Transcranial Magnetic Stimulation and Post Traumatic Stress Disorder

The benefits wore off slightly during a two-month follow-up period.

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The researchers plan further studies to explore what dose and frequency of TMS are most effective, and exactly which areas of the brain should be targeted. March 12, — High-frequency repetitive transcranial magnetic stimulation rTMS may have a therapeutic effect in patients with posttraumatic stress disorder PTSD , according to the results of a double-blind, placebo-controlled study published in the March issue of the American Journal of Psychiatry. None of the patients suffered from a chronic medical disease. However, all but four of the subjects were receiving polypharmacy.

Patients did not stop or change drug treatment in the three weeks before or during the study.

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They also continued to receive supportive psychotherapy. Investigators administered stimulus over the right dorsolateral prefrontal cortex for 20 minutes per day over 10 week days. The placebo group received treatment in the same way as the group receiving high-frequency rTMS, but the coil was held at 90 degrees vertical over the stimulated head area.

Patients in the low-frequency rTMS received 1 Hz for 5 seconds per train; the intertrain interval was 55 seconds. Subjects in the high-frequency rTMS group received 10 Hz for 2 seconds per train; the intertrain interval was 58 seconds. A blinded investigator assessed symptoms of PTSD, anxiety, and depression at baseline, day 5, day 10, and day 24 14 days after intervention. Post-hoc tests revealed no significant difference between treatments or times for the Hamilton depression scale, however.

Fourteen patients across all treatment groups reported headache, but treatment was generally well tolerated. Eleven participants across all treatment groups also reported sleep improvement. It is suggested that in further studies the stimulation could be repeated as maintenance therapy, as in [electroconvulsive therapy] Dr.

For continuous outcomes, the meta-analysis was performed on endpoint PTSD scores. Since studies used more than one PTSD scale, we extracted data corresponding to the study's definitions of the primary outcome. When a study reported scores at more than one time-point, we used the scores corresponding to the longest time period prior to unblinding.

For studies in which three groups were compared, two separate datasets were compared in each of two different analyses. For example, in the study by Boggio et al. Likewise, in the study by Cohen et al. We therefore compared high frequency right DLPFC stimulation with sham stimulation in one analysis and in another analysis we compared low frequency right DLPFC stimulation with sham stimulation. The study by Isserles et al. The groups were configured as follows: Even though all groups received some kind of treatment, we considered group c to be the sham group since TMS was not applied. In a crossover study conducted by Osuch et al.

We assessed the methodological quality of each trial by assessing the following: All analyses were performed using the statistical packages for meta-analysis available in Stata 13 for Mac OSX.

• References.
• PTSD: Similar Effects of High- and Low-Frequency rTMS!
• Dating on the Super Highway.

For the main outcome PTSD scores we initially calculated the standardized mean difference and the pooled SD of each comparison. This procedure is convenient when handling different scales such as PTSD scales since it standardizes the effect sizes across all studies based on the SD of each study.

For the study by Boggio et al. For the study by Osuch et al. Hedges' g was used as the measure of effect size, which is appropriate for studies with small sample sizes. The pooled effect size was weighted by the inverse variance method and measured using the random-effects model.

Studies that failed to provide crucial data such as SD or scale assessment were excluded from the final analysis. Publication bias was evaluated using a funnel plot, which displays confidence interval boundaries to assist in visualizing whether the studies are within the funnel, thus providing an estimate of publication bias e.

A sensitivity analysis was also performed, assessing the impact of each study on the overall results by excluding one study at a time. Our systematic review yielded 54 studies after duplicates were removed. Of these, 49 articles did not meet the eligibility criteria. Mean age was No washout of drugs was performed. Demographics and stimulation protocols are summarized in Table 1. The quality assessment revealed that all studies were randomized. Sham TMS was performed in four different ways: Finally, all studies reported that raters were blinded to treatment allocation.

We calculated the effect size for the endpoint. The forest plot was used to graphically illustrate the relative strength of treatment effects for each study reviewed.

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The vertical line represents the overall effect. We found that exclusion of each of these studies in turn did not have a significant impact on the results, with resulting effect sizes close to the overall effect size. Therefore, no single study in particular was driving the results of our analysis.

The following variables were assessed: Meta-regression showed no particular influence of any variable on the results. Our results are in line with those of a previous meta-analysis.

Neuroscientists use magnetic stimulation to amplify PTSD therapy

We also improved the quality of data analysis. The previous investigation did not analyze heterogeneity or publication bias and did not conduct meta-regression to detect the influence of variables or exclude each study one by one in the meta-analysis to evaluate their impact on the final result.

• Neuroscientists use magnetic stimulation to amplify PTSD therapy.
• Childrens Book Learn about Whales - Pop Quiz Edition (Curious Kids Press Pop Quiz Edition 2).
• PTSD: Similar Effects of High- and Low-Frequency rTMS;
• TMS Studies.

The funnel plot assessment conducted in the present study showed that the risk of publication bias was also low, further strengthening our results. Importantly, we found that between-study heterogeneity was high. New clinical trials with uniform intervention protocols could clarify results in future analyses. Another characteristic of our meta-analysis is that we analyzed separately two datasets for each of three studies, Boggio et al.

Indeed, using this approach we were able to increase the sample size and narrow the confidence interval further. In our meta-analysis we included intervention protocols that either stimulated or inhibited left or right DLPFC. Meta-regressions were performed in order to identify the possibility of different results if protocols were evaluated separately. Moreover, in order to verify the influence of each study on the overall effect, subgroup analysis was performed using the metaninf command in Stata.

No single study influenced the overall effect by itself. The neurobiological hypothesis for the efficacy of TMS in PTSD treatment is based on dysfunctions of brain regions so far associated with processing threatening and fear-inducing stimuli, including the amygdala, the frontal lobe, and the hippocampus.

PTSD treatment | post traumatic stress | TMS Therapy | TheraMind

The ventral prefrontal areas are richly connected to lateral prefrontal areas and amygdala. The right ventromedial frontal area provides access to object-recognition systems to the amygdala, where the fear or threat response is mediated. These authors showed greater activation in the right ventrolateral prefrontal cortex VLPFC compared to the control group, suggesting that PTSD patients may require more effort to ignore emotionally distracting stimuli.

The increased activation in the VLPFC was associated with decrease in the dorsolateral prefrontal cortex and with increased activation of the amygdala. The interpretation was that amygdala activation signaled the emotional distraction, which was inhibited by the VLPFC, taking attention away from tasks, as indicated by activation of the DLPFC.

Modulating the DLPFC using TMS was proposed to assess its efficacy in PTSD treatment, since it is a safe, non-invasive treatment that uses an electromagnetic field to modulate the activity of cortical areas based on a high-intensity current through a magnetic coil placed on the scalp, generating a time-varying pulsed magnetic field that penetrates the cranium approximately 2-cm from the scalp surface to cortical tissue.