Assessment: EEG-Guided Targeting

EEGHRVClinical Evaluation

Before treatment begins, we measure. Clinical evaluation identifies the presenting problem; quantitative EEG reveals the underlying brain patterns; heart-rate variability captures the state of the autonomic nervous system. These measurements answer the question that symptom-based diagnosis alone cannot: which circuits are actually contributing to this patient's condition, and how should that shape treatment?

The answer determines which stimulation modality (or combination) to use, where to target it, and at what parameters. As treatment progresses, we re-measure and adjust.

This is the difference between fixed protocol and personalized care.

Transcranial Magnetic Stimulation (TMS)

FDA-ClearedDepressionOCDMigraine

TMS uses a focused magnetic pulse to induce electrical activity in a targeted region of the cortex. The pulse passes through the skull without pain or anesthesia; the patient sits awake in a chair. Over the course of a treatment series, repeated stimulation strengthens the activity of specific circuits — most commonly the dorsolateral prefrontal cortex in depression, but many others depending on the condition.

TMS is FDA-cleared for treatment-resistant depression, obsessive-compulsive disorder, smoking cessation, and migraine. It is also used off-label for anxiety, PTSD, ADHD, bipolar depression, and post-concussive syndrome, with growing evidence in each area.

We select the target site and stimulation frequency for each patient based on EEG findings rather than applying a single fixed protocol.

Transcutaneous Vagus Nerve Stimulation (tVNS)

Autonomic RegulationNon-Invasive

tVNS delivers mild electrical stimulation to the vagus nerve through the skin of the ear or neck, without surgery. The vagus nerve is the primary channel of the parasympathetic nervous system — the system that regulates rest, recovery, and emotional balance.

Chronic anxiety, PTSD, insomnia, and inflammatory conditions often involve suppressed vagal tone. tVNS is used to help restore that regulation, complementing other treatments when the autonomic system needs direct support.

Transcranial Direct Current Stimulation (tDCS)

Cognitive SymptomsAdjunctive

tDCS applies a low-intensity electrical current across the scalp to gently modulate the excitability of underlying cortical regions. It does not force neurons to fire; it shifts how readily they respond to their existing inputs, priming targeted circuits toward greater or lesser activity.

tDCS is useful for cognitive symptoms — attention, working memory, executive function — and as an adjunct to cognitive rehabilitation and to TMS.

Cranial Electrotherapy Stimulation (CES)

FDA-ClearedAnxietyDepressionInsomnia

CES uses very low-level alternating current delivered through clip-on electrodes at the earlobes. It is FDA-cleared for anxiety, depression, and insomnia. Compared with TMS and tDCS, CES is gentler and can be used at home in appropriate cases.

We often incorporate CES as a supportive treatment for patients whose symptoms include sleep disturbance or persistent anxiety, and as a bridge between in-office sessions.

Combining Modalities

Multi-ModalIndividualized

No single technique fits every patient. Depression may respond best to TMS of the prefrontal cortex; PTSD often requires both prefrontal TMS and vagal support through tVNS; cognitive symptoms after concussion may respond to tDCS with EEG-guided targeting. When one modality is not enough, we combine — informed by ongoing measurement rather than trial-and-error.

Treatment is individualized, measured, and adjusted over time.