Fryml Leah D, Pelic Christopher G, Acierno Ron, Tuerk Peter, Yoder Matthew, Borckardt Jeffrey J, Juneja Natasha, Schmidt Matthew, Beaver Kathryn L, George Mark S
J ECT. 2019 Mar;35(1):53-60. doi: 10.1097/YCT.0000000000000505.
This is a small preliminary but novel study assessing the feasibility of repetitive transcranial magnetic stimulation (rTMS) delivery to veterans with posttraumatic stress disorder (PTSD) while they simultaneously receive prolonged exposure (PE) therapy.
A prospective, randomized, double-blinded, active sham-controlled design combined weekly sessions of rTMS and standard PE at the Veterans Administration Hospital. Eight adult patients received a full course of protocol-driven PE therapy and were randomly assigned to receive either rTMS or sham rTMS. Repetitive transcranial magnetic stimulation was delivered to the right or left prefrontal cortex with a figure-eight solid core coil at 120% motor threshold, 10 Hz, 5-second train duration, and 10-second intertrain interval for 30 minutes (6000 pulses) weekly for 5 weeks (30,000 stimuli).
Of the 12 veterans consented, 8 completed the study treatment protocol. The dropout rate was 34%, roughly equivalent to the pooled average dropout rates observed in traditional PE therapy with Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD, suggesting that veterans had no difficulty tolerating the addition of rTMS to PE therapy and that this is a feasible study design for larger trials in the future. Clinician-Administered PTSD Symptom scores reflected a general nonsignificant trend toward improvement, and subjects with comorbid major depression appeared to experience significant antidepressant benefit with treatment despite the fact that the doses used in this protocol were much smaller than those used to treat patients with major depressive disorder.
This pilot study demonstrates the safety and feasibility of rTMS delivery to PTSD patients while they simultaneously receive PE. This unique approach to the treatment of PTSD highlights the need for further studies with larger sample sizes to assess treatment outcomes.
这是一项小型的初步但新颖的研究，旨在评估在创伤后应激障碍（PTSD）退伍军人同时接受延长暴露（PE）疗法时，重复经颅磁刺激（rTMS）治疗的可行性。
采用前瞻性、随机、双盲、活性安慰剂对照设计，在退伍军人管理局医院将每周的rTMS治疗与标准PE治疗相结合。八名成年患者接受了完整疗程的方案驱动PE治疗，并被随机分配接受rTMS或假rTMS治疗。使用八字形实心线圈，以120%运动阈值、10赫兹、5秒脉冲串持续时间和10秒脉冲串间隔，将重复经颅磁刺激施加到右侧或左侧前额叶皮质，每周30分钟（6000个脉冲），共5周（30000次刺激）。
在12名同意参与的退伍军人中，8人完成了研究治疗方案。脱落率为34%，大致相当于在持久自由行动/伊拉克自由行动中患有PTSD的退伍军人接受传统PE治疗时观察到的综合平均脱落率，这表明退伍军人在PE治疗中添加rTMS没有耐受性困难，这是未来更大规模试验的可行研究设计。临床医生评定的PTSD症状评分总体上呈现出不显著的改善趋势，尽管本方案中使用的剂量远小于用于治疗重度抑郁症患者的剂量，但患有共病重度抑郁症的受试者在治疗后似乎有显著的抗抑郁效果。
这项初步研究证明了在PTSD患者同时接受PE治疗时进行rTMS治疗的安全性和可行性。这种独特的PTSD治疗方法凸显了需要进行更大样本量的进一步研究以评估治疗效果。
