Personalized Approach to Brain Health

“I understood the logic of the process and treatment; my wife was my early adopter, and I just followed orders. But honestly, the results were unexpected. Having no known trauma or injury, except for many years of fairly high stress, I figured I might sleep better. Instead my thinking is relaxed and focused. My level of mental athleticism is much higher. Stamina, agility, quickness, vision, it makes me happy to use my brain. Any useful wisdom gained over the years is now complemented by youthful mental energy and flexibility. (I actually hear better too. So music sounds better. But, per my wife, my selective hearing has not improved.) Now I have the responsibility to manage this renewed capability. An invigorating challenge and opportunity. Thank you BHH.” ~G.Y. October 2021

Treatment is safe, painless and non-invasive and typically takes 25-35 minutes per session, Monday through Friday, for 6-8 weeks.  The goal of treatment is to improve brain health, rhythm and functioning as measured by neurocognitive scores, brainwave analysis and mapping, and subjective report of the patient.

Transcranial Magnetic Stimulation is a non-invasive, drug-free brain treatment that is FDA cleared for treatment of Depression, Migraine headaches, and Obsessive-Compulsive Disorder. The neuromodulation equipment used by Dr. Keifer has been cleared by the FDA, and may be used off label for other symptoms and conditions in the practice of medicine. At leading medical centers on he mainland & ongoing phase 3 trials in the U.S., and clinical practice in Europe, TMS is demonstrating measurable positive outcomes in patients suffering from PTSD, mood disorders, autism, chemo-brain, postpartum depression, concussion, and other neurologic conditions.

Most current treatments in neurology and mental health involve pharmaceuticals and largely rely on a one size fits all approach. If you are looking for a more personalized approach to your health contact Dr. Keifer. We will individualize your treatment targeting your unique brain and what it needs to restore health and optimize performance.

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TMS

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique used to treat various psychiatric and neurological conditions. It involves applying recurring magnetic pulses to brain regions, typically the left dorsolateral prefrontal cortex, to modulate cortical excitability.

How rTMS Works

rTMS uses magnetic pulses, leading to neuronal depolarization and modulation of brain activity. The treatment can be classified into two main types:

1. High-frequency rTMS (>1 Hz): Increases cortical excitability
2. Low-frequency rTMS (≤1 Hz): Decreases cortical excitability

Evidence for rTMS in Adult Depression

Several studies have demonstrated the efficacy of rTMS in treating depression, particularly in cases resistant to conventional treatments:

1. Efficacy in Clinical Trials: Multiple randomized controlled trials have shown that daily left prefrontal TMS over several weeks is effective in treating depressive symptoms, with remission rates of 30-40%
2. Real-World Effectiveness: Observational studies in clinical settings have reported similar efficacy rates, with 58% of patients responding to treatment and 37% achieving remission
3. Comparison to Sham Treatment: Meta-analyses have consistently found rTMS to be superior to sham treatment, with odds ratios for response and remission ranging from 3 to 5
4. Durability of Effects: The antidepressant effects of rTMS appear to be as durable as those achieved with other antidepressant interventions, with many patients maintaining improvement for months to years after treatment
5. Treatment-Resistant Depression: rTMS has shown  promise in treating patients with treatment-resistant depression, who have failed to respond to multiple antidepressant medications

TMS can be used in Children and Teens →

Safety and Side Effects

rTMS is generally considered safe and well-tolerated. Unlike electroconvulsive therapy (ECT), it does not require anesthesia or cause seizures or memory loss. Common side effects are typically mild and may include scalp discomfort at the site of stimulation and headache.

FDA-Approved Conditions for TMS

• Major Depressive Disorder (MDD) – TMS was first approved by the FDA for treating Major Depressive Disorder in 2008.
• Obsessive-Compulsive Disorder (OCD) – In 2018, the FDA permitted marketing of TMS for the treatment of Obsessive-Compulsive Disorder.
• Depression with Comorbid Anxiety
• Smoking Cessation
• Migraines
• Adolescent Depression – In 2024, the FDA cleared TMS as an adjunct treatment for adolescent patients aged 15 and up with Major Depressive Disorder.

Other Applications

While depression is the most well-studied application, rTMS has also shown promise in treating other conditions:

• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Migraine
• Smoking cessation
• Post Concussion
• ADHD

Research and clinical treatments are ongoing in the US treating additional psychiatric and neurological disorders.

Transcranial Magnetic Stimulation (TMS) has been approved for several conditions in Europe.

Approved Conditions for TMS in Europe

• Major Depressive Disorder (MDD)
• Depression with Comorbid Anxiety
• Obsessive Compulsive Disorder
• Alzheimer’s disease
• Autism
• Bipolar Disorder
• Chronic Pain
• Parkinson’s disease
• Post-traumatic Stress Disorder (PTSD)
• Schizophrenia (negative symptoms)
• Smoking cessation
• Stroke
• Multiple Sclerosis

PrTMS: A Personalized Approach to Brain Health

In recent years, brain health has become a key focus for understanding, assessing, and enhancing overall well-being. Among the most innovative treatments available are Transcranial Magnetic Stimulation (TMS) and its advanced, more personalized dosing version, Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS). While both treatments share FDA-cleared technology and aim to improve neural function, PrTMS stands out through its tailored approach and clinical outcomes.

What is TMS?

TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the left dorsolateral prefrontal cortex (L-DLPFC), a region of the brain thought to play a key role in mood regulation. Primarily used to treat conditions like depression, L-DLPFC TMS delivers repetitive magnetic pulses to activate underactive brain regions. By enhancing neural activity in this area, TMS has been proven effective in alleviating symptoms and promoting emotional well-being.

PrTMS: A More Tailored Approach to Brain Health

Building on the foundation of standard L-DLPFC TMS, PrTMS introduces an important layer of customization. Like standard TMS, it uses FDA-cleared magnetic pulse technology but incorporates a more fine tuned approach to dosing and augmentation to promote optimal results for each individual.

How Does PrTMS Process Work?

Before treatment begins, we use a spectral analysis EEG brain map to measure your brain’s activity. This “brain map” reveals unique features of your brain function, providing personalized data to fine tune TMS dosing to your specific neural patterns. Just as precise medication dosing can make a difference in treatment outcomes, small but strategic adjustments in TMS dosing are central to PrTMS, enhancing its clinical effectiveness and durability based on our experience tracking outcomes over years in thousands of people.

PrTMS vs Standard TMS?

Personalized Treatment

PrTMS is tailored to your unique brain activity patterns, offering more effective and durable results compared to standard dosing in our experience with thousands of patients. 

Improved Outcomes

Small, personalized adjustments in L-DLPFC TMS dosing with strategic augmentations have shown better clinical results in people with mood, anxiety, brain injury, memory and executive function challenges, autism, ADHD, Long COVID, MCI, and for people seeking brain enhancement.

Non-Invasive, More Comfortable

PrTMS is non-invasive, requiring no surgery or medication, and tailored dosing makes it more gentle, minimizing adjustment effects, and allowing for use in children and people with tactile sensitivity.

Taking the Next Step

If you or a loved one is struggling with depression, anxiety, brain injury, PTSD, ADHD, Long COVID, or memory issues, or is looking to improve brain health and function, Brain Health Hawaii offers a promising, personalized option with proven results.

Explore PrTMS Today

Contact us to schedule a brain map assessment and learn more about how PrTMS can help you achieve improved brain health.