One hertz versus ten hertz repetitive TMS treatment of PTSD: A randomized clinical trial

Kozel, F. Andrew; Trees, Kimberly Van; Larson, Valerie A; Phillips, Sean; Hashimie, Jaffrey; Gadbois, Brian; Johnson, Suzanne Bennett; Gallinati, Jessica; Barrett, Blake; Toyinbo, Peter; Weisman, Mark; Centorino, Michael B.; Gibson, Carri-Ann; Catalano, Glenn

doi:10.1016/j.psychres.2019.01.004

Cited by 47 publications

(57 citation statements)

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“…There is an increased need for the development of novel treatments for PTSD, specifically for the Veteran population, as current PTSD treatments, such as psychotherapy and pharmacotherapy, may not be as effective in symptom reduction in Veterans compared to the general population [25]. Neuromodulation interventions, such as repetitive transcranial magnetic stimulation (rTMS, hereafter TMS), are proving to be an effective treatment for pharmacoresistant major depressive disorder (MDD) [4,16] and PTSD [3,13]. TMS provides a pulsed magnetic field, typically for the left dorsolateral prefrontal cortex (DLPFC) for MDD, which induces an electric current to modulate activity in that brain region.…”

Section: Introductionmentioning

confidence: 99%

Changes in functional connectivity after theta-burst transcranial magnetic stimulation for post-traumatic stress disorder: a machine-learning study

Zandvakili

Swearingen

Philip

2020

Eur Arch Psychiatry Clin Neurosci

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Intermittent theta burst stimulation (iTBS) is a novel treatment approach for post-traumatic stress disorder (PTSD), and recent neuroimaging work indicates that functional connectivity profiles may be able to identify those most likely to respond. However, prior work has relied on functional magnetic resonance imaging, which is expensive and difficult to scale. Alternatively, electroencephalography (EEG) represents a different approach that may be easier to implement in clinical practice. To this end, we acquired an 8-channel resting-state EEG signal on participants before (n = 47) and after (n = 43) randomized controlled trial of iTBS for PTSD (ten sessions, delivered at 80% of motor threshold, 1,800 pulses, to the right dorsolateral prefrontal cortex). We used a cross-validated support vector machine (SVM) to track changes in EEG functional connectivity after verum iTBS stimulation. We found that an SVM classifier was able to successfully separate patients who received active treatment vs. sham treatment, with statistically significant findings in the Delta band (1-4 Hz, p = 0.002). Using Delta coherence, the classifier was 75.0% accurate in detecting sham vs. active iTBS, and observed changes represented an increase in functional connectivity between midline central/occipital and a decrease between frontal and central regions. The primary limitations of this work are the sparse electrode system and a modest sample size. Our findings raise the possibility that EEG and machine learning may be combined to provide a window into mechanisms of action of TMS, with the potential that these approaches can inform the development of individualized treatment methods.

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Section: Introductionmentioning

confidence: 99%

Changes in functional connectivity after theta-burst transcranial magnetic stimulation for post-traumatic stress disorder: a machine-learning study

Zandvakili

Swearingen

Philip

2020

Eur Arch Psychiatry Clin Neurosci

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“…[10,11]). Studies using varied stimulation frequencies, sites of stimulation, and stimulation approaches (e.g., combination with symptom provocation or psychotherapy) have consistently indicated efficacy [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

One-year clinical outcomes following theta burst stimulation for post-traumatic stress disorder

Petrosino

Wout-Frank

Aiken

et al. 2019

Neuropsychopharmacol.

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Theta burst transcranial magnetic stimulation (TBS) is a potential new treatment for post-traumatic stress disorder (PTSD). We previously reported active intermittent TBS (iTBS) was associated with superior clinical outcomes for up to 1-month, in a sample of fifty veterans with PTSD, using a crossover design. In that study, participants randomized to the active group received a total of 4weeks of active iTBS, or 2-weeks if randomized to sham. Results were superior with greater exposure to active iTBS, which raised the question of whether observed effects persisted over the longer-term. This study reviewed naturalistic outcomes up to 1-year from study endpoint, to test the hypothesis that greater exposure to active iTBS would be associated with superior outcomes. The primary outcome measure was clinical relapse, defined as any serious adverse event (e.g., suicide, psychiatric hospitalization, etc.,) or need for retreatment with repetitive transcranial magnetic stimulation (rTMS). Forty-six (92%) of the initial study's intent-to-treat participants were included. Mean age was 51.0 ± 12.3 years and seven (15.2%) were female. The group originally randomized to active iTBS (4-weeks active iTBS) demonstrated superior outcomes at one year compared to those originally randomized to sham (2-weeks active iTBS); log-rank ChiSq = 5.871, df = 1, p = 0.015; OR = 3.50, 95% CI = 1.04-11.79. Mean days to relapse were 296.0 ± 22.1 in the 4-week group, and 182.0 ± 31.9 in the 2-week group. When used, rTMS retreatment was generally effective. Exploratory neuroimaging revealed default mode network connectivity was predictive of 1-year outcomes (corrected p < 0.05). In summary, greater accumulated exposure to active iTBS demonstrated clinically meaningful improvements in the year following stimulation, and default mode connectivity could be used to predict longer-term outcomes.

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“…However, in the presence of signs or symptoms that suggest CNS organic compromise, “inhibitory” protocols should be preferred in favor of minimizing the theoretical risk of induced seizures. Low-frequency stimulation of the right DLPFC would be an alternative since one trial that compared both high and low-frequency protocols found no superiority of one intervention over the other in the improvement of PTSD symptoms ( 204 ). Furthermore, low-frequency pulses delivered to the right DLPFC may also be effective for the treatment of generalized anxiety disorder ( 205 ).…”

Section: Methodsmentioning

confidence: 99%

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

et al. 2020

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Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway.Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

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One hertz versus ten hertz repetitive TMS treatment of PTSD: A randomized clinical trial

Cited by 47 publications

References 50 publications

Changes in functional connectivity after theta-burst transcranial magnetic stimulation for post-traumatic stress disorder: a machine-learning study

Changes in functional connectivity after theta-burst transcranial magnetic stimulation for post-traumatic stress disorder: a machine-learning study

One-year clinical outcomes following theta burst stimulation for post-traumatic stress disorder

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

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