Treatments and Therapies Offered at MINDS

Focused and specialized treatment strategies for various neurological disorders are continuously being developed. At MINDS we endeavour to stay at the leading edge of therapeutic developments and as treatments become available the most promising are considered for our patients. Below is a sampling of the treatments MINDS clinicians currently offer in-house. For therapies that require infusions such as IVIG or immunomodulatory treatments for MS patients are referred to hospital settings.

Transcranial Magnetic Stimulation (TMS)

A noninvasive procedure that involves a series of short magnetic pulses directed to the brain to stimulate nerve cells. The magnetic pulses stimulate area neurons and change the functioning of the brain circuits involved.

Transcranial Magnetic Stimulation (TMS)

-Repetitive Transcranial Magnetic Stimulation (rTMS) is a therapeutic medical procedure that was approved by Health Canada in 2002. Since 1985, research has been conducted with TMS to understand and treat a number of neurological conditions (i.e. migraine, refractory tinnitus) and psychiatric conditions (i.e. depression and auditory hallucinations in individuals with schizophrenia). Most recently, researchers have been focusing on the use of repetitive TMS pulses (rTMS) as a treatment option for major depressive disorder and concomitant depression (eg post stroke depression), Functional Neurologic disorders, Upper extremity rehabilitation post-stroke, and mild traumatic brain injury and traumatic brain injury related headaches and depression. Additional evidence is emerging in the treatment of auditory hallucinations in schizophrenia, cognitive disorders, obsessive-compulsive disorder and posttraumatic stress disorder.

Nerve Block and/or Trigger Point Injections

Both outpatient procedures, have been seen to help patients manage chronic pain caused by a number of conditions.

Nerve blocks target certain nerves or groups of nerves causing the discomfort, where Trigger Point Injections are used to treat painful areas of muscle or knots of muscle that form when muscles do not relax. Commonly we offer trigger point injections to patients with Cervicogenic headache, or whiplash associated disorders. Common nerve blocks include: Occipital Nerve blocks for Headache management and Occipital neuralgia, and superficial nerve blocks for pain management.

Botox for Chronic Migraines

Chronic Migraine headaches cause severe pain that can last for hours, or even days, and cause sensitivity to light and noise, nausea and vomiting, blurred vision and lightheadedness several days per month.

They can interrupt your relationships and hobbies and cause you to miss work. There are many different treatment options, including medications and Botox injections, Botox or onabotulinum toxin A, has been approved by the U.S. Food and Drug Administration as a treatment for chronic migraines. The treatment involves a series of several small injections targeting muscles in your face, head and neck once every three months. The amount injected, as well as injection locations, is adjusted based on your reported pain. How long should I try Botox before making a decision? A trial of 3 cycles (or 9 months) is reasonable. The effect over the first treatments seems to be cumulative. 10% of people will notice an improvement only at the third treatment, especially if the situation was very severe to start with. Could Botox work if I have medication overuse headache? Studies show that Botox works for people with or without medication overuse. Of course, if there is a severe overuse, or if there is opioid use, it might be best to plan a withdrawal as a part of your treatment plan. People taking opioids were not included in the Botox studies. Could Botox work if other preventives did not work for me? Yes. Botox has a different mechanism of action than oral preventives. Studies have demonstrated a benefit in patients who had tried other preventives. In real life, Botox is covered only after previous trials, and improvements are observed. Is the effectiveness of Botox sustained over time? Yes. For most people who respond to Botox, the benefit are sustained over time. Remember that migraine is a fluctuating disease and that even if Botox is effective for you, you may have better phases and more difficult ones.

Carpal tunnel syndrome: corticosteroid treatments

Caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome. Injecting corticosteroids near the carpal tunnel is a common treatment. Steroids reduce swelling in the connective tissue, which relieves the pressure on the median nerve. The benefits of corticosteroid injections have been tested in several studies. In these studies, the corticosteroid injections were compared with either non-surgical treatments or injections that didn't contain any medication (placebo injections).

Physiotherapy : Concussion (mTBI)

Physiotherapists are one of the health-care professionals in the multidisciplinary concussion management team, and collaborate with other providers (e.g., physicians, psychologists, occupational therapists) and professionals (educators, employers) in the delivery of optimal care.

Physiotherapy is indicated and can be effective in concussion management when dizziness, neck pain, headache and impaired balance have cervical spine and/or vestibular involvement. Treatment is based on the physiotherapy differential diagnosis made through patient history and clinical assessment of presenting signs and symptoms. Physiotherapy management includes education and support, treatment of signs and symptoms responsive to physiotherapy such as impairments of the cervical spine and/or vestibular system and sub-symptom threshold aerobic exercise.

Physiotherapy : Vestibular /Balance and dizzyness

Vestibular Rehabilitation includes treatment of vertigo and balance issues related to the vestibular system (or inner ear problems).

Conditions Treated People with balance issues, a history of falls and certain types of dizziness, may benefit from a comprehensive physical therapy evaluation to determine the cause of balance problems and dizziness. BPPV: Benign Proximal Positional Vertigo Unilateral Vestibular Hypofunction / Vestibular Neuritis Bilateral Vestibular Hypofunction Cervicogenic Dizziness Motion Sensitivity Abnormality of Walking and Balance concussion Individualized Treatment Physical therapists evaluate a person’s strength, range of motion, gait and balance as well as perform specific tests of the vestibular system. Vestibular rehabilitation Balance retraining Gait training ROM, flexibility, strength and endurance exercises Patient education Fall risk reduction Vestibular rehabilitation has been shown to be effective in the management of dizziness and gait and balance dysfunction following concussion in both children and adults. Techniques may include adaptation, substitution, habituation, standing and dynamic balance retraining, and canalith repositioning maneouvers. A retrospective chart review of home programs prescribed by vestibular therapists to patients following concussion showed that the most frequent home program exercises prescribed were eye/head co-ordination, followed by standing static balance exercises and ambulation exercises

Physiotherapy : Neck and Low Back pain (radiculopathy/ Sciatica)

Radiculopathy refers to symptoms that develop when there is compression of a spinal nerve root. Most commonly, the nerve compression is related to a disc herniation or spondylosis (degenerative changes in the spine) and may occur with or without trauma.

Nerves in your neck provide sensation and strength in your arms, while nerves in your low back provide sensation and strength in your legs. The symptoms associated with radiculopathy are typically unilateral (affecting one side of the body). The pain can worsen with certain movements of the neck or low back, with prolonged sitting or walking, and sometimes with coughing or sneezing. The diagnosis of radiculopathy is based on your medical history and a physical examination, including evaluation of nerve function (testing reflexes, strength, and sensation).An EMG (electromyogram) is a needle test that can be done to assess the health of muscles and nerves and can show evidence of a nerve problem such as radiculopathy. Typically, neck pain, low back pain, and radiculopathy can be treated successfully without surgery. Physical therapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. This may include specific excercises, mechanical traction therapy and pain management stratergies.


Transcranial Magnetic stimulation

During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression.

Repetitive TMS is a non-invasive form of brain stimulation used for depression. Unlike vagus nerve stimulation or deep brain stimulation, rTMS does not require surgery or implantation of electrodes. And, unlike electroconvulsive therapy (ECT), rTMS doesn’t cause seizures or require sedation with anesthesia.

Generally, rTMS is considered safe and well-tolerated. However, it can cause some side effects.

Common Side Effects

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache
  • Scalp discomfort at the site of stimulation
  • Tingling, spasms or twitching of facial muscles
  • Lightheadedness

Your doctor can adjust the level of stimulation to reduce symptoms or may recommend that you take over-the-counter pain medication before the procedure.

Uncommon Side Effects

Serious side effects are rare. They may include:

  • Seizures
  • Mania, particularly in people with bipolar disorder
  • Hearing loss if there is inadequate ear protection during treatment

Tell your doctor or mental health provider if:

  • You’re pregnant or thinking of becoming pregnant.
  • You have any metal or implanted medical devices in your body. In some cases, people with metal implants or devices can have rTMS. However, due to the strong magnetic field produced during rTMS, the procedure is not recommended for some people who have the following devices:
    • Aneurysm clips or coils
    • Stents
    • Implanted stimulators
    • Implanted vagus nerve or deep brain stimulators
    • Implanted electrical devices, such as pacemakers or medication pumps
    • Electrodes for monitoring brain activity
    • Cochlear implants for hearing
    • Any magnetic implants
    • Bullet fragments
    • Any other metal device or object implanted in your body
  • You’re taking any medications, including prescription or over-the-counter medications, herbal supplements, vitamins or other supplements, and the dosages.
  • You have a history of seizures or a family history of epilepsy.
  • You have other mental health disorders, such as substance misuse, bipolar disorder or psychosis.
  • You have brain damage from illness or injury, such as a brain tumour, a stroke or a traumatic brain injury.
  • You have frequent or severe headaches.
  • You have any other medical conditions.
  • You’ve had prior treatment with rTMS, and whether it was helpful in treating your depression.

Before Your First Appointment

Repetitive TMS isn’t invasive, doesn’t require anesthesia and can be performed on an outpatient basis. You don’t need to arrange for someone to drive you home after treatment — unless, for the first treatment, you prefer a driver until you get a sense of how you’ll feel afterward.

Before considering treatment, check with your health insurance company to see whether rTMS is covered. Your policy may not cover it.

What You Can Expect

Repetitive TMS is usually done in a doctor’s office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks.

Your First Treatment

Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes.

Most likely, during your first appointment:

  • You’ll be taken to a treatment room, asked to sit in a reclining chair and given earplugs to wear during the procedure.
  • An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You’ll also feel a tapping sensation on your forehead. This part of the process is called mapping.
  • Your doctor will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.

During Each Treatment

Once the coil placement and dose are identified, you’re ready to begin. Here’s what to expect during each treatment:

  • You’ll sit in a comfortable chair, wearing earplugs, with the magnetic coil placed against your head.
  • When the machine is turned on, you’ll hear clicking sounds and feel tapping on your forehead.
  • The procedure will last about 40 minutes, and you’ll remain awake and alert. You may feel some scalp discomfort during the treatment and for a short time afterward.

After Each Treatment

You can return to your normal daily activities after your treatment. Typically, between treatments, you can expect to work and drive.


If rTMS works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.

The effectiveness of rTMS may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate.

Ongoing Treatment

After completion of an rTMS treatment series, standard care for depression ― such as medication and psychotherapy ― may be recommended as ongoing treatment.

It’s not yet known if maintenance rTMS sessions will benefit your depression. This involves continuing treatment when you are symptom-free with the hope that it will prevent the return of symptoms.

However, if your depression improves with rTMS, and then later you have another episode of symptoms, your rTMS treatment can be repeated. This is called re-induction. Some insurance companies will cover re-induction.

If your symptoms improve with rTMS, discuss ongoing or maintenance treatment options for your depression with your doctor.


Who is a Candidate?

In order to ensure patient safety, the following general requirements will need to be met prior to receiving rTMS therapy:

  • Have a diagnosis by a psychiatrist or physician*
  • No implanted ferromagnetic items (i.e. pacemaker)
  • No previous history of epilepsy
  • No foreign metal bodies or metallic/magnetic implants in the head

How is rTMS administered?

  • rTMS is an outpatient procedure = no hospitalization, no anesthetics and non-invasive.
  • rTMS therapy is therefore administered in a clinical setting by a trained technician under the supervision of a medical doctor.
  • During the treatment session, patients are fully conscious.
  • The intensity of the stimulus that will be delivered is determined by inducing a motor-evoked potential (i.e. causing a movement or twitch to occur) in the abductor pollicis brevis, or the thumb muscle.
  • A tingling or tapping sensation on the head may be felt, or scalp muscles may feel a little tense, during and after the procedure. This is normal and may result in a minor headache.
  • Most patients describe this as a “mild tapping sensation”. Patients are also asked to wear earplugs in order to reduce the clicking noise made by the machine.

Who will be involved in the treatment?

A medical practitioner, involved throughout the rTMS therapy procedure, will complete the preprocedure consultation, and be available for questions during treatment. An rTMS technician will administer the rTMS treatment sessions.

How often will patients receive rTMS therapy?

Generally, rTMS therapy consists of two stages:

  1. Acute therapy: involves 20-30 consecutive treatment sessions over a FOUR to SIX-week period.
  2. Maintenance therapy: may be required every 6-12 months, depending on results.

How long is each rTMS treatment session?

A trained rTMS technician administers each treatment session. On the first day of treatment, a technician explains the procedure in detail and informs the patient as to what to expect during the first session. Each subsequent rTMS treatment session lasts approximately half an hour.

What are the risks?

While there are some risks associated with having rTMS therapy, they are minimal.

A potential side effect of rTMS therapy is a mild headache, resulting from muscle stimulation on the scalp. This is experienced by only 1 in 10 patients. Typically, the headache will pass with a few hours or with a dose of Tylenol. The earplugs will minimize the noise during the procedure. With proper pre-procedural screening, the risk of any serious side-effect such as a seizure becomes extremely rare.

How long will the benefits last?


  • Highly effective (based on results of clinical research)
  • Minimal side effects
  • The quick onset of therapeutic effect
  • Painless procedure
  • Non-invasive
  • No anesthesia required
  • Outpatient therapy
  • rTMS therapy may be applied with or without medication

Acute Therapy

Most patients tend to be aware of the therapeutic benefit in the second week of treatment (after 14-20 sessions).

  • Typically, results become noticeable within two weeks from the beginning of the rTMS treatment.
  • Late-responders may require additional sessions to achieve significant symptom reduction. During and following acute therapy, results will be continuously assessed.

Maintenance Therapy

  • Patients may return for maintenance therapy after approximately 6-12 months. This time frame varies between patients.
  • Maintenance entails half the number of rTMS sessions that were originally completed (typically two weeks of therapy = 10 treatment sessions).

What is the cost?

The MINDS Neuromodulation Unit believes in providing quality care to patients. Although there has been significant research on the use of rTMS as a treatment for depression, and the equipment is considered a medical device by Health Canada, this is still a new treatment in the medical community in Canada. Currently, Alberta and Quebec are the only two provinces covering the cost of rTMS. In Ontario, the cost for TMS is covered by insurance providers, or directly by patients. The length of treatment and expertise required is reflected in the cost. Please call us directly to discuss the costs and inquire with your insurance provider as to what coverage you may have.