Transcranial Magnetic Stimulation (rTMS/TMS)

Stimulation of nerve cells to the brain

Not Routinely Funded

Norfolk and Waveney Integrated Care Board do not routinely commission or fund Transcranial Magnetic Stimulation (TMS) or associated treatment modalities such as repetitive TMS (rTMS) for any indication, including but not limited to severe/treatment resistant depression and headache.  This includes circumstances where there may be contraindications for alternative treatment options, such as individuals unable to tolerate general anaesthesia for Electroconvulsive therapy (ECT).

Rationale:

Norfolk & Waveney ICB has determined Transcranial Magnetic Stimulation to be of low priority for funding. Like any other organisation, the NHS has limited resources, and N&W ICB have a duty to manage them to a robust process.

Current commissioned treatment pathways for severe/treatment resistant depression include non-pharmaceutical treatment options such as Electroconvulsive therapy (ECT) and psychological therapies. Current guidance and the existing evidence support the use of ECT as a treatment option for treatment resistant/severe depression (unless contraindicated) and the use of psychological therapies. While some evidence suggests that rTMS may be more effective than ECT for some patients with treatment resistant depression, other evidence suggests ECT may be more effective when compared against rTMS in patients with any type of depression, and result in a higher clinical response and greater likelihood of remission.

Guidance does not support the use of rTMS over ECT. Existing evidence does not support the use of rTMS or TMS treatment for any other condition.

IFR Policy & Experimental & Unproven Treatments Policy

Cases for individual consideration

On a case to case basis, patients might be eligible for this intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.