Deep Transcranial Magnetic Stimulation to Alleviate Symptoms of Post-Traumatic Stress Disorder

Samenvatting

Source: Tendler, A., et al. How to Use the H1 Deep Transcranial Magnetic Stimulation Coil for Conditions Other than Depression. J. Vis. Exp. (2017)

This video demonstrates the use of deep transcranial magnetic stimulation (dTMS) to alleviate symptoms of post-traumatic stress disorder, or PTSD. It begins by identifying reduced activity in the medial prefrontal cortex (mPFC) as a key factor contributing to the overactivation of the amygdala and heightened fear responses. By applying targeted magnetic pulses to the mPFC, the procedure restores its inhibitory control over the amygdala, helping to reduce fear responses and relieve PTSD symptoms.

Protocol

All procedures involving human participants have been performed in compliance with the institutional, national, and international guidelines for human welfare and have been reviewed by the local institutional review board.

1. Measure the Motor Threshold

1. Place the blue cap with the two intersecting rulers on the subject.
2. Place the 0-cm mark of the white sagittal ruler on the nasion and the 25 cm mark of the clear coronal ruler at 40% of the nasion-inion distance, with the 0 on the left side of the patient's head.
3. Use the helmet to find the resting motor threshold (MT) of the right hand, starting with the front of the helmet 7 cm from the nasion and the left side of the coil tilted 2 cm to the right.
4. Using the "Single Pulse" mode on the stimulator touch screen, administer single pulses at 50% of the stimulator output while observing the patient's resting right hand. Increase the stimulator intensity if no visible movement is observed or if a visible movement is observed less than 50% of the time. Initially, use 5% intervals.
5. Decrease the stimulator intensity if a visible movement is observed more than 50% of the time. Start with 5% intervals and then fine-tune it.
6. Repeat steps 1.4 and 1.5 to identify the minimal MT. This location is called the "hot spot."

2. Setting Up Parameters Within the Device User Interface

1. Press "Repetitive Mode" on the stimulator touchscreen.
2. Enter parameters by touching the boxes on the screen and adjusting them using the side wheel. Enter the parameters from Table 1 and press "Run Session."
3. Arm the machine by pressing the green button. Warn the patient that the stimulation is starting, and start the stimulation with the yellow button or the pedal.

3. Stimulate the medial prefrontal cortex (mPFC) for Alcohol Dependence or post-traumatic stress disorder (PTSD)

1. Place the helmet over the mPFC, symmetrically with respect to right-left, with the 0 mark on the helmet's front edge aligned with the 3 cm mark on the sagittal ruler of the cap (i.e., 3 cm from the nasion).

Disorder	Anatomical Target/ H1 Position	Stimulation Protocols	Treatment Frequency	Treatment Changes
PTSD	Medial PFC Coil symmetrical	After listening to a personalized traumatic script, 120 MT, 20 HZ, 2 sec train, 20 sec interval, 42 trains, 1680 total pulses	3d a week for 5 weeks. If the patient does not respond after 15 treatments, choose an alternative treatment.	If the patient goes into remission or has a sustained improvement, continue treatments twice a week for a period of three months. For complex PTSD with multiple traumatic events, change the traumatic script and start again
Alcohol Addiction	Medial PFC Coil symmetrical	After 90 sec personalized provocation of alcohol cravings, 120 MT, 20 HZ, 2.5 sec train, 30 sec interval, 30 trains, 1,500 total pulses	5d a week until remission or sustained improvement. If the patient does not respond after 20 treatments, choose an alternative treatment.	If the patient goes into remission, continue treatments twice a week for a period of three months.

Table 1: H1 Protocol: The focus of this paper is to demonstrate the positioning of the coil over the mPFC. It will not focus on programing the stimulator. That information is more readily available in the instructions for use that comes with the device. These protocols were designed in accordance with the principles outlined in the declaration of Helsinki.

Materialen

Lijst van materialen gebruikt in dit artikel

Naam	Bedrijf	Catalogusnummer	Opmerkingen
dTMS System			Includes H1 coil, positioning arm, cart,stimulator, cooling system
Patient Caps	Brainsway		Includes blue caps with rulers
Ear plugs			Rated to 30dB