross Blue Shield plans including Nebraska, Rhode Island, Massachusetts, Blue Care Network (MI), Independence, CareFirst, Michigan, South Carolina, Alabama, HMSA, HCSC ( Illinois, Texas, Oklahoma, New Mexico and Montana), and Blue shield of California also cover TMS for the treatment of depression. [4] Optum Behavioral Health Solutions has published coverage criteria guidelines and it is the decision of each of the plans that are contracted with Optum to establish coverage. [5] UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. [6] Other commercial insurance plans whose 2014 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence. [7]
References
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![]() | This edit request by an editor with a conflict of interest was declined. A reviewer felt that this edit would not improve the article. |
Dear User:Doc James, User:Jytdog
Thank you for your comments, much appreciated!
There was an edit made to the treatment section by user Corker1 on the 19th of March this year, which removed references to APA and CANMAT. While I understand Corker1's point of view (the references did not, in fact, indicate endorsement of any kind by these organizations), would it be possible to rephrase the text instead? For your reference, I've mentioned the original text as well as the proposed updated version. Please note that, as before, this edit has been requested by Neuronetics.
Protein3EFN ( talk) 10:31, 13 April 2015 (UTC)
Original Text:
For treatment-resistant major depressive disorder, HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) is effective and low-frequency (LF) rTMS of the right DLPFC has probably efficacy. [1] [2] The American Psychiatric Association, [3] the Canadian Network for Mood and Anxiety Disorders, [4] and the Royal Australia and New Zealand College of Psychiatrists have endorsed rTMS for trMDD. [5]
Proposed Text:
For treatment-resistant major depressive disorder, HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) is effective and low-frequency (LF) rTMS of the right DLPFC has probably efficacy. [1] [2] TMS is included in the American Psychiatric Association Practice Guideline for the treatment of Major Depressive Disorder as a treatment option for patients when they have not benefited from initial antidepressant treatments. [3] Additionally, the Canadian Network for Mood and Anxiety Treatments recognizes TMS as a treatment option in adults suffering from Major Depressive Disorder. [4] The Royal Australia and New Zealand College of Psychiatrists has endorsed rTMS for trMDD. [5]
References
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In addition to the APA/CANMAT edits, there are a couple of edits Neuronetics would like to suggest to the Health Insurance Considerations section of the page. Please take a look and let me know if these are acceptable to you.
Protein3EFN ( talk) 10:19, 1 June 2015 (UTC)
Original Text[Section: Commercial Health Insurance]:
In 2013, several commercial health insurance plans in the United States, including Anthem, Health Net, and Blue Cross Blue Shield of Nebraska and of Rhode Island, covered TMS for the treatment of depression for the first time. In contrast, UnitedHealthcare issued a medical policy for TMS in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.
Proposed Text:
The first commercial coverage policy for TMS was drafted in 2010 by Priority Health. [1] Since 2013, commercial health insurance has rapidly expanded with the majority of US plans adding TMS as a covered benefit, including Anthem, multiple Blue Cross Blue Shield plans and United Behavioral Healthcare (Optum). [2] [3] [4] As of March 2015, over 200 million US individuals have TMS as a covered benefit. [4] Information for specific insurance providers are typically available on their website or by contacting their benefits staff. United Behavioral Healthcare (Optum) published coverage criteria guidelines for TMS in 2015 despite an older medical policy issued for TMS in 2013 that stated there was insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. [3] Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence. [5]
References
References
References
Dear User:Doc James, User:Jytdog,
I'm writing to address a general complaint regarding content organization.
The bulk of this article is written regarding and from the perspective of proven clinical efficacy. This being said, TMS is for the most part a research tool and the standard for proven clinical efficacy is often FDA-type approval from various governmental agencies. There is a lot of reliance on the Lefaucheur article, which while a great article, talks mostly about demonstrated clinical efficacy. The problem is that talking about all of these TMS applications in terms of clinical efficacy, the layman is unable to distinguish between the demonstration of clinical efficacy and the degree of clinical efficacy. To quote the Lefaucher paper "The absence of evidence should not be taken as evidence for the absence of effect".
For example, unipolar depression for TMS has demonstrated definite clinical efficacy, with an effect size of ~0.7 (depending on the paper). Whereas other studies may have similar effect sizes, but not enough studies to have demonstrated clinical efficacy to the standard that would satisfy a commission on the topic. This is confusing because after the introduction it kind of breaks down into specific treatments and efficacy recommendations from Lefaucher without any elaboration. This is purely the difference between "weakly demonstrated efficacy" and "demonstrated weak efficacy".
The wiki continues on to mention adverse effects, then three sentences about procedure (which actually is a useless section) and then a few line items about specific approvals for rTMS devices, then an interesting technical section, then a tiny history section. One sentence to address all of TMS research, and 5 sentences to address specific issues regarding study blinding. Somehow in all of this, the use of TMS for solely neuroscience purposes (looking at intracortical inhibition), using paired pulse inhibition to map cortical pathways, simultaneous use of TMS in fMRI, TMS as a cognitive-enhancement method, and basically anything non-medical are just not mentioned.
Given the disorganization in the article I think it would make sense to just wholesale reorganize it using a style of the EEG page (kind of) /info/en/?search=Electroencephalography
I would propose:
-Side Effects
-Health insurance considerations
(I think we can actually skip the mentioning of specific devices and just throw them in a table)
-Research Considerations (study blinding, safety) — Preceding unsigned comment added by Azurex120 ( talk • contribs) 24 April 2015 (UTC)
I removed the wrong values of the magnetic fields (1-10mT). Web sources like [1], an older rewriting attempt ("Magnetic field: often about 2 tesla on the coil surface and 0.5 T in the cortex") in the oldest archive of the discussion here and the 2003 edition of the given source tell us about values in the magnitude of Tesla. Please add newer, correct cited sources if possible. -- Amtiss, SNAFU ? 21:47, 29 September 2015 (UTC)
From the article: "transient induction of hypomania". This is fascinating -- is there any research on this specifically? -- Impsswoon ( talk) 23:10, 24 November 2015 (UTC)
Most of the data in the article seem to be from 2013 and earlier. In a fast-developing field, that's too old. For example, the article makes no mention of the experimental use of TMS in treating autistics. See John Elder Robison's new book, Switched On: A Memoir of Brain Change and Emotional Awakening. J. D. Crutchfield | Talk 15:04, 24 March 2016 (UTC)
Hello.
I'm missing a section about the application for Neuro enhancement. Englisch is not my mother language, and I seeking a copyright free text about TMS as neuro enhancement :-) . — Preceding unsigned comment added by 2003:5B:4C5E:1E00:7125:38C0:ED4:42D4 ( talk) 12:11, 14 June 2016 (UTC)
Perhaps someone with an exceptional level of knowledge on the topic should review the introduction of this article. It seems to be questionably biased.
Hi there! I rewrote the history section using one of the previous writer's sources as well as reliable ones that I found as well. Please let me know if there are any issues that need to be addressed. Thank you. Maddieaalund ( talk) 02:15, 28 February 2017 (UTC)
This text was affed "Many ethical concerns arose after ECT became immensely popular as a treatment for various types of mental illnesses that led to many side effects, both mental and physical." I am not seeing this ref as supporting this "Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder"? Thus restored the prior version. Doc James ( talk · contribs · email) 06:18, 10 April 2017 (UTC)
Possibly a Dangerous Idea, but the internet shows some research has been done in this area. Nevertheless, sleep deprivation being the problem that it is (and WILL BE considering the effects of aging upon sleep deprivation) would necessitate that significant research be done in this area. Likely everything I say has already been done (or thought about), nevertheless it is still worth commenting upon :
1) Use of probes at certain spatial locations upon the brain, each of which is capable of generating certain frequencies of magnetic field strengths (for induction of Maxwell-Faraday-equation based neuronal stimulation) would allow the neuronal 'activation profile' of the brain to mimic those brain profiles associated with healthy volunteer sleep patterns (though whether this is a good idea, and whether some other intermediate profile should be used as the 'target profile', so as to be more gentle for the subject's brain, is clearly a question worth considering - made more difficult by the fact that knowledge of a natural subjects normal neuronal activation sleep profile will be unknown unless TMS coils could somehow be coupled with EEG sensors and combined with a computational unit so as to optimise the process via which certain brainwave patterns are induced in the sleeping patient).
2) The causal consequences of inducing sleep via TMS might include some effect upon the brain's own ability to induce sleep naturally by itself subsequent to the application of TMS (we are imposing from 'outside' a pattern that should be arising naturally from 'inside' or internal mechanisms - so there must be some causally mediated fault that prevents internal mechanisms from inducing sleep).
I haven't fully looked through the below paper BUT the upshot is that "Moreover, evoked slow waves lead to a deepening of sleep and to an increase in EEG slow-wave activity (0.5–4.5 Hz), which is thought to play a role in brain restoration and memory consolidation.". So there appears to be some level of SUCCESS. ASavantDude ( talk) 11:59, 17 October 2017 (UTC) Example Paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895978/
The first sentence makes no sense. It says TMS is a "method." TMS is a method of doing what? If you don't say what it is a method of, it makes no sense.-- Nomenclator ( talk) 20:25, 22 January 2018 (UTC)
Significant rewrite, basically cleaned up the article got rid of a lot of primary research, some promotional material, and weak refs. Also significantly reorganized per WP:MEDRS. Several sections still need work. I enjoy sandwiches ( talk) 23:05, 26 February 2019 (UTC)
I noticed that there is no mention of the use of TMS to create "virtual lesions", a name often found in research papers, in cognitive neuroscientific experiments. This seems to be an already major and increasingly used function of the method. Should this not be included under "Research", and possibly mentioned in the lead? Prinsgezinde ( talk) 15:55, 22 October 2019 (UTC)
UHC does now cover, so this should be updated. 98.223.62.20 ( talk) 16:22, 12 December 2019 (UTC)
The intro has almost identical text to the later subsections for medical uses and adverse effects. Could be condensed into 2-3 sentences up top with specifics below... I am not up on my wiki SOPs though, so maybe it is OK as is? Vern.zimm ( talk) 18:56, 29 January 2020 (UTC)