FAQs

Frequently Asked Questions About MeRT

What is MeRT treatment and how does it work?

-MeRT stands for Magnetic e-Resonance Therapy. MeRT treatment combines technologies of repetitive transcranial magnetic stimulation (rTMS, an FDA cleared therapy), Quantitative Electroencephalogram (qEEG), and Electrocardiogram (ECG/EKG) to deliver treatments tailored for each individual’s unique brain pattern.

-The patient’s EEG and ECG are analyzed to determine the brain’s pattern of function, detect any possible abnormalities, and determine its state of optimal neural synchronization. The information is used to develop a personalized treatment protocol for each patient, with a goal of restoring the brain to its optimal state. This can lead to significant clinical improvements.

Definition of Terms:

rTMS = Repetitive Transcranial Magnetic Stimulation: a non-invasive therapy that utilizes pulsed magnetic fields to change neural activity.

EEG = Electroencephalogram: a non-invasive procedure that records the electrical activity of the brain.

ECG = Electrocardiogram (also known as EKG): a non-invasive procedure that records the electrical activity of the heart.

How is MeRT treatment different from rTMS?

-Unlike standard rTMS therapy, which delivers stimulation to one location at a fixed frequency for all patients, MeRT treatment individualizes the treatment frequency and location based on each patient’s Quantitative EEG and ECG. This results in a “custom-fit” MeRT treatment protocol as opposed to the “one-size-fits-all” approach of rTMS.

What takes place during a typical MeRT treatment session?

-Cortical MeRT treatment delivers magnetic pulses to specifically targeted areas of the brain. A typical appointment of MeRT consists of 36 trains of electromagnetic stimulation delivered with rest period in between trains to a specific location on the head. The session lasts approximately thirty minutes.

What benefits may result from MeRT treatment?

-Functional recovery is the primary objective of treatment. Results are individual in nature, depending on the initial presenting symptoms.

-Common benefits of functional recovery include:

-Increased sleep quality

-Increased sleep duration

-Increased attention span

-Increased sociability

-Increased motivation

-Increased concentration and focus

-Increased emotional stability

-Increased ability to adapt to change

-Improvement in clarity of thought

-Improvement in mood

-Improved self-confidence and self-esteem

-Reduction of anxiety

-Reduction of pain

-Decreased cravings (e.g. drugs and alcohol)

What are the side effects or risks of the treatment?

-Side effects are few and generally mild. The most commonly reported side effect is a mild tension headache at the site of stimulation, which can last 1-2 hours and responds well to over-the-counter analgesics. Other possible side effects are hyperactivity, increased agitation, or euphoria. With brain stimulation there is also a risk of seizures; however, the risk is minimal with MeRT treatment. At Neuroenhancement & Cognitive Optimization Associates (NEUCOA), we also limit the intensity of stimulation to further reduce the possible risk of seizure activity.

- Similar to other treatment methods (e.g. medication) there is a risk of worsening depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior are possible during treatment. Patients undergoing treatment will be observed closely for clinical worsening and suicidality and, if worsening of symptoms continues, we will consider discontinuing rTMS treatment.

How soon after I start MeRT treatment should I expect to see a response?

-Every individual’s response to treatment is different. Some individuals will notice a response in 1-2 weeks.

How long should I receive MeRT treatment to achieve the best results?

-We recommend at least four to six weeks of treatment (20-30 MeRT treatment sessions). However, overall duration of treatment is based on an individual’s response rate. Length of treatment will be decided by the clinician and patient after reviewing clinical and EEG changes.

What is the success rate with MeRT treatment for different diagnoses treated?

-Preliminary results suggest that 40 to 60 % of patients with a diagnosis of Autism Spectrum Disorder (ASD) show a significant clinical response, defined as 30% or greater reduction in CARS scores, after 4-6 weeks of treatment.

-For patients with a diagnosis of Post-Traumatic Stress (PTS), preliminary results suggest that over 60% of patients show significant reduction in the Post-Traumatic Stress Disorder (PTSD) Checklist – Military version (PCL­5) scores, after 4 weeks of treatment.

How long will the effects of MeRT treatment last?

-Results can vary per individual. In general, the longer the length of treatment, the longer the changes remain, especially if receiving treatment for greater than one month. If a reduction in positive gains are noted after leaving NEUCOA, patients may return for additional treatment.

Will missing one MeRT treatment affect my results?

-Consistency of treatment is important, especially during the first assessment week of treatment. However, outside of the assessment period, missing one day of treatment should not affect overall results.

Why is it sometimes recommended to take a break from MeRT treatment?

-A patient’s response to therapy sometimes plateaus even though the brain has not yet reached its optimal state. The patient may be advised to take a break from treatment. During this time the brain may be able to improve its plasticity or ability to change for future MeRT treatment.

Why did my MeRT treatment protocol change?

-Protocol adjustments are implemented based on changes in your EEGs and clinical symptoms.

Why is my protocol different from other patients’?

-Since each brain is unique, the MeRT treatment protocol will be different for each patient as it is based on the individual’s own EEG/ECG data.

Why do I have to keep my eyes closed during MeRT treatment stimulation?

-The treatment is most effective when the individual’s brain is in a calm awake state, without receiving and processing too much information. Thus, the treatment should be administered in a quiet room (reduced auditory input) with the patient sitting awake in a chair with their eyes closed (reduced visual info) during the MeRT treatment stimulation (5 seconds).

Does my child still get the benefits of MeRT treatment if he does not close his eyes?

-Yes, the treatment will still be effective with eyes open but to maximize the effects we recommend that patients close their eyes during the MeRT treatment stimulation.

Should I be concerned about medications I am taking?

-During your intake appointment, disclose all medications you are currently taking. Your clinician will address any and all questions regarding medications.

Should I continue other medical or therapeutic treatments and activities while receiving MeRT treatment?

-We do not advise making any changes to your normal routine without first seeking the guidance and direction of your primary medical provider.

Should I be concerned if I have a pacemaker?

-Notify the clinician if you have a pacemaker or other internal electric device(s) during your intake session. Pacemakers exclude treatment, but individual circumstances will be evaluated by your clinician.

Can I wear eyeglasses, earrings, jewelry, or hearing aids during MeRT treatment?

-It is not necessary to remove eyeglasses, earrings, or jewelry. But it is recommended to remove hearing aids during treatment.

Why is it important to eat after a MeRT treatment session?

-You should eat a healthy snack soon after a MeRT session in order to replenish your body’s glucose stores that will decrease during the treatment session. This is especially important if you feel light-headed or tired after treatment.

Will MeRT treatment affect my appetite?

-A change in appetite might be noticed as a byproduct of decreased anxiety or increased energy level and motivation.

Is it common to become more emotional after initial MeRT treatments?

-Some patients report a re-discovery or awareness of emotions after initial MeRT treatments.

Is MeRT Right for Me? (Contraindications)

Absolute contraindications (not appropriate) MeRT treatment below:

Pacemaker

Defibrillator

Vagal Nerve Stimulator

VP Shunt/ Magnetic intracranial shunts

Deep Brain Stimulator implant

Epidural Cortical stimulator

Steel shunts/stents/filters

Cranial metal fragments (ie shrapnel, excluding titanium)

Aneurysm clips, coils, pipeline flow diversion

Cochlear implant

Pregnant or breastfeeding

Primary or metastatic brain cancer (unless palliative treatment brain cancer)

Magnetic dental implant

Ocular implants

Tumors in the central nervous system

Relative contraindications (require protocol attention, but may not disqualify someone from receiving cortical MeRT treatment):

History of Seizure or seizure disorder

Titanium shunts/stents

Spinal Cord Stimulator

Magnetic ink tattoo

Bipolar Disorder Type 1&2, psychotic disorder, and/or schizoaffective disorder

Active suicide plan or recent suicide attempt

Concurrent antidepressant medication use and cannot tolerate the discontinuation of current antidepressant medication

Substance (prescribed or illicit drug)/alcohol abuse

Baha Implant Absolute

Absolute contraindications for peripheral MeRT depending on location, (Also include all cortical MeRT treatment contraindications):

Cochlear implant

Pacemaker

Vagal Nerve Stimulator

Defibrillator

Steel screws or hardware (contraindicated for placement over ferrous material)

Any implanted electrical device

Pregnant or breastfeeding

Urogenital implants

Ferrous implants

IVC Filters

Pain pumps

Sleep and Circadian Rhythm

How does morning light help me?

-Exposure to morning blue light (450-500nm) regulates your circadian rhythm by suppressing melatonin to keep you alert and awake during the day and releasing melatonin at night to help you sleep well. Blue light exposure from electronic devices (cell phones, computers, etc.) after sunset delays the release of melatonin which is counterproductive to obtaining quality sleep. It is highly recommended to limit the use of electronic devices 1-2 hours prior to bedtime.

Why is sleep important, especially between 10pm-2am?

-People are in their deepest sleep in the earlier parts of the night. Deep sleep allows your body to regenerate and allows the brain to rest and recharge. If your brain does not get enough rest, it will not function optimally. Maintaining healthy sleep habits plays an important role in obtaining the best results from MeRT treatment.

If I already sleep well, do I still need the morning light?

-Yes. Although you may be sleeping through the night, your sleep may not necessarily be deep or restful sleep. Morning light will help regulate your sleep-wake cycle and improve the quality of your sleep.

Do I still get the benefits of morning light if it is overcast?

-Yes, the blue light penetrates through the clouds.

Do I get the benefit of blue light if I drive with the window down?

-Driving in your car with the windows down might provide some benefit, but we recommend 45 minutes to 1 hour of exposure to blue light between 7am to 11am outside, with no glasses or contacts covering your eyes.

Will MeRT treatment be less effective if I do not get morning light?

-Treatment is most effective when you have sufficient, good quality sleep. If your lack of blue light exposure in the morning results in poor quality sleep, then you may not respond to treatment as well as someone with good quality sleep. As such, we advise regular morning exposure to blue light.



Not Getting Enough Sunlight?

Are you getting enough sunlight?

-Between being confined to offices and not having the opportunities to get the recommended daily amount of unfiltered sunlight, to using our phones before bed, the lack of or late exposure to blue light may be affecting your circadian rhythm. If you are unable to adjust your schedule to incorporate 45 minutes to an hour of morning blue light between 7am to 11am into your schedule, a light therapy lamp can be used as a convenient alternative.

What are light therapy lamps?

-Light therapy lamps, also called light boxes, bright light therapy boxes, and phototherapy boxes and are intended to mimic outdoor light. Please note that there are also light therapy lamps intended to treat skin disorders. You will want to look for a light intended to treat seasonal affective disorder (SAD).

What specifications should I look for?

-While options and specifications for use will vary between brands, you will want to look for a light that provides the following:

-Emits little to no UV light

-Provides intensity of 10,000 Lux

-Some lamps offer additional options:

-LEDs vs bulbs

-Adjustable brightness levels

-Timers

Some other factors to consider:

-Do you need a portable lamp or will the lamp remain stationary?

-There are desktop models as well as models you can mount to a wall

-Additional factors to consider for portable lamps:

-Power source – will carrying an additional, device-specific charger be an inconvenience? If so, you may want to search for a lamp that utilizes USB charging. Please note that while some lamps may use a cord with a USB end connector, it might not be compatible with other USB power ports, as there will not be enough power supplied.

-Size – smaller light faces will require longer usage, possibly at closer range to your face; refer to your lamp’s instructions

-Lux output – most lights operating at 10,000 Lux will require 30-45 minutes of usage with the light placed approximately 24 inches from your face. Using lamps at lower setting or increased distance will require longer usage time.