Noninvasive Brain Stimulation With High-Frequency and Low-Intensity Repetitive Transcranial Magnetic Stimulation Treatment for Posttraumatic Stress Disorder

Abstract

Objective-We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)-associated symptoms.Method-In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV-diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment. Results-Resultsshow that both active conditions-20 Hz rTMS of left and right DLPFCinduced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD.Conclusions-These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy. Although selective serotonin reuptake inhibitors (SSRIs)-among other antidepressantshave resulted in various degrees of improvement in patients with PTSD, there is no definitive pharmacotherapy available to date for the treatment of this debilitating disorder. A review of 37 clinical trials of pharmacotherapies 4 found inadequate evidence to determine the value of antidepressants, benzodiazepines, anticonvulsants, α-blockers, and secondgeneration antipsychotics for the treatment of PTSD. Even so, according to an American Psychiatric Association guideline, 5 SSRIs remain the first line of treatment for PTSD. In addition, due to the complex nature of this disorder, individuals with PTSD also seem to benefit from 10 to 12 sessions of cognitive-behavioral therapy, prolonged-exposure therapy, or cognitive-processing therapy. Nevertheless, many individuals respond inadequately to currently available therapies, and research for more effective treatment paradigms is ongoing. NIH Public AccessMost recently, repetitive transcranial magnetic stimulation (rTMS)-a method of noninvasive neuromodulation-has been emerging as a potentially effective technique in the treatment of PTSD. Indeed, rTMS has already been shown to be highly effective in the treatment of medically refractory depression 6 and is n...

Repetitive transcranial magnetic stimulation ameliorates anxiety-like behavior and impaired sensorimotor gating in a rat model of post-traumatic stress disorder

“…Accordingly, we determined whether rTMS, a well-established therapeutic method PTSD treatment, offered benefits as early intervention after stress. Prior studies have indicated that administration of high-frequency rTMS to the right dorsolateral prefrontal cortex is beneficial for ameliorating PTSD symptoms [26,27]. Our data presented herein demonstrated for the first time that chronic administration of rTMS has anxiolytic effect on stressrelated anxiety-like behaviors without affecting control rats.…”

“…In the first, action precedes the stress with the intention of enhancing resistance to stress while in the second rTMS on Model Rat of PTSD approach, treatment is introduced after in order to prevent establishment of a stress related syndrome [27]. Since many traumatic incidents are unpredictable, the latter approach is likely the one that is feasible.…”

Transcranial magnetic stimultation: scientific and modern technology for treatment of psychiatric and neurological disorders

“…18 Modulation of prefrontal cortex can alleviate the core symptoms of Post Traumatic Stress Disorder and suggest that high-frequency rTMS of right prefrontal cortex might be the optimal treatment strategy. 19 Another study confirms that five daily sessions of high frequency rTMS over the left and then the right prefrontal cortex improves cognitive function in patients with mild to moderate degree of Alzheimer's Disease. 20 Adverse effects: Although TMS is generally regarded as safe, …”

Repetitive transcranial magnetic stimulation in neurology and psychiatry

“…Показана эффективность низкочастотной стимуля-ции правой DLPFC при генерализованном тревожном расстройстве [159]; высокочастотной -как левой, так и правой DLPFC при посттравматическом тревожном рас-стройстве [160]; высокочастотной -левой DLPFC и низ-кочастотной -зоны SMA при обсессивно-компульсив-ном расстройстве [161,162]. При паническом расстрой-стве достоверных различий по сравнению с группой ими-тации стимуляции получено не было [163].…”