Talk:Transcranial magnetic stimulation/Archive 3

Location of devices section
I think that for this article, it makes sense to have a brief description of what the device is and how it is used at the top of the article, to orient the reader. This is pretty arcane technology, not like a pill you take, So I moved that section to the top. In this dif, moved it to after the medical use section. Doc do you see my reasoning for moving this up? Thanks! Jytdog (talk) 14:27, 2 January 2015 (UTC)
 * We discuss what it is in the lead thus not convinced it needs to come first. Feel free to restored if you feel strongly. Best Doc James  (talk · contribs · email) 20:55, 2 January 2015 (UTC)

FDA approval
Since when is there an FDA approved therapy and what kind of stimulation is used in both (MDD, migraine) cases? -- Amtiss, SNAFU ? 21:09, 13 February 2015 (UTC)

Suggested edits to the TMS Page
Dear User:Doc James,User:Jytdog

I'd like to suggest two edits edits to the page; please note that these edits were requested by Neuronetics. I've tried to maintain a neutral point of view; please let me know if you have any objections. The required references are provided in line for these edits.

Thanks for your inputs!

Protein3EFN (talk) 11:29, 27 February 2015 (UTC)

1) Medicare Section

Current Text:

There is no national policy for Medicare coverage of TMS in the United States. Policies vary according to local coverage determinations (LCDs) that Medicare administrative contractors (MACs) for the Centers for Medicare and Medicaid Services (CMS) make for geographical areas over which they have jurisdiction. CMS presently has ten to fifteen MAC jurisdictions that each cover several U.S. states.

LCDs for individual MAC jurisdictions can change over time. For example:

In early 2012, the efforts of TMS treatment advocates resulted in the establishment by a MAC with jurisdiction over New England of the first Medicare coverage policy for TMS in the United States. However, a new MAC for the same jurisdiction subsequently determined that Medicare would not cover services for TMS performed in New England on or after October 25, 2013. In August 2012, the MAC whose jurisdiction covered Arkansas, Louisiana, Mississippi, Colorado, Texas, Oklahoma and New Mexico determined that, based on limitations in the published literature there was insufficient evidence to cover the treatment, but the same MAC subsequently determined that Medicare would cover TMS for the treatment of depression for services performed within the MAC's jurisdiction on or after December 5, 2013. In December 2012, Medicare began covering TMS for the treatment of depression in Tennessee, Alabama and Georgia. CMS maintains a searchable database that enables users to find current Medicare LCDs for TMS for individual U.S. states.

Proposed Text:

Medicare policies vary according to local coverage determinations (LCDs) that Medicare administrative contractors (MACs) for the Centers for Medicare and Medicaid Services (CMS) make for geographical areas over which they have jurisdiction. CMS is currently engaged in a MAC consolidation strategy, moving from 15 A/B MAC jurisdictions to 10 A/B MAC jurisdictions.

The majority of the Medicare contractors cover TMS therapy for the treatment of depression, including:


 * Cahaba (Georgia, Alabama, Tennesee)
 * Novitas (Pennsylvania, New Jersey, Delaware, DC, Arkansas, Louisiana, Mississippi, Texas, Colorado, Oklahoma and New Mexico)
 * NGS (Massachusetts, Rhode Island, New Hampshire, Vermont, Maine, Connecticut, New York, Illinois, Wisconsin and Minnesota)
 * First Coast Service Options (Florida, Puerto Rico and the US Virgin Islands).

CMS maintains a searchable database that enables users to find current Medicare LCDs for TMS for individual U.S. states.

2) Commercial health insurance section

Current Text:

In 2013, several commercial health insurance plans in the United States, including Anthem, Health Net, and Blue Cross Blue Shield of Nebraska and of Rhode Island, covered TMS for the treatment of depression for the first time. In contrast, UnitedHealthcare issued a medical policy for TMS in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.

Proposed Text:

Since 2010, commercial health insurance plans in the United States including Priority Health, Federal Employee Health Plan, Tufts, Health New England, Health Net, Anthem, EmblemHealth, Premera, MVP, Harvard Pilgrim, The National Association of Letter Carriers, and Washington State have begun covering TMS for the treatment of depression. (1) (2)  (3)  (4)  (5)  (6)  (7)  (8)  (9)  (10)  In addition, several Blue Cross Blue Shield plans including Nebraska, Rhode Island, Massachusetts, Blue Care Network (MI), Independence, CareFirst, Michigan, South Carolina, Alabama, HMSA,  HCSC (Illinois, Texas, Oklahoma, New Mexico and Montana), and Blue shield of California also cover TMS for the treatment of depression. (1) (2)  (3)  (4)  (5)  (6)  (5)  (7)  (8)  (9)  (10)  (11)  (12)  (13)  (14)  Optum Behavioral Health Solutions has published coverage criteria guidelines and it is the decision of each of the plans that are contracted with Optum to establish coverage. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. Other commercial insurance plans whose 2014 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.


 * Hi Protein3EFN, thanks for making the appropriate disclosure on your User talk page and here.
 * There are several problems with your proposed content, and I will not be implementing it. I recognize the existing content was crappy (I just edited it to improve it) and you were following that model.
 * It is clear that your client would like WP readers to know where TMS is covered and is not covered, and what plans cover it and what plans don't cover it, but WP is WP:NOTDIRECTORY and WP:NOTHOWTO and the article will never be a complete guide to where TMS is covered and what plans cover it.  Please do not try to use it that way.   The point of this whole insurance section, from the perspective of an encyclopedia is to help readers see that some insurance companies cover TMS treatment and some don't, at a high level, but with enough granularity to validate that.
 * Too much content about Medicare itself with too much jargon (i recognize you were following the lead of the bad existing text)
 * The proposed content about medicare coverage is not encyclopedic with regard to time - see WP:RELTIME
 * as mentioned above, we are not going to follow the blow-by-blow of various plans adding TMS and others cutting it. If the situation changes such that any of the plans that we mention as examples drops it or adds it, that would be good to hear about - we don't want anything here to be inaccurate. Jytdog (talk) 11:54, 27 February 2015 (UTC)
 * Suggestion too long and too complicated. As a paid editor would suggest small suggestions. Like replace sentence X with sentence Y supported by ref Z Doc James  (talk · contribs · email) 01:09, 28 February 2015 (UTC)

Suggested edits to the treatment section
Dear User:Doc James,User:Jytdog

Thank you for your comments, much appreciated!

There was an edit made to the treatment section by user Corker1 on the 19th of March this year, which removed references to APA and CANMAT. While I understand Corker1's point of view (the references did not, in fact, indicate endorsement of any kind by these organizations), would it be possible to rephrase the text instead? For your reference, I've mentioned the original text as well as the proposed updated version. Please note that, as before, this edit has been requested by Neuronetics.

Protein3EFN (talk) 10:31, 13 April 2015 (UTC)

Original Text:

For treatment-resistant major depressive disorder, HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) is effective and low-frequency (LF) rTMS of the right DLPFC has probably efficacy. The American Psychiatric Association, the Canadian Network for Mood and Anxiety Disorders, and the Royal Australia and New Zealand College of Psychiatrists have endorsed rTMS for trMDD.

Proposed Text:

For treatment-resistant major depressive disorder, HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) is effective and low-frequency (LF) rTMS of the right DLPFC has probably efficacy. TMS is included in the American Psychiatric Association Practice Guideline for the treatment of Major Depressive Disorder as a treatment option for patients when they have not benefited from initial antidepressant treatments. Additionally, the Canadian Network for Mood and Anxiety Treatments recognizes TMS as a treatment option in adults suffering from Major Depressive Disorder. The Royal Australia and New Zealand College of Psychiatrists has endorsed rTMS for trMDD.


 * thanks for your comments, but i don't see a big difference. what is the point? Jytdog (talk) 12:17, 13 April 2015 (UTC)


 * Hi Jytdog,


 * The article states approval from the regulatory body (FDA) and insurance providers (the Commercial health insurance section), but has no mention of the organizations that are responsible for treatment guidelines in the US/Canada. I believe this edit aims to fix that. As the current content mentions endorsement by the relevant organization in Australia/New Zealand under the Treatment section, I'd suggested that we mention the fact that APA/CANMAT guidelines include rTMS as an option for trMDD alongside.


 * Protein3EFN (talk) 16:13, 14 April 2015 (UTC)
 * oh it is the mention of the "treatment guidelines" specifically? Jytdog (talk) 16:16, 14 April 2015 (UTC)
 * Hi Jytdog,
 * Yes, the fact that treatment guidelines issued by major professional organizations for mental health (APA, CANMAT) have included rTMS as a viable treatment option for MDD/trMDD. Protein3EFN (talk) 09:01, 15 April 2015 (UTC)


 * Hi Jytdog,
 * Just following up on this edit; I can see from your talk page that you're fairly busy, but do you have any inputs from your end or are you alright with making the suggested changes to the page? Thanks! Protein3EFN (talk) 07:12, 20 April 2015 (UTC)
 * i looked at this and it is fussy and small. i don't care and don't understand why you do. please save these things for significant updates, or explain better why this matters. thanks. Jytdog (talk) 00:07, 6 May 2015 (UTC)


 * Hi Jytdog,
 * The approval of TMS by the FDA validates the safety and efficacy of the therapy, while inclusion of TMS in the APA guidelines shows acceptance by the association as to its place in clinical practice. As I'd mentioned, it does not state “endorsement” but communicates that the APA acknowledges TMS as a treatment for patients who’ve not benefited from drugs. It helps to validate that this treatment is no longer “experimental".


 * In addition, there's an article in the Journal Advances in Physiology Education that talks about Wikipedia as an important source of information for physicians and medical students (among others). "Guidelines/position statements released from major societies/associations" is mentioned as a gap in information on Wiki pages, which may be addressed for the TMS page through this edit (the article is specific to respiratory topics, but the assumption is that this would apply across therapy areas). Doc James, tagging you here as well in case you're not aware of this article; I'd love to get your thoughts on it.
 * Protein3EFN (talk) 09:12, 1 June 2015 (UTC)

Dear Doc James, Jytdog

In addition to the APA/CANMAT edits, there are a couple of edits Neuronetics would like to suggest to the Health Insurance Considerations section of the page. Please take a look and let me know if these are acceptable to you.

Protein3EFN (talk) 10:19, 1 June 2015 (UTC)

Original Text[Section: Commercial Health Insurance]:

In 2013, several commercial health insurance plans in the United States, including Anthem, Health Net, and Blue Cross Blue Shield of Nebraska and of Rhode Island, covered TMS for the treatment of depression for the first time. In contrast, UnitedHealthcare issued a medical policy for TMS in 2013 that stated there is insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. UnitedHealthcare noted that methodological concerns raised about the scientific evidence studying TMS for depression include small sample size, lack of a validated sham comparison in randomized controlled studies, and variable uses of outcome measures. Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.

Proposed Text:

The first commercial coverage policy for TMS was drafted in 2010 by Priority Health. Since 2013, commercial health insurance has rapidly expanded with the majority of US plans adding TMS as a covered benefit, including Anthem, multiple Blue Cross Blue Shield plans and United Behavioral Healthcare (Optum). As of March 2015, over 200 million US individuals have TMS as a covered benefit. Information for specific insurance providers are typically available on their website or by contacting their benefits staff. United Behavioral Healthcare (Optum) published coverage criteria guidelines for TMS in 2015 despite an older medical policy issued for TMS in 2013 that stated there was insufficient evidence that the procedure is beneficial for health outcomes in patients with depression. Other commercial insurance plans whose 2013 medical coverage policies stated that the role of TMS in the treatment of depression and other disorders had not been clearly established or remained investigational included Aetna, Cigna and Regence.


 * Anyone other than some US plans cover it?
 * What ref supports "has rapidly expanded with the majority of US plans"?
 * Doc James (talk · contribs · email) 10:28, 1 June 2015 (UTC)


 * Hi Doc,
 * I'd suggested an edit earlier that contains a large list of US plans that include TMS as an option, but was advised that it's against WP:NOTDIRECTORY. The list itself can be seen in archive 3 of this talk page (https://en.wikipedia.org/wiki/Talk:Transcranial_magnetic_stimulation/Archive_3). I'm not sure how many plans I'd need to come up with to show you "majority of US plans", but as per Neuronetics' internal data (reference 4 above), approximately 212 million people in the US are covered for TMS. Does a simple majority in terms of people covered work? (US population 2014: 318.9M)
 * Protein3EFN (talk) 11:21, 2 June 2015 (UTC)
 * is there any independent source that discusses insurance coverage? an article in a trade rag perhaps?  the establishment of widespread coverage for an emerging technology seems to be the kind of thing that should have been discussed somewhere.  what you keep offering here is an argument built off a collection of PRIMARY sources, and that is what we are struggling with (see WP:SYN).  do you see the problem? (real question, please answer. i want you to learn so this process becomes more efficient)  Jytdog (talk) 11:26, 2 June 2015 (UTC)


 * Hi Jytdog,
 * Thanks for the information; I wasn't aware I was in violation of WP:SYN. I'm looking for independent sources to cite this information, but I'm coming up against an interesting problem - most third parties that list insurance coverage of TMS tend to quote Neuronetics as the source of their information (whether these are news articles or websites of independent practices). Within the TMS ecosystem, Neuronetics is an influential entity, which may explain this observation. This makes it difficult for me to be in conformation with WP:THIRDPARTY, WP:IS, and WP:COI. What would you recommend in such a case?


 * There is a provision in WP:THIRDPARTY that states non-independent sources may be used in some instances, but I'm not sure of whether this is applicable in this instance. The closest I could come to a trade rag mentioning insurance coverage is Reuters, but this again quotes a press release from Neuronetics...would this be acceptable if we were to explicitly state "according to Neuronetics", for example?


 * Looking forward to your inputs!
 * Protein3EFN (talk) 09:55, 10 June 2015 (UTC)


 * No that is not acceptable.Jytdog (talk) 12:20, 10 June 2015 (UTC)


 * Hi Jytdog,
 * There's an article on Yahoo Health dated the 15th of May this year that talks about drug-free treatment options for depression. The article mentions the increased coverage that people now experience ("over 200 million people"). There are two other publications (a news article and an interview on the Carlat report ) that mention increased insurance coverage as well.
 * I think I missed stating this earlier, but the intent of this edit is not necessarily to include the specific numbers around insurance coverage. The idea is to highlight the positive shift in the insurance landscape regarding TMS and policies associated with it (the current content is reflective of the more ambivalent stance regarding TMS back in 2013). Doc, I'd welcome your inputs here as well. Could you please share your thoughts on what the appropriate content/language should be?
 * Protein3EFN (talk) 08:11, 15 June 2015 (UTC)


 * Hi Jytdog, any thoughts on the above? Protein3EFN (talk) 13:38, 25 June 2015 (UTC)


 * Hi Jytdog, Doc,
 * Would be great if you could share your thoughts on the material I've shared. I believe, as it currently stands, there is no promotional tone to the content, and it is backed up by independent, third-party sources. Please let me know if you're alright with the material being posted on the main page. Thanks!
 * Protein3EFN (talk) 10:07, 2 July 2015 (UTC)
 * I just looked for fresh sources on this again, and the most recent I found were from 2013 and said pretty much what we say here - that coverage is uneven.... Jytdog (talk) 12:04, 14 July 2015 (UTC)

organization
Dear User:Doc James,User:Jytdog,

I'm writing to address a general complaint regarding content organization.

The bulk of this article is written regarding and from the perspective of proven clinical efficacy. This being said, TMS is for the most part a research tool and the standard for proven clinical efficacy is often FDA-type approval from various governmental agencies. There is a lot of reliance on the Lefaucheur article, which while a great article, talks mostly about demonstrated clinical efficacy. The problem is that talking about all of these TMS applications in terms of clinical efficacy, the layman is unable to distinguish between the demonstration of clinical efficacy and the degree of clinical efficacy. To quote the Lefaucher paper "The absence of evidence should not be taken as evidence for the absence of effect".

For example, unipolar depression for TMS has demonstrated definite clinical efficacy, with an effect size of ~0.7 (depending on the paper). Whereas other studies may have similar effect sizes, but not enough studies to have demonstrated clinical efficacy to the standard that would satisfy a commission on the topic. This is confusing because after the introduction it kind of breaks down into specific treatments and efficacy recommendations from Lefaucher without any elaboration. This is purely the difference between "weakly demonstrated efficacy" and "demonstrated weak efficacy". The wiki continues on to mention adverse effects, then three sentences about procedure (which actually is a useless section) and then a few line items about specific approvals for rTMS devices, then an interesting technical section, then a tiny history section. One sentence to address all of TMS research, and 5 sentences to address specific issues regarding study blinding. Somehow in all of this, the use of TMS for solely neuroscience purposes (looking at intracortical inhibition), using paired pulse inhibition to map cortical pathways, simultaneous use of TMS in fMRI, TMS as a cognitive-enhancement method, and basically anything non-medical are just not mentioned.

Given the disorganization in the article I think it would make sense to just wholesale reorganize it using a style of the EEG page (kind of) https://en.wikipedia.org/wiki/Electroencephalography

I would propose:


 * Introduction
 * History (only 1 paragraph)
 * How TMS works (technical information)
 * TMS in the Clinic (FDA approved and techniques that can be considered on the way to approval)

-Side Effects

-Health insurance considerations

(I think we can actually skip the mentioning of specific devices and just throw them in a table)


 * TMS in research (neuroscience and mentioning of other things under investigation but not yet viable for a real non-research application)

-Research Considerations (study blinding, safety) — Preceding unsigned comment added by Azurex120 (talk • contribs) 24 April 2015‎ (UTC)
 * thanks for your thoughts! this is a medical device, in clinical use, so we have treated it per WP:MEDMOS with regard to organization, where the medical use is the first thing. I like the organization of the EEG article (which is very very under-sourced, btw), but i don't think you will be able to get consensus to move away from MEDMOS.   I agree the research section is a stub, and it would be great if you wanted to flesh that out (I see you do a lot of work on technologies used in scientific research like Functional near-infrared spectroscopy - your expertise would be great here!)  Ditto, history, which is not here at all and would be really interesting to include.   About the technical information section - that section is a disaster in my view from the perspective of WP:TECHNICAL.  I left it in here but it doesn't belong in an encyclopedia for the general public in my view.  It needs to stay way way at the bottom of the article. Jytdog (talk) 11:37, 24 April 2015 (UTC)
 * Have worked to fix Electroencephalography Thanks Doc James  (talk · contribs · email) 15:05, 6 May 2015 (UTC)
 * TMS is equally important in neuroscience research. It would be consensus for me and other neuroscientists, that this part of the machine is emphazised much more. I would even tend to say, that the medical use is more rare than the scientific use, as the the approvals are missing in many countries. @Azurex: where if not here should the history of that machine be mentioned? 1 paragraph is too few imo. -- Amtiss, SNAFU ? 16:54, 9 September 2015 (UTC)

Wrong magnitude - removed
I removed the wrong values of the magnetic fields (1-10mT). Web sources like, an older rewriting attempt ("Magnetic field: often about 2 tesla on the coil surface and 0.5 T in the cortex") in the oldest archive of the discussion here and the 2003 edition of the given source tell us about values in the magnitude of Tesla. Please add newer, correct cited sources if possible. -- Amtiss, SNAFU ? 21:47, 29 September 2015 (UTC)

Hypomania
From the article: "transient induction of hypomania". This is fascinating -- is there any research on this specifically? -- Impsswoon (talk) 23:10, 24 November 2015 (UTC)

Please update
Most of the data in the article seem to be from 2013 and earlier. In a fast-developing field, that's too old. For example, the article makes no mention of the experimental use of TMS in treating autistics. See John Elder Robison's new book, Switched On: A Memoir of Brain Change and Emotional Awakening. J. D. Crutchfield &#124; Talk 15:04, 24 March 2016 (UTC)
 * I added a short paragraph here: . CatPath (talk) 05:14, 25 March 2016 (UTC)


 * Excellent. Thanks.  It would probably be good for somebody to update the insurance information, if anything has changed since 2013.  J. D. Crutchfield &#124; Talk 14:23, 25 March 2016 (UTC)
 * Moved that to the research section along with a bunch of other content that had been added to the Treatment section. Jytdog (talk) 15:16, 25 March 2016 (UTC)


 * I think the cochrane link was already operational before Jytdog. Anyway. Also working now too.


 * I plan to update areas of the article, particularly, but not only, relating to MDD & schizophrenia. There are many reliable sources of recent years. It's an important article IMO.Charlotte135 (talk) 13:56, 7 June 2016 (UTC)
 * It went to Cochrane - click it.Jytdog (talk) 18:52, 7 June 2016 (UTC)
 * Ok. I thought I had linked it as cochrane review, which worked before I saved the page. Not sure why only the word cochrane was linked. Either way, thanks. It's a relevant link and it's working now.Charlotte135 (talk) 21:01, 7 June 2016 (UTC)

Section about "Neuro Enhancement"?!
Hello.

I'm missing a section about the application for Neuro enhancement. Englisch is not my mother language, and I seeking a copyright free text about TMS as neuro enhancement :-) . — Preceding unsigned comment added by 2003:5B:4C5E:1E00:7125:38C0:ED4:42D4 (talk) 12:11, 14 June 2016 (UTC)

Biased Introduction
Perhaps someone with an exceptional level of knowledge on the topic should review the introduction of this article. It seems to be questionably biased.
 * What specifically do you find biased? Jytdog (talk) 06:02, 10 March 2017 (UTC)

History Section Rewrite
Hi there! I rewrote the history section using one of the previous writer's sources as well as reliable ones that I found as well. Please let me know if there are any issues that need to be addressed. Thank you.Maddieaalund (talk) 02:15, 28 February 2017 (UTC)
 * sources are not reliable. they were already bad but you added tmsneuro.com, about.com, and cerebromente.org.br.   Please use high quality sources like academic books and reviews in the biomedical literature.    is not great but it is OK and free, and there are others in a pubmed search that look promising. Jytdog (talk) 03:05, 28 February 2017 (UTC)
 * This is my second attempt. I found another source and revised what I wrote previously. I focused primarily on the evolution that led up to TMS. The previous writer was missing some important facts. Please let me know if this is okay. Thank you!Maddieaalund (talk) 02:21, 29 March 2017 (UTC)

This text was affed "Many ethical concerns arose after ECT became immensely popular as a treatment for various types of mental illnesses that led to many side effects, both mental and physical." I am not seeing this ref as supporting this "Transcranial magnetic stimulation for the treatment of obsessive-compulsive disorder"? Thus restored the prior version. Doc James (talk · contribs · email) 06:18, 10 April 2017 (UTC)

Transcranial Magnetic Stimulation Used to Induce SLEEP
Possibly a Dangerous Idea, but the internet shows some research has been done in this area. Nevertheless, sleep deprivation being the problem that it is (and WILL BE considering the effects of aging upon sleep deprivation) would necessitate that significant research be done in this area. Likely everything I say has already been done (or thought about), nevertheless it is still worth commenting upon :

1) Use of probes at certain spatial locations upon the brain, each of which is capable of generating certain frequencies of magnetic field strengths (for induction of Maxwell-Faraday-equation based neuronal stimulation) would allow the neuronal 'activation profile' of the brain to mimic those brain profiles associated with healthy volunteer sleep patterns (though whether this is a good idea, and whether some other intermediate profile should be used as the 'target profile', so as to be more gentle for the subject's brain, is clearly a question worth considering - made more difficult by the fact that knowledge of a natural subjects normal neuronal activation sleep profile will be unknown unless TMS coils could somehow be coupled with EEG sensors and combined with a computational unit so as to optimise the process via which certain brainwave patterns are induced in the sleeping patient). 2) The causal consequences of inducing sleep via TMS might include some effect upon the brain's own ability to induce sleep naturally by itself subsequent to the application of TMS (we are imposing from 'outside' a pattern that should be arising naturally from 'inside' or internal mechanisms - so there must be some causally mediated fault that prevents internal mechanisms from inducing sleep).

I haven't fully looked through the below paper BUT the upshot is that "Moreover, evoked slow waves lead to a deepening of sleep and to an increase in EEG slow-wave activity (0.5–4.5 Hz), which is thought to play a role in brain restoration and memory consolidation.". So there appears to be some level of SUCCESS. ASavantDude (talk) 11:59, 17 October 2017 (UTC) Example Paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895978/


 * Have you ever experienced TMS? It's like being repeatedly tapped on the head with a small hammer. Not exactly conducive to sleep. Also, single experimental studies are not acceptable medical sources. Famous  dog   (c) 12:40, 17 October 2017 (UTC)
 * Also, Wikipedia is not a forum. Famous  dog   (c) 12:47, 17 October 2017 (UTC)

Method
The first sentence makes no sense. It says TMS is a "method." TMS is a method of doing what? If you don't say what it is a method of, it makes no sense.--Nomenclator (talk) 20:25, 22 January 2018 (UTC)
 * It did make sense, but does this work better for you? Jytdog (talk) 20:34, 22 January 2018 (UTC)
 * Changing electrical current in the coil generates a changing magnetic field; that changing magnetic field in turn generates electric current in the brain. This is maxwell's law from basic physics applied in two steps. Jytdog (talk) 20:39, 22 January 2018 (UTC)

Summary of edit series
Significant rewrite, basically cleaned up the article got rid of a lot of primary research, some promotional material, and weak refs. Also significantly reorganized per WP:MEDRS. Several sections still need work. I enjoy sandwiches (talk) 23:05, 26 February 2019 (UTC)
 * Should the "History" section be hidden so far down? Thanks. Martinevans123 (talk) 23:10, 26 February 2019 (UTC)
 * Sure, will probably be more enduring aspect of the therapy than its specific regulatory approvals/insurance coverage. Kind of unusual how much there is about the latter in the article tbh, moved it to the end. I enjoy sandwiches (talk) 02:17, 27 February 2019 (UTC)

Virtual lesions
I noticed that there is no mention of the use of TMS to create "virtual lesions", a name often found in research papers, in cognitive neuroscientific experiments. This seems to be an already major and increasingly used function of the method. Should this not be included under "Research", and possibly mentioned in the lead? Prinsgezinde (talk) 15:55, 22 October 2019 (UTC)

United Health Care
UHC does now cover, so this should be updated. 98.223.62.20 (talk) 16:22, 12 December 2019 (UTC)

Reiterated sections
The intro has almost identical text to the later subsections for medical uses and adverse effects. Could be condensed into 2-3 sentences up top with specifics below... I am not up on my wiki SOPs though, so maybe it is OK as is? Vern.zimm (talk) 18:56, 29 January 2020 (UTC)