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

Abstract

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.

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

“…We used the EEG data recorded during a previously published randomized, double-blind study of iTBS for PTSD, conducted at the Providence VA Medical Center in Providence, RI, USA. For full details of the study, including inclusion/exclusion criteria, clinical outcomes, and initial fMRI results, see [ 17 , 20 ]. In brief, all participants met DSM-5 criteria for PTSD and eligibility to receive TMS treatment, and any medications and psychotherapeutic treatments were stable for at least 6 weeks before beginning study procedures.…”

Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity

“…Therefore, the use of TBS (either iTBS over the left DLPFC or biTBS over the bilateral DLPFC) could also be an alternative for the treatment of patients with MDD who did not show adequate response after 10 sessions of conventional HF-rTMS protocol. However, there has been few studies investigating the effects of TBS in MDD patients with other psychiatric comorbidities, even though recent data has indicated effectiveness of iTBS in reduce craving in substance-use disorders [66] and treating PTSD [46,67].…”

A Systematic Review of Neuromodulation Treatment Effects on Suicidality

“…No cases of completed suicide occurred either in the active-treatment or sham-treatment group. During 1 year follow-up, overall clinical outcomes were better in the active-treatment group, the relapse rate was lower and the duration between treatment and relapse was longer in the active-treatment group (Petrosino et al, 2020).…”