KETAMINE THERAPY COMBINED WITH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) FOR MAJOR DEPRESSIVE DISORDER AT A SUBURBAN TERTIARY CLINIC

Abstract

Background:Autism is a heterogeneous neurodevelopmental disorder with social and executive deficits. Symptoms do not isolate to a specific brain network, and there is atypical cortical plasticity with a reduction in cortical inhibition. Autistic patients have a high degree of comorbidity, disability and disease burden with a 2025 forecasted annual cost of care of $461billion (exceeding ADHD, diabetes and stroke). 40% of autistic patients manifest anxiety including obsessive compulsive disorder (OCD). TMS is indicated for several adult neuro-psychiatric conditions and has a superior safety profile in the paediatric literature. Here we present the treatment course of a 10-year-old male verbal autistic patient with severe anxiety and OCD resistant to psychotherapy and pharmacotherapy. Methods: Treatments were administered over four months using the H7 coil. Symptoms were assessed with the Screen-for-Child-Anxiety-Related-Disorder (SCARED) and Child-Yale-Brown-Obsessive-Compulsive-Scale (CYBOCS). Anxiety being prominent, TMS was initiated with twenty right PFC sessions over 4weeks at 1HZ/120hand. After COVID exacerbated his OCD three sessions of 20Hz/100MTfoot over medial PFC/ACC were administered. After further worsening, switched to 1HZ/100MTfoot for 20sessions/4weeks. Results:After the initial 20 LF sessions over PFC, SCARED score decreased from 52 to 28 with sustained benefit for two months. Following the 3 HF sessions over PFC/ACC, CYBOCS worsened dramatically (25/37). Finally, after switching to LF for another 20 sessions, CYBOCS score improved from 37 to 15. Noticeable were decreased stereotypies, improved eye contact, interpersonal and spontaneous interactions and coping abilities. Conclusions:This case demonstrates safe and successful use of the H7 deep-TMS device in a treatment-resistant 10-year-old with autism, severe anxiety and OCD. Further controlled studies in this age group are warranted. Funding: None. Disclosures: AM OM AJ have a financial interest in commercial TMS. AT has a financial interest in commercial TMS and in BrainsWay, the manufacturer of the H7 coil.

Subthreshold repetitive transcranial magnetic stimulation suppresses ketamine-induced poly population spikes in rat sensorimotor cortex

“…Due to their overlapping effects, rTMS and subanesthetic ketamine have been combined to treat neuropsychiatric disorders in humans and shown synergetic effects (Best and Griffin, 2015;Pradhan and Rossi, 2020;Davila et al, 2021). However, the interaction of rTMS and anesthetic ketamine on cortical activities including cortical oscillations and neuronal spike firing has not been explored yet.…”