Comparing TMS Machines

An Introduction

Apollo: The Apollo TMS therapy system is developed and manufactured in Germany by Mag& More, a TMS specialist with more than 15 years of experience. Apollo is designed to make TMS therapy easy and intuitive to use for the operator. In May 2018, Apollo received FDA clearance for the 37.5 and 19 minutes treatment of Major Depressive Disorder [MDD] in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.

Bransway Deep: In January 2013, the FDA approved Deep TMS therapy developed by BrainsWay. Deep TMS therapy penetrates a deeper and boarder area of the brain than traditional TMS treatment. It treats adult patients suffering from Major Depressive Disorder who have failed to achieve satisfactory improvement through various antidepressant medication treatments. In August of 2018, BrainsWay became the only TMS provider FDA-cleared for treatment of OCD using Deep TMS therapy. It has been used to treat depression in several other countries and is currently under investigation for other conditions.

CloudTMS: CloudTMS is manufactured by Neurosoft, Ltd. a global leader in the development of TMS devices since 1996. The CloudTMS system has received FDA clearance for the 37.5 and 19 minutes treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode. CloudTMS has received regulatory clearances in more than 25 countries. 

Magstim: Magstim is the Brains behind TMS. This company pioneered Transcranial Magnetic Stimulation technology over 25 years ago. In 2019, Magstim received FDA clearance for StimGuide, the first TMS navigation system developed specifically for the clinical setting. StimGuide provides simple, precise and consistent coil positioning using 4 parameters to guide you. Also in 2019, Magstim received 510k clearance for a 3-minute protocol. In 2018, Magstim received FDA clearance for the Horizon Performance System, a next generation TMS Therapy offering, which features the Energy Recovery System, (ERS). This ensures consistent stimulation throughout a treatment. Horizon is cleared for the 3, 19, and 37.5 minute protocols and is indicated for the treatment of Major Depressive Disorder in adult patients who have failed prior antidepressant medications. Magstim received its initial FDA clearance to market the Rapid2 Therapy System in 2015.

MagVenture: MagVenture TMS therapy was used for the world’s largest randomized trial with TMS to date, comparing the standard 37 minute TMS protocol to the newer 3, minute Theta Burst protocol. The study concluded that the Theta Burst protocol is just as safe and effective as standard TMS. In 2018, MagVenture received FDA clearance for the 3 minute protocol which was market under the trademarked name Express TMS®. MagVenture also has FDA approval for the standard 37 minute protocol as well as the 19 minute protocol. MagVenture has been conducting research on TMS since 1992. 

Neurostar: In October 2008, the FDA cleared the NeuroStar Advanced Therapy brain-stimulating device for patients suffering from Major Depressive Disorder who have not improved from antidepressants. Neuronetics pioneered clinical TMS practice in the US and played a pivotal role in educating the public and clinicians on TMS. NeuroStar was first to receive FDA clearance for the 19-minute treatment time, and they provide the most comprehensive practice support and service program which guarantees 99% customer uptime. It's also the first device to offer both surface TMS and rTMS.

Nexstim: To personalize TMS for the treatment of MDD, Nexstim has developed SmartFocus™ technology. The Nexstim® NBT System 2 allows the physician to define the TMS target from a patient’s MRI scan and have visual confirmation that therapy is always on-target. SmartFocus™ uniquely allows the physician to personalize the TMS target and dose—and uniquely ensures that repeat TMS treatments are targeted to the prefrontal cortex with the precision demanded by neurosurgeons for preprocedural planning.

Are All TMS Machines Equal? 

A recent study found there to be a significant difference in the average time to remission between the NeuroStar and MagVenture machines. The study was conducted at CNI, using PHQ-9 scores and Log-Rank statistics to compare the remission rates of depression between the two machines. They found that patients treated using the MagVenture instrument experienced a shorter mean time to remission, higher overall 6-week remission rates, and augmented response rates to CBT. are all tms machines equal

Is Deep TMS and rTMS the Same?

After a large review of different TMS studies, it looks like deep TMS is more effective at treating MDD than rTMS. However, these study reviews are not the same as a head-on comparison. deep tms and rTMS Now looking at the effectiveness of deep TMS and rTMS by comparing Brainsway and Neurostar, there are pros and cons to both. Neurostar offers a low frequency cycle so you can target anxiety specifically as well as depression. The machine is also known to be very high quality. BrainsWay’s deep TMS technology has been known to properly regulate and stabilize neural activity. BrainsWay procedures have demonstrated an extremely high remission rate. Additionally, their equipment is smaller and more portable. If you just want a high chance of remission, brainsway may be for you. However data shows the relief from neurostar can be very long-lasting so if you want remission to last a long time, rTMS and neurostar may be for you. 

Common Terms

rTMS: repetitive TMS, this has better long term remission rates than standard TMS 

Deep TMS: TMS that penetrates deeper than standard TMS

H-coil: a coil set up in an H shape [brainsway uses this]

H1-coil: deep penetrating coil used in Deep TMS

Figure 8-coil: a coil set up in an 8 shape [Neurostar, Magstim, Magpro, and CloudTMS use this]