Subtle stimulation: Spokane neurologist offering transcranial magnetic stimulation

Spokane neurologist Dr. David Greeley sees more people these days dealing with depression, often patients also with Parkinson’s disease or dementia.

That’s partly why he has new space in his Northwest Neurological practice to offer a noninvasive treatment for depression, transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells in the brain.

Recently, Greeley began offering the treatment under the business name Kingfisher TMS. The FDA approved the procedure 10 years ago but Spokane residents have had little access, said Greeley, who hopes to help more people regionally impacted by depression.

“I think depression and psychiatric illnesses are affecting a lot of people in this country, and it’s growing,” Greeley said. While working in Spokane as a neurologist for about 26 years, his patients have gone from being in their 50s and 60s to now 80s and 90s.

“There’s just a lot more elderly and a lot more depression,” he said. “With dementia comes a lot of depression among the patients, caregivers and family.”

Greeley also hopes to use TMS equipment to research how the treatment might help those whose depression stems from traumatic brain injuries.

Locally, the condition of chronic traumatic encephalopathy, which is caused by repeated brain injury, made national news in June when the parents of Washington State football quarterback Tyler Hilinski revealed their son had first-stage CTE. Hilinski took his own life Jan. 16.

Greeley is experienced with CTE and is approved to assess retired football players involved in the NFL Concussion Settlement Program. The NFL’s payout to players, as part of the settlement, is expected to reach $1.4 billion.

Greeley said he sees former NFL players who have either retired in the Northwest or travel here, because he’s one of a few neurologists in a five-state Western region approved to conduct player assessments.

In doing that work, he and others have realized few treatment options exist for such patients.

“I started working with the NFL and working on concussion and chronic traumatic encephalopathy, and basically there are a lot of behavioral and cognitive changes that come following repeated head injury,” he said.

“We looked into other things that could possibly be done to help, and one thing was TMS.”

But beyond research, the main use for NeuroStar equipment will be for depression treatment, he said.

Studies indicate patients using TMS see improvements in mood and mental health.

“With this procedure, people walk in and walk out and drive home,” Greeley said. “By the second or third week, people are starting to see significant improvement.

“By six weeks, we have 30 to 50 percent chance of putting somebody into remission in their depression, which is as good if not better than any antidepressant on the market.”

Most insurers, including Medicare, pay for the treatment, he said, although some companies require proof that patients haven’t seen benefits from use of at least three or four antidepressants.

The TMS equipment at Northwest Neurological is staged within three small exam rooms, each with a chair much like one you’d see in a dental office.

A large unit behind the chair looks like big suitcase with a magnetic generator, but the actual device swings by a machine arm up to the head with a rectangular box about the size of a large cellphone placed near the forehead. That box is thick, he said, by about 3 inches.

“It’s like getting dental X-rays; you feel it’s held there with lateral pressure.”

Greeley describes that the TMS treatment requires 20 minutes a day, for five days a week over a six-week period. An electromagnetic coil is placed against the scalp near the forehead to stimulate part of the brain involved in mood control and depression.

The first TMS visit usually takes closer to one hour to find the correct area on an individual’s head to target, and placement of equipment, he said. Most patients tell him the treatment is relatively painless, although it might hurt a bit the first time.

“It’s not pain that’s horrible, and people come back,” Greeley said. “It delivers 40 pulses of electromagnetic power basically in four seconds, so it feels like someone tapping on your forehead fairly aggressively, not as bad as woodpecker, but that’s what people joke about.

“The treatment isn’t breaking the skin, and it doesn’t leave a mark. It’s applied providing electromagnetic pulse that goes a few inches into the brain. TMS energizes an area of the brain about the size of a golf ball when using a NeuroStar machine.”

Next year, Kingfisher TMS principals plan to expand the service to other locations, from Colville to Pullman. Greeley said the NeuroStar equipment and TMS uses a targeted amount of energy to only a small area of the brain that in turn energizes other parts.

Older one-time shock treatments from decades ago were violent, “used tons of energy,” and often caused people to have seizures, he said.

“This procedure is cleaner, and there’s never been a seizure reported. I tell people it’s kind of like giving a small amount of electricity just to the battery, versus a car getting hit by a lightning bolt.”