Issue with rTMS for Depersonalization Disorder

So I did rTMS on the right TPJ and gave up after 13 sessions because I didn't notice any response. I want to try the right VLPFC but as I have been researching into this I have come across an issue with TMS (other than the expense and the hassle of finding a clinic that will do something that isn't FDA approved) and that is that the trials done on the VLPFC used nueronavigation technology to more accurately target the site of the VLPFC. This means the trials used brain scans in addition to the TMS machine to conduct the trials. Here is how it is written in the article about the VLPFC trial:

"A structural MRI was obtained for all participants prior to rTMS... Images were converted to DICOM format for use within BrainSight 2, a widely used neuronavigation software program which ensures that stimulation can only be delivered when the target site is positioned using the frameless stereotaxy."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906152/

When I did rTMS there were no brain scans done and the target site was located by coordinates drawn on a cap I was wearing that was the site of the right TPJ for most people. I'm concerned whether or not using the scalp coordinates for TPJ or VLPFC are good enough...? I wonder if I had access to nueronavigation when I did TPJ rTMS would I have responded?

I emailed Professor Anthony David about this (the guy who conducted the VLPFC trial) and this is what I said and what he said:

Hello professor David. I am a long term suffer of depersonalization disorder and recently received 13 sessions of rTMS over the right TPJ. I did not respond to treatment but would like to try rTMS over the VLPFC. My question is whether or not nueronavigation software and individual structural MRIs are necessary to obtain accurate coordinates for the site of stimulation for the individual? I was able to try the TPJ with coordinates sent to my doctor from the SmartTMS clinic in the UK but I haven't been able to get a straight answer from them if they have coordinates to try VLPFC. Do you suppose the coordinates can be the same for everyone or is the site of stimulation heavily reliant on what the brain scans reveal for the individual?

Thank you

Thanks for your enquiry.

The actual coordinates are the same but what neuronavigator does is put your brain into the grid so that the coordinates can be found in your brain (if that makes sense) and it needs an MRI scan of your brain to do this. Presumably the "coordinates" that were sent, were a set of measurements done on the scalp which approximate to TPJ? This is OK but not nearly as accurate.

We are hoping to do a larger study of rTMS some time in the future but first need to raise some grant funds.

Best wishes

So as I'm considering throwing out some more money for TMS I wonder how worth it it is going to be to try since I can't even get the treatment done the same exact way it was done on these trials. It was a hassle to get this all together to get the TMS clinic in my town even do the right TPJ and any regular TMS clinic in the U.S. is not going to have nueronavigation software combined with their TMS machine. I know not many of you have tried TMS, but those that have did you have any brain scans done prior to your TMS treatment in order to target the site of stimulation? Any other thoughts on this?