The Magic of Science and How TMS Saved Me

I used to hate magic shows.

Nothing frustrated me more than trying to figure out how the guy removes the beautiful woman from the box on stage, only to wow the audience moments later by revealing her—in the flesh—sitting in the theatre’s balcony with a big smile on her face. Magicians will never tell you their secrets, they will never disclose how the rabbit got in the hat, much less how he pulled the poor thing out of it. The stock answer, if ever asked, is a smug, “It’s just magic!”

Many years ago I attended a magic show where the showman singled me out of the audience to be his “assistant.” I climbed up on the stage quite sure I’d get the inside scoop on his tricks. I struggled to concentrate while watching the magician’s nimble hands snip a rope into two parts and then deftly join the cut ends back together. When he ceremoniously yanked on the rope to prove to me and to the audience how fantastic his stunt really was, my frustration at not catching how he pulled it off settled it — I was done with magic and magicians! I stopped attending magic shows from then on because they ticked me off far more than they entertained me.

But just as with magic tricks, things in life aren’t always what they seem.

I’ve since discovered that many things in my life have been an illusion, especially traditional treatment for major depression. After multiple, futile trials of medications that were supposed to be the real deal in restoring my mental health prior to and following an unsuccessful suicide attempt, my sister serendipitously came upon a magazine ad for transcranial magnetic stimulation. The headline read: “Treat Depression Without Medication.” I was desperate for anything to pull me out of my emotional abyss, and I had been convinced—along with millions of other people—that medications or ECT were the only therapy options available. The concept that invisible magnetic pulses penetrating my skull could erase all my misery seemed like it might be, well, magic.

Martha Rhodes Photograph

Martha Rhodes and Josie

The F.U.D. Factor immediately set in: Fear, Uncertainty, and Doubt. But such is the case with all new technologies, that is, hoping it would work, trusting it was a bona fide, proven and effective treatment, worrying if it was safe. At the time I started treatment in May 2010, TMS had only been FDA cleared eighteen months earlier. There was no layperson literature available to educate me, and little to no anecdotal data regarding efficacy and/or risk. My decision to pursue TMS was based purely on crossed fingers and blind faith that the wizards behind the curtain would help me along the yellow brick road to achieving mental healthfulness.

As a patient who had given up on life altogether, I found myself struggling with that nagging FUD Factor and wondering, “How the heck is a four-second tapping on the outside of my head going to take all this hopelessness and sadness away?!” Swallowing a pill every morning is a tangible thing. You see it, you gulp it down with cold water, you know it’s going into your bloodstream and it will hopefully do the trick. TMS is far more discreet and mysterious. The fact that it’s based on invisible magnetic pulses automatically lends itself to the realm of magic in a patient’s mind. However, it may be invisible and non-invasive—but science proves it works. And my own full remission from depression with TMS therapy is further proof.

Many people in life are not what they seem to be, either—family, friends, strangers, and casual passersby included. In the midst of my own crowded life, I realize how alone a depressed person can feel even when he or she may appear to be upbeat and happy. Just as I did, other people can magically disguise their true emotions and trick the world by hiding the hopelessness and isolation they feel. But undiagnosed, untreated depression is a dangerous illness that demands serious attention and a therapy that effectively dispels the all-consuming darkness.

I’ve come to accept that it’s people who make the magic in life happen. In my case, it is a union of brilliant scientists, doctors, health care professionals, family, and friends who have proven this scientifically, philosophically, spiritually, emotionally, and physically.

I’m thankful for the genius and perseverance of the many Emory scientists, researchers, and administrators who have brought TMS to treatment resistant depressed patients such as myself. I’m not a scientist and never will be. I’m one of the stricken, an ostensibly “okay” kind of gal whose brain goes on the fritz every now and then, who gratefully accepted the Office of Technology Transfer Director, Todd Sherer’s invitation to come to Emory and work with Linda Kesselring on the “Put a Face On It” TMS project, and to meet Dr. Chip Epstein who invented the NeuroStar TMS® technology. While I had been an advocate for TMS for several years I didn’t know the whole story behind the development of this treatment, Emory’s role, nor what technology transfer was. The project was a wonderful experience for me and as a patient meeting one of the key developers behind the treatment that has saved my life—that’s pretty special.

TMS is no magical trick, it is the newest, safest, and least invasive alternative to traditional depression therapies that deserves the enthusiastic endorsement of the entire healthcare community for the sake of over 4.5 million patients who are suffering with treatment resistant major depressive disorder.

I am so grateful that I didn’t allow not knowing how TMS works to deter me from trying it six years ago. Things aren’t always what they seem, so it is in the hoping, trusting, and entertaining the mere possibility that something—visible or invisible—can be real and valuable enough to make life worth living.

I will never know how the magician works his illusions. He will never tell me. I must accept this as the unspoken law among the wizards of the world. But thanks to TMS, I’ve learned to accept the unseen, to trust that it is not for me to know how everything in life works, so that I can simply enjoy the show.

– Martha Rhodes

There are six videos on the Emory’s TMS technology listed below:

This piece is one in a series of four blogs related to Emory’s TMS technology. They look at the development and management of the technology, its impact, and this project from several points of view.

It Started in My Basement, Now it Improves Patients Lives

Charles M. Epstein, MD, or “Chip” as he’s been known since childhood, is a professor of neurology specializing in epilepsy and the founder of  the Laboratory for Transcranial Magnetic Stimulation (TMS). He is also a co-inventor for the technology that is utilized by Emory partner Neuronetics, Inc in their NeuroStar TMS Therapy® for treating depression. Neuronetics has safely administered more than 10,000 NeuroStar TMS Therapy® treatments with clinically significant results: among patients studied, 54 percent responded to the therapy and 33 percent found their depression in remission.

Neurostar wasn’t the first technology you were involved with. Could you tell us about some of your previous technologies?

Charles Epstein, MD

Charles Epstein, MD

NeoControl was actually the first magnetic technology that went on the market thanks to Neotonus. This company was the first to develop TMS to treat urinary incontinence in women.

World wide, women have been more prone to urinary incontinence than men. This was especially true after childbirth and before modern obstetrics. Using electromagnetics, treatment is much more comfortable than prior methods. The magnets work right through clothing and are essentially painless. This was the foundation of Neotonus’ technology, NeoControl. Unlike brain stimulation, TMS in the pelvic area takes even more power and without our technology, would have been impractical. The company was moderately successful with sales primarily in Asia, but ultimately went out of business during the recent recession.

Does TMS have a role in your current research?

I continue to use TMS in several kinds of brain research, and am beginning a preliminary collaboration to explore its potential for experimental stroke treatment. My “day job” is epilepsy. TMS hasn’t been used as much in the epilepsy field, though, and the reason for this is a bit complicated.

In simple terms, we don’t use TMS for epilepsy as much because epileptic seizures often come from too deep in the brain and are difficult for us to reach. Often times we don’t even know precisely where the seizures are coming from, so we wouldn’t know where to aim with the stimulatoror be able to guarantee that we could cover a big area.

Do you think TMS could be used to treat other medical conditions?

With other conditions, the data is promising but too limited to know exactly how effective it is. Far more conditions have been reported to respond to TMS than I think are likely to hold up, but there’ll need to be more studies to determine that.

How did your work with magnets come about and progress?

The funny thing is, the basis of this technology is something I put together in my basement. The coil is the key; it’s what makes NeuroStar so much more reliable and cheaper to build.

To give you a sense of the power requirement for TMS, think about this: A standard light bulb uses 100 watts of electrical power. 100 watts gives you a fair amount of light. TMS comes in pulses, usually 10 pulses over and over. For other systems, a single pulse requires up to 5 million watts. That’s 50,000 standard light bulbs going off all at once for a tiny fraction of a second, a ten-thousandth of a second, to be exact. Now, to do that takes a lot of power and generates a lot of heat. What we’ve invented takes a quarter of the power, and produces eight times less heat on a person’s head. We no longer need to keep air and water running around the coil to cool it.

What is it like to work on a project and meet a patient whose life has been changed by your technology?

TMS Prototype Photograph

First Magnet Prototype for TMS

What’s it like to work on a project and meet a patient? It’s fantastic! To have built something in the basement that is out there treating thousands of people and making them better and changing their lives is amazing. And, even by extension, making it possible for other magnetic stimulators to make lives better – because likely none of them would have been cleared for sale if it weren’t for NeuroStar – is positive.

In general what was the process of creating NeuroStar like?

Well, science and medicine are a lot more chaotic and random than they appear from outside. And what you see in pictures is older scientists frowning in white coats. What people don’t see often enough is that science is actually fun, along with hard work. That fun and playfulness are fundamental to a lot of new things, and were fundamental to NeuroStar. I was essentially playing in a lab and in my basement with a different goal, and with no idea what this coil would lead to. Alexander Fleming is famous for the fact that he was playing with bacteria when he created penicillin. A big part of discovery is play. This has been fun from beginning to end, and hopefully we’re not at the end.

What has been the most satisfying part of seeing NeuroStar hit the market?

My job is to make people better and it’s very gratifying that NeuroStar has multiplied the number of people I can make better by hundreds and thousands. That’s a great feeling that I don’t think I would have experienced otherwise.

There are six videos on the Emory’s TMS technology listed below:

This piece is one in a series of four blogs related to Emory’s TMS technology. They look at the development and management of the technology, its impact, and this project from several points of view.

Case Managers’ Reflect on Their Time with TMS

OTT’s first disclosure from Charles “Chip” Epstein, MD related to his work with an iron core stimulation coil was received in the spring of 1995, with a second disclosure related to transcranial magnetic stimulation (TMS) coming along in late 1997. These were not only the early days for the technology but also the early days of our budding Tech Transfer office. The technology looked promising since it was both the first magnetic stimulator to utilize an iron core design which enabled improvements in power efficiency, heat generation, focal stimulation, and costs. Recognizing these benefits, OTT decided to pursue patent protection resulting in two primary patent families; one focused on stimulating the nervous system and the other on stimulating the brain.

TMS Prototype Photograph

First Magnet Prototype for TMS

These two disclosures formed the foundation of technologies licensed to two Emory start-ups Neotonus and Neuronetics and the winding path for a successful TMS treatment for depression began. Originally Neotonus licensed both patent families in late 1996 and launched into product development. The company’s primary focus was on their NeoControl system which was a non-surgical, non-invasive, painless treatment for female urinary incontinence also involving TMS. The system received FDA clearance in 2000.

Orman Simpson Photograph

Orman Simpson

When Neuronetics came along in 2001, it was an opportunity to split Chip’s two magnetic stimulation technologies between two companies, each working in the two differing fields of use. Following some negotiations, Neotonus agreed to return the patent rights to the transcranial magnetic stimulation technology. “It was good fortune for all involved that the two fields-of-use could be separated into two different patent families. Given the level of time, effort, and resources required for a start-up to get a product to market this allowed each company to narrow its focus; it was a “win-win-win” for everyone” recalls Orman Simpson the former case manager in OTT.

Once the rights and licenses had been sorted out, product development continued at Neuronetics ultimately leading to the NeuroStar TMS Therapy®. In 2004 the company embarked on its largest clinical trial at that time, using the device to treat major depressive disorder; in 2008 it received FDA clearance and in 2011 an insurance reimbursement code. “The staff were always joking and asking to try on the first TMS prototype which we affectionately referred to as the ‘helmet’ says Connie Newsome, program associate in OTT.

Jennifer Sherer Photograph

Jennifer Sherer

“In the end one of the elements that may have pushed TMS to success was an insurance reimbursement code allowing patients an opportunity for coverage” says Jennifer Sherer, former OTT case manager “because as you can imagine, if insurance isn’t going to pay for it, that limits the treatment and the impact.”

Technology transfer is a high risk, high reward business, it’s more than just evaluating technology, filing for patents, marketing, and negotiating an agreement. “So often the focus is on getting the deal, and yes, that is a critical component, but the real work starts after the license” says Cale Lennon, current OTT case manager. Following licensing and throughout the development process, the University, OTT, Chip, and Neuronetics continued to work together supporting various parts of the process of getting a product to market.

“The experience reminded me that technology transfer from the university into commercial reality is far more than just licensing. It’s easy to get caught up in the art of negotiating and crafting the agreement, but technology transfer is a people thing. What I remember most were all of the discussions with each of the parties involved and how they all worked through the process with me in a very helpful, positive, and cooperative way” says Simpson.

Almost every success story involves a long and winding road, and this one was no different. When universities license to a commercial partner, the discovery is not ready for the market; there are many years of additional research and development layered on top of that basic scientific breakthrough. In this case it took two start-ups, half a dozen agreements, 13 patent applications, and more than a decade to be successfully treating patients.

“In technology transfer you work with a lot of really interesting technology but unfortunately a lot of it doesn’t make it to the market, so seeing something make it thru and impact people’s lives is incredibly fulfilling, even when you’ve only played a very small part, as we have” says Sherer. “It’s just a bonus when the inventor is someone as passionate and supportive as Chip.”

There are six videos on the Emory’s TMS technology listed below:

This piece is one in a series of four blogs related to Emory’s TMS technology. They look at the development and management of the technology, its impact, and this project from several points of view.