TMS Articles
Learn more about different aspects of accelerated fMRI-guided TMS. See if treatment can help you live the life you want to live.
If depression keeps holding you back, you’re not alone—and you’re not out of options. Our non-invasive treatment uses advanced brain imaging to guide a highly targeted form of TMS therapy. The result? A faster and more effective path to feeling like yourself again.
Grey represent fMRI guided TMS and black is sham treatment. (Cole et al 2022)
"Cognitive FX gave our daughter her life back! ... Cognitive FX is incredible; I can not adequately put into words how much we believe in their recovery program. We love the staff, and diagnostic measures, the recovery program, and the post-care follow up. I honestly can not think of one negative thing to say. The therapists are so attentive, skilled, caring and fun. Dr. Fong and RN Kaydee Severs are so incredibly smart, thorough in their explanations and exceptionally compassionate."
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"Everyone was super nice and encouraging. The therapies were tailored to my individual strengths, weaknesses, and needs. I have had significant improvement and my last FMRI came back looking significantly better than the first one. I feel like I am getting back to my old self after nearly 5 years of problems and pain. I'm so grateful to everyone at Cognitive FX who helped me on my journey!"
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"This place saved the life of someone we love. I was so impressed with the level of professionalism and care that we received. This facility is a blessing and I wouldn't hesitate at all to work with this team."
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"Cognitive Fx is a great place to receive treatment for post-concussive syndrome. They definitely listen to all the symptoms you experience in an objective manner. Their exams provide great validation of the weird post-concussive symptoms that neurologist typically have a hard time diagnosing. Also, just after a few days of treatment, I began noticing improvements on my symptoms. I’m very thankful for Cognitive Fx and I look forward to their science and research being utilized more in the treatment of brain injuries and complications."
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"...EPIC treatment at Cognitive FX was a lifesaver. I was shocked at how much better I felt after my week there! The fog lifted and the fatigue finally began to let up. I could focus, read, and attend better. I felt like myself! When the fNCI scan scientifically backed up what I was feeling, I cried with joy! The entire team is great! Everyone was so caring and helpful! The value of brain function is well worth the cost. I would recommend anyone who is struggling with PCS to meet with Dr. Fong. It was worth every penny I paid and more! I continue to work the program for brain health given to me when I completed the treatment."
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"Best decision of my life, great experience, absolutely the best staff in health care, learned more about my injury than I would’ve dreamed of and got to know people that have gone through the same hardship as me, very helpful! If you’ve been suffering with PCS, think no further!"
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"I found this clinic during an online search of my symptoms. These guys are the first people to have ever taken me seriously and are some of the kindest human beings I have ever met. The program is extremely intensive and while I have not recovered fully yet, I feel like I have hope for the first time in 5 years. They give you a customized program to follow when you go home and I hopeful that by following this I will continue to improve. If you are struggling with brain function issues, please give them a shot - they are expensive but truly the best of the best."
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"This therapy treatment program was a lot of work but after just my first 2 days I had already seen so many positive impacts in my health. My body started to begin functioning like it did before my concussion. Everyone was very helpful and patient with me. I also loved that all the treatments were catered to my physical needs everyday."
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I cannot rate Cognitive FX highly enough! Their accelerated TMS treatment proved to be incredibly effective with clear results. The staff were approachable and friendly, happy to assist in any way possible, making sure my every comfort and need were being met. They were careful to collect all the fMRIs and other information they needed before starting treatment. The treatment itself took five, eight-hour days and I had a reliable schedule created for me, treatments intermittent with exercise, therapy, massage sessions, and time just to relax and take a break. Food was provided for lunches as well as snacks any time I wanted. The accelerated TMS, while not a comfortable treatment, was made better by the staff taking feedback and adjusting the machine accordingly and entertaining me through each ten minute session. This treatment and facility went above and beyond my expectations. Cognitive FX turned out to be the miracle I needed and it's my hope that more places like Cognitive FX will make this treatment accessible to anyone who needs it.
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Accelerated fMRI - TMS | Magnus Saints TMS | |
---|---|---|
FDA Approved iTBS | ✔ | ✔ |
FDA Approved Neuronavigators | ✔ | ✔ |
FDA Approved Figure 8 Coils | ✔ | ✔ |
Number of Treatment Days | 5 | 5 |
Treatments per Day | 10 | 10 |
Total Treatments | 50 | 50 |
Number of TMS Pulses | Approx 90,000 | 90,000 |
Resting motor threshold pulse intensity | 90-120% | 90-120% |
FDA Approved Personalized DLPFC Targeting | ✘ | ✔ |
Personalized DLPFC Targeting Assists Doctor in target location. | ✔ | ✘ |
Personalized E Field Coil orientation | ✔ | ✘ |
Cost | $7,000 to $12,000 | $30,000+ |
TMS is a non-invasive outpatient procedure that uses magnetic fields to stimulate a part of the brain that’s consistently impacted by major depression. The brain region it targets is called the dorsolateral prefrontal cortex (DLPFC), which is associated with a patient’s ability to feel positive feelings such as reward and motivation.
During a TMS treatment session, an electromagnetic coil is positioned over the patient's head, directly above the DLPFC, and magnetic pulses are delivered at specific intervals to stimulate the neurons in that area. The result is TMS-induced plasticity that increases neural activity in that region, which can help alleviate symptoms and improve mental health in depressed patients.
TMS is a very safe protocol. Less than one in 10,000 treatments has an adverse outcome; the most commonly reported side effects are headache, scalp tenderness, and muscle twitching during treatment.
SAINT treatment, which stands for Stanford Accelerated Intelligent Neuromodulation Therapy, uses proprietary software developed by Magnus Medical to analyze fMRI data and pinpoint the ideal stimulation site in the dorsolateral prefrontal cortex. This software uses a specific algorithm to identify the brain area most anti-correlated with the subgenual anterior cingulate cortex (sgACC), which is believed to drive depression symptoms.
At Cognitive FX, we also use fMRI scans to determine the optimal stimulation site, but our approach relies on clinical expertise rather than Magnus Medical’s proprietary algorithm. A trained neuroscientist and physician use advanced post-processing of each patient’s brain to identify the ideal target based on functional connectivity patterns. While the methodology differs slightly, the end result—precision targeting of the DLPFC using fMRI—is functionally the same.
This distinction is similar to the difference between a brand-name medication and a compounded version: same active components and clinical intent, just without the proprietary branding. Cognitive FX has been providing clinical fMRI scans for over 10 years and has developed many of the tools needed to process scans in-house, avoiding expensive licensing fees. Allows us to provide the individualized target location at a lower cost.
TMS has been around for over 20 years. rTMS, the most common type of TMS, is delivered once a day for six weeks. fMRI-guided Theta Burst TMS is administered in 10-minute sessions, 10 times a day for one week. This new approach has been shown to almost double the efficacy of treatment. 79% of patients reported their depression in remission after treatment.
For patients with depression or treatment-resistant depression, the target site is called the Dorsolateral Prefrontal Cortex (DLPFC). This site is found in rTMS therapy by finding the motor cortex and measuring down 5.5cm. This approach can lead to many different targets based on head size and shape, which vary from patient to patient. Functional magnetic resonance imaging allows us to precisely target the DLPFC and ensure we place the TMS coil in the right location every time.
Chen et al 2024
Treatment will last one week, 10 hours a day. The stimulation protocol will last about 12 minutes each hour, and then the remaining time will be used for cardio or rest. You will have your own private room to relax in during the rest period of treatment.
If you are dealing with symptoms of depression, TMS treatment could be right for you. If SSRIs haven't worked or you don't like the way you feel on medication, TMS could be a good option. As of now, fMRI-guided TMS is the most effective treatment option for those dealing with depression.
Pricing ranges from $7000 to $12000, depending on what other services you might need. Given the recent FDA clearance of fMRI-guided Theta Burst treatment, most insurance companies have yet to add it to the formularies they cover. Medicare covers in-hospital treatment for $19,703.00. Treatment is eligible for HSA and FSA reimbursement.
Currently, insurance only covers the rTMS protocol, which takes six weeks and is about 45-50% effective. If you need to pay via insurance, we have a sister clinic that offers rTMS treatment. Compared to other forms of TMS, you’re also likely to find a clinic offering rTMS closer to where you live.
Learn more about different aspects of accelerated fMRI-guided TMS. See if treatment can help you live the life you want to live.
DISCLAIMER: SAINT™ is a trademark of The Board of Trustees of the Leland Stanford Junior University (“Stanford”) and has exclusively licensed such mark to Magnus Medical. Cognitive FX is neither endorsed by Stanford nor utilizes Magnus Medical equipment nor claims to be offering the SAINT protocol as prescribed by Stanford University et. al. or Magnus Medical. We provide fMRI guided intermittent theta burst TMS with target locations determined by fMRI and our prescribing physician.