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Apollo TMS
Apollo TMS therapy system is developed and manufactured in Germany by MAG & More. Apollo is designed to make TMS treatment easy and intuitive to use for the operator and accomplishes this with the HANS (head and neck support) positioning system and touch based Patient Management System. In May 2018, Apollo received FDA clearance for both the 37.5 and 19 minutes treatment of major depressive disorder.
The Apollo TMS system is fashionable and aesthetically pleasing. The HANS positioning system ensures stimulation of the correct treatment spot by following head movement. The HANS rotates on an axis behind the patient’s head with alternatives for coil mounting. Apollo uses an F8 coil that is relatively quiet offers both repetitive (rTMS) and theta burst stimulation (iTBS).
Apollo uses a uniquely coated cooling system to cool the coil between treatment sessions. They do offer an air cooling add-on function to their coil, which seems to cool the coil quicker.
BrainsWay Deep TMS
In January 2013, the FDA approved Deep TMS (dTMS) therapy developed by BrainsWay, as Israel-based TMS device manufacturer. Brainsway has FDA clearance for depression, OCD, anxious depression, and smoking cessation. The device is also FDA cleared for theta burst stimulation (iTBS). BrainsWay uses a Hesel coil (H-coil).
The H-coil, which is incompatible with navigation systems, is housed in a helmet which delivers a broader and deeper stimulation. This type of stimulation increases the possibility of “hitting the correct target location.” This method of treatment also delivers a more powerful impulse during treatment. This could increase the chance of discomfort to the patient and put the patient at higher risk for seizure when compared to the standard focal TMS with a figure-of-8 treatment coil.
CloudTMS
CloudTMS is manufactured by Neurosoft, Ltd. a global leader in the development of TMS devices since 1996 with thousands of TMS machines operated in psychiatric and neurological clinics in the US and around the world. 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 an installed customer base of over 1500 devices worldwide and received regulatory clearances in more than 25 countries.
Magstim
Magstim is the Brains behind TMS. Magstim pioneered transcranial magnetic stimulation technology over 25 years ago. In 2019, Magstim received FDA clearance for StimGuide, the first TMS navigation-like system developed specifically for the clinical setting. In 2019, Magstim received 510k clearance for the theta burst stimulation (iTBS) 3-minute protocol. In 2018, they received FDA clearance for the Horizon Performance System, a TMS system that features the Energy Recovery System (ERS). The proprietary ERS software helps to enable a consistent stimulation throughout a treatment with no pulse decay.
The Magstim Horizon TMS system is cleared for the 3-minute, 19-minute and 37.5 minute protocols. Magstim received its initial FDA 510 (k) clearance to market the Rapid2 Therapy System in 2015.
MagStim uses an air-cooling system which facilitates cooling of the coil, but the air-cooled system can be quite loud.
H3 is their updated TMS system. It builds on the sound foundations of Horizon Performance with StimGuide and enhances the user interface software.
MagVenture TMS Therapy
MagVenture is a Denmark-based TMS device manufacturer and is a pioneer of TMS in Europe. The company sold their first TMS system to the Medical University of South Carolina (MUSC) in 1992, where Dr. Mark George (the godfather of TMS) practices and teaches. MagVenture has a long-standing legacy within the neuroscience community, providing TMS solutions to researchers since 1992.
MagVenture TMS Therapy® was used for the world’s largest RCT with TMS to date (Blumberger et al, 2018, The Lancet: “THREE-D: a randomised non-inferiority trial”), comparing the standard, 37-minute TMS treatment protocol to the newer, 3-minute theta burst protocol. The study concluded that the theta burst is just as safe and effective for the treatment of major depressive disorder as standard TMS. In 2018, MagVenture received FDA clearance for the 3-minute protocol which they market under the trademarked name Express TMS®. MagVenture is also FDA cleared for the standard 37-minute protocol and the 19-minute protocol. They also have FDA clearance for the MDD and OCD.
The company offers many coils for both research and outpatient treatment. MagVenture’s Brainsight or Locality neuro-navigation system can be added to their top-of-the-line TMS system. They collaborated with Axilum for a robotic arm. The robotic arm automatically changes the coil’s position based on patient movements and input from a navigation system. MagVenture uses a liquid cooling system, which enables quick cooling and back-to-back treatments without difficulty.
NeuroStar
Neuronetics, Inc., established in 2003, was the first TMS device manufacturer to receive FDA clearance with their NeuroStar system for the treatment of depression in 2008. For some time, Neuronetics was able to dominate the market, as they had no competition. It is important to know that Neuronetics did not invent TMS therapy, as it was initially developed in Europe.
NeuroStar uses a figure-of- 8 coil. The system offers three treatment variations: 1) the standard 37.5-minute session; 2) the DASH 19-minute sessions (it cuts the inter-train intervals from 26 secs to 11 secs); and 3) TouchStar™ Theta Burst, an iTBS protocol. NeuroStar doesn’t have a navigation system to ensure the placement of the coil. Instead, NeuroStar has a "Contact Sensing" to alert the treater if contact is lost.
Neuronetics has a hefty pay-per-use business model, meaning the TMS clinic must pay a fee for every TMS session before able to administer the treatment to the patient. This pay-per-fee use can equate to as much as 25-40% of revenue.
In May 2022, Neuronetics announced an FDA clearance for their F-8 coil to be used for OCD. In July 2022, they received FDA clearance for anxious depression.
NexStim
Nexstim is an innovative TMS device manufacturer based in Finland. To personalize TMS for the treatment of MDD, NexStim 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 precision.
SmartFocus™ was originally designed to assist neurosurgeons with brain mapping prior to surgery. This technology requires a specific structural MRI of the brain for ‘true’ neuronavigation. The NexStim TMS systems is FDA cleared for the treatment of MDD, and treatment protocols for theta burst stimulation, and neuronavigation.
TMS Therapy Systems Not Yet FDA-Approved
Magnus Medical
Magnus Medical is creating the next generation of neuromodulation technology to improve quality of life rapidly and effectively. The FDA has awarded Breakthrough Device Designation to Magnus Medical’s non-invasive technology to rapidly treat major depressive disorder (MDD) in adults who have not responded to antidepressant medication.
Use the below TMS Therapy Comparison Chart to help navigate your decision
TMS Systems | CloudTMS | Magstim | Magventure | Apollo | Nexstim | Brainsway | NeuroStar |
|---|---|---|---|---|---|---|---|
Per Session Fee | NO | NO | NO | NO | NO | YES | YES |
FDA-Cleared | YES | YES | YES | YES | YES | YES | YES |
Coil Type | Angle Fig. 8 | Flat Fig. 8 | Angle Fig. 8 | Flat Fig. 8 | Flat Fig. 8 | H-Coil | Curved |
Cooling System | Liquid | Air | Liquid | Liquid | Optional | Air | Air |
Patient Software | Included | Included | Available | Included | Included | Available | Included |
EMG Compatible | YES | YES | YES | NO | YES | NO | NO |
Neuronavigation | Compatible | Compatible | Compatible | NO | Compatible | NO | NO |
Chair Included | Sold separately | YES | YES | YES | YES | YES | YES |
A guide to making the best TMS device selection.
Here are a few key TMS system features to consider before purchasing a TMS therapy system
Cooling System – Be sure to choose a cooling system that best suits your needs. Liquid cooled systems tend be quieter and allow for back-to-back treatment. This doesn’t mean a liquid-cooled system is better overall than the other systems. All devices may have pros and cons which varies from provider to provider depending on a number of variables.
Patient Database – It is important to track each patient’s treatment status and record their improvement.
No Per Session Cost – A pay-per-use treatment cost can dip into your revenue as much as 40%. Be sure this is the business model you want before diving in.
Support and Warranty – Be sure to partner with a TMS manufacturer who stands by their warranty. Do they answer the phone when you call? Can they offer quick repairs to ensure your practice is always up and running without delays in patient care?
