Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans

Milan T Makale; Shaghayegh Abbasi; Chad Nybo; Jason Keifer; Lori Christman; J Kaci Fairchild; Jerome Yesavage; Kenneth Blum; Mark S Gold; David Baron; Jean Lud Cadet; Igor Elman; Catherine A Dennen; Kevin T Murphy

doi:10.1016/j.heliyon.2023.e18943

Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans

Heliyon. 2023 Aug 8;9(8):e18943. doi: 10.1016/j.heliyon.2023.e18943. eCollection 2023 Aug.

Authors

Milan T Makale¹, Shaghayegh Abbasi², Chad Nybo³, Jason Keifer⁴, Lori Christman⁵, J Kaci Fairchild^{6

7}, Jerome Yesavage⁶, Kenneth Blum^{8

9

10

11}, Mark S Gold¹², David Baron⁸, Jean Lud Cadet¹³, Igor Elman¹⁴, Catherine A Dennen¹⁵, Kevin T Murphy¹⁶

Affiliations

¹ Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.
² Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA.
³ CrossTx Inc., Bozeman, MT, 59715, USA.
⁴ Brain Health Hawaii, Honolulu, HI, 96816, USA.
⁵ StatKing Clinical Services, Fairfield, OH, 45014, USA.
⁶ Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
⁷ Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Medical Center, Palo Alto, CA, 94304, USA.
⁸ Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA.
⁹ Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Hungary.
¹⁰ Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA.
¹¹ Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel.
¹² Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
¹³ Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA.
¹⁴ Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
¹⁵ Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA.
¹⁶ PeakLogic Inc., Del Mar, CA, 92130, USA.

Abstract

Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.

Keywords: Alpha oscillations; Automatic cognition; Contextual; Default mode network; EEG; Experience-based; Fast thinking; Implicit; Intuitive; PTSD; PTSD checklist for DSM-5 (PCL-5); Power spectrum; rTMS.