Makale Milan T, Abbasi Shaghayegh, Nybo Chad, Keifer Jason, Christman Lori, Fairchild J Kaci, Yesavage Jerome, Blum Kenneth, Gold Mark S, Baron David, Cadet Jean Lud, Elman Igor, Dennen Catherine A, Murphy Kevin T
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA.
Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA.
Heliyon. 2023 Aug 8;9(8):e18943. doi: 10.1016/j.heliyon.2023.e18943. eCollection 2023 Aug.
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.
新出现的数据表明，创伤后应激障碍（PTSD）源于大脑默认模式网络（DMN）活动紊乱，表现为脑电图（EEG）α振荡失调。因此，我们采用一种扩展形式的重复经颅磁刺激（rTMS），即个性化rTMS（PrTMS），对185名患有PTSD的退伍军人进行治疗。在这种治疗方法中，基于脑电图频谱的引导被用于通过以下方式迭代优化症状缓解：（1）以降低的功率刺激多个运动感觉和额叶皮质部位；（2）在治疗过程中，根据一种专有的频率算法（PeakLogic公司，圣地亚哥）调整皮质治疗位点和刺激频率，该算法可识别α振荡带DMN元素中的刺激频率。在除常规PTSD治疗外进行4至6周的PrTMS®治疗后，退伍军人表现出显著的临床改善，同时皮质α中心频率增加，α振荡同步性增强。超过50%的患者PTSD症状完全缓解。这些数据支持DMN参与PTSD的病理生理学，并提示其在治疗结果中的作用。可能需要进行前瞻性、假对照的PrTMS®试验，以验证我们的临床发现，并研究针对患有战斗性和非战斗性PTSD的个体患者独特需求的新型预防、诊断和治疗策略中DMN靶向的贡献。
