Transcranial Magnetic Stimulation (TMS): A Breakthrough Treatment Approach

1. The Brain — A Sophisticated System of Balance

The human brain functions through the delicate balance of billions of neurons, which continuously communicate with one another through electrical and chemical signals. This balance is maintained across multiple dimensions: between excitation and inhibition, among different regions of the brain, and across neural networks responsible for emotion, movement, language, and cognition.

When this balance is disrupted — whether due to injury, aging, or disease — neurological and psychiatric symptoms may emerge, including depression, anxiety, insomnia, chronic pain, memory impairment, and movement disorders.

2. Treating Neurological Disorders: Multiple Pathways Toward the Same Goal

There are many ways to influence the nervous system and help the brain regain its balance:

• Medications are absorbed through the gastrointestinal tract into the bloodstream and cross the blood-brain barrier to regulate neurotransmitters such as serotonin, dopamine, and GABA.
• Physical exercise stimulates cerebral blood flow and promotes the production of brain-derived neurotrophic factor (BDNF), helping maintain healthier neurons.
• Cognitive therapeutic activities — such as memory training and learning new skills — activate functional brain regions and promote neuroplasticity, in which neurons change their structure and function to adapt to new tasks.

The common principle is that the brain can change in a positive direction when exposed to appropriate interventions.

However, in many cases — particularly chronic or treatment-resistant conditions — medications and conventional therapies may not be sufficient to comprehensively regulate the nervous system. This is where Transcranial Magnetic Stimulation (TMS) emerges as a breakthrough treatment option.

3. What Is TMS and How Does It Work?

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that uses magnetic pulses to induce small electrical currents in specific areas of the brain, thereby directly modulating neuronal activity.

3.1. Mechanism of Action — Neuromodulation from Outside the Skull

When a TMS coil placed against the scalp delivers magnetic pulses, the magnetic field passes harmlessly through the skull and induces a small electrical current in the underlying area of the cerebral cortex. This activates or inhibits neurons in the target region, depending on the technical parameters applied.[1,2]

This is known as neuromodulation: rather than using chemicals that circulate throughout the body, TMS acts directly and precisely on the brain region involved in the condition.[1]

For example, in depression, the left dorsolateral prefrontal cortex (DLPFC) is often underactive. High-frequency TMS stimulates this region to restore normal activity. Conversely, in anxiety or obsessive-compulsive disorder (OCD), low-frequency TMS is used to “inhibit” areas of the brain that are excessively active.[5,6,7]

3.2. Why Is TMS Suitable for Chronic Neurological Disorders?

Chronic neurological disorders share a common characteristic: persistent imbalances within neural circuits. Medications regulate neurotransmitters, but they are not always sufficient to “reset” neural circuits that have been disrupted over a long period. TMS directly influences neuroplasticity, the mechanism through which the brain reorganizes itself.[1,3]

Repeated TMS sessions (rTMS) gradually help re-establish normal neural connectivity, producing lasting changes — not only alleviating symptoms but also restoring the underlying functional foundation.[1]

4. What Conditions Can TMS Treat?

TMS has been extensively studied and clinically applied for the following indications [3]:

TMS does not replace foundational treatments such as medication or psychotherapy. Instead, it serves as an add-on therapy that helps optimize treatment when conventional approaches have not provided sufficient results.[3]

5. Advantages and Considerations of TMS

Key Advantages

✅ Non-invasive — No surgery, needles, or general anesthesia are required.[3,4]

✅ Does not affect memory — Unlike electroconvulsive therapy (ECT), TMS does not cause memory impairment; conversely, some studies have reported improvements in cognitive function with TMS.[13]

✅ Few side effects — Side effects are mainly mild scalp discomfort or transient headaches, which usually resolve within a few hours.[4]

✅ No hospitalization required — TMS is performed on an outpatient basis, allowing patients to return home and resume normal activities immediately after each treatment session.[3]

✅ No drug interactions — TMS can be used alongside ongoing medication treatment.[3]

Contraindications to Consider

⚠️ Metallic or electronic devices implanted in the head (such as aneurysm clips or pacemakers, etc.)

⚠️ A history of seizures or conditions that lower the seizure threshold[4]

6. Why Choose University Medical Center Ho Chi Minh City (UMC)?

Leading Team of Specialists

UMC brings together neurologists and psychiatrists with advanced training both domestically and internationally, as well as practical experience in TMS planning and administration, helping ensure accurate diagnosis and an optimized treatment protocol.

Modern TMS Equipment Meeting International Standards

The TMS system at UMC meets international standards, providing access to the latest treatment technology while optimizing both efficacy and safety.

Personalized Treatment Protocols — Flexible Adjustments Throughout Treatment

Each patient receives an individualized TMS treatment protocol based on their medical condition and individual characteristics. The protocol is not fixed throughout the treatment course. Doctors closely monitor each patient and make timely adjustments — including stimulation parameters, target areas, and medication combinations — according to the patient's actual progress.

Combining Rehabilitation and Occupational Therapy — A Distinctive Feature of UMC

One major advantage of treatment at UMC is the multidisciplinary coordination provided within the same treatment session.

After TMS, patients can immediately proceed to physical therapy or rehabilitation to take advantage of the “golden window” during which the brain is in a highly activated state.

For certain treatment protocols, cognitive occupational therapy is performed concurrently with TMS — combining external brain stimulation with internal cognitive training to create an optimal synergistic effect based on the principle of neuroplasticity.

UMC’s physical therapy and occupational therapy teams are professionally trained to provide these combined interventions during TMS treatment sessions, helping ensure the highest possible level of safety and effectiveness.

7. What Does a TMS Treatment Course Involve?

Duration: A typical treatment course lasts 4–6 weeks, with 5 sessions per week. Each session takes approximately 20–40 minutes.

• Initial assessment — Clinical examination, determination of indications and contraindications.
• Personalized treatment planning — Identification of the target brain region, stimulation frequency, and stimulation intensity.
• TMS administration — Performed on an outpatient basis without general anesthesia.
• Monitoring and adjustment — Periodic assessment of treatment response using specialized psychiatric and neurological assessment scales, with adjustments to the treatment protocol when necessary.
• Post-treatment evaluation — Comparison of outcomes before and after treatment and development of a maintenance plan.

8. Frequently Asked Questions

• Is TMS painful? Most patients experience only a light tapping sensation or mild discomfort on the scalp, which usually decreases after the first few treatment sessions.[4]
• Is hospitalization required? No. TMS is performed entirely on an outpatient basis — patients can drive themselves home and resume normal activities immediately after the treatment session.[3]
• Does TMS affect memory? No — this is one of its major advantages compared with electroconvulsive therapy (ECT). Some studies have also reported improvements in cognitive function among patients with depression and dementia.[13,14]
• Do I need to continue taking medication after TMS? It depends on the individual patient. TMS is commonly used in combination with medication to optimize treatment outcomes, and medication does not necessarily need to be discontinued. However, in some cases, the dosage may be reduced after a good response to treatment.[3,5,6]
• Is TMS suitable for treatment-resistant conditions? This is one of the key indications for TMS, particularly treatment-resistant depression (after ≥2 medications have been tried without adequate effectiveness). TMS provides a treatment pathway with a different mechanism of action.[5,6]

The brain is not an unchanging black box.

Modern neuroscience has demonstrated that the brain can change, reorganize, and recover — when it receives the right intervention at the right time.

If you or a loved one is undergoing treatment for a neurological or psychiatric condition but has not achieved the expected results, talk to your doctor about TMS therapy.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.

9. References

• [1]  Pell GS et al. (2010). Modulation of cortical excitability induced by repetitive transcranial magnetic stimulation: influence of timing and geometrical parameters and underlying mechanisms. Progress in Neurobiology. doi:10.1016/j.pneurobio.2009.10.003
• [2]  Wang JB et al. (2024). Effects of transcranial magnetic stimulation on the human brain recorded with intracranial electrocorticography. Molecular Psychiatry. doi:10.1038/s41380-023-02190-8
• [3]  Iglesias AH. (2020). Transcranial Magnetic Stimulation as Treatment in Multiple Neurologic Conditions. Current Neurology and Neuroscience Reports. doi:10.1007/s11910-020-01042-4
• [4]  Zewdie E et al. (2019). Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single centre evidence from 3.5 million stimulations. Brain Stimulation. doi:10.1016/j.brs.2018.12.002
• [5]  Fitzgerald PB et al. (2006). A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression. American Journal of Psychiatry. doi:10.1176/ajp.2006.163.1.88
• [6]  Morriss R et al. (2024). Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nature Medicine. doi:10.1038/s41591-024-02975-y
• [7]  Carmi L et al. (2019). Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. American Journal of Psychiatry. doi:10.1176/appi.ajp.2019.18101180
• [8]  Silva VA et al. (2025). Motor cortex repetitive transcranial magnetic stimulation in fibromyalgia: a multicentre randomised controlled trial. BJA: British Journal of Anaesthesia. doi:10.1016/j.bja.2024.09.031
• [9]  Chou YH et al. (2015). Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Neurology. doi:10.1001/jamaneurol.2014.4380
• [10]  Zhang W et al. (2022). Efficacy of repetitive transcranial magnetic stimulation in Parkinson's disease: A systematic review and meta-analysis of randomised controlled trials. eClinicalMedicine. doi:10.1016/j.eclinm.2022.101589
• [11]  Zhang J et al. (2021). Effects of repetitive transcranial magnetic stimulation (rTMS) on aphasia in stroke patients: A systematic review and meta-analysis. Clinical Rehabilitation. doi:10.1177/0269215520950324
• [12]  Hofmeijer J et al. (2023). Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope?. Stroke. doi:10.1161/STROKEAHA.122.040282
• [13]  Chou YH et al. (2019). A systematic review and meta-analysis of rTMS effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease. Neurobiology of Aging. doi:10.1016/j.neurobiolaging.2018.10.010
• [14]  Pagali SR et al. (2024). Efficacy and Safety of Transcranial Magnetic Stimulation on Cognition in Mild Cognitive Impairment, Alzheimer Disease, Alzheimer's Disease Related Dementias, and Other Cognitive Disorders: A Systematic Review and Meta-Analysis. International Psychogeriatrics. doi:10.1017/S1041610224000231

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.