At Newport Brain Research Laboratory and Brain Treatment Center, magnetic resonance therapy (MRT) is employed as an effective method to treat posttraumatic stress disorder (PTSD). MRT works by manipulating activity patterns in brain networks associated with this condition using magnets.
Two RCTs have investigated second-generation TMS modalities for treating PTSD. The first randomized 103 veterans to active or sham 1Hz TMS to the DLPFC prior to weekly CPT sessions.
Symptoms
Post-Traumatic Stress Disorder, or PTSD, is caused by any kind of trauma – war, sexual assault, car accidents or severe illness can all lead to it – as well as any subsequent events like abuse, loss and death of loved ones. People affected may experience intense and persistent feelings of fear, anxiety or depression which worsen over time and make functioning normally increasingly challenging; symptoms can linger for months or years and include nightmares, flashbacks and difficulty sleeping; lack of concentration as well as emotional numbness are just some symptoms associated with PTSD.
MeRT (Magnetic E-resonance Therapy) is a noninvasive treatment method using brainwave analysis to realign neural pathways in your brain. The process includes placing coils around your head and applying magnetic pulses that affect how neurons communicate between each other, with your doctor then being able to adjust intensity levels of magnetic fields in order to target areas that need realigning in your mind. MeRT may be beneficial in improving mental health as it offers alternative solutions compared to medications or other forms of treatment.
A former Marine helicopter crew chief reclines in a medical suite with eyes closed while an ex-Army squad leader holds a paddle-shaped wand against his forehead, providing short bursts of electromagnetic stimulation to his frontal lobe of brain. For six seconds, this device produces a staccato rhythm as short bursts are delivered directly into his brain’s frontal lobes via electromagnetic stimulation.
This phase II trial used double-blind, placebo-controlled stimulation of both right and left DLPFC with active 20Hz rTMS to reduce symptoms associated with DSM-IV diagnosed PTSD in 30 patients diagnosed using DSM IV criteria. Each condition resulted in significant reductions of core symptoms including hyperarousal, vigilance, intrusive thoughts and emotional numbness – though right condition had larger effect than left condition.
Cortical MeRT should generally be administered only if pregnant or breastfeeding patients can avoid certain absolute contraindications that require close protocol attention, but can typically be avoided by those not pregnant or breastfeeding. These include a history of seizures, pacemakers or defibrillators, pacemakers/defibrillators, pacemakers or defibrillators, pacemakers or defibrillators, pacemakers or defibrillators, pacemakers or defibrillators, pacemakers or defibrillators implants aneurysm clips aneurysm clips ear implants cochlear implant and metallic foreign bodies present within the brain (excluding titanium). In addition to absolute contraindications discussed with your physician; relative contraindications include mental illnesses including bipolar Disorder Types I/III disorders Types; Tinnitus; depression.
Diagnosis
As soon as PTSD first surfaced in the 1990s, doctors believed it to be caused by an abnormal brain circuit that shifted memory and emotional processing toward the right side of the cortex. Treatment options typically included psychotherapy sessions aimed at forcing patients to revisit traumatic events as well as antidepressant medications belonging to the SSRI class.
However, these treatments can often have unpleasant and even dangerous side effects. Another possibility is eye movement desensitization and reprocessing (EMDR), which uses rapid eye movements to help victims process trauma memories – however this process is time consuming, costly, and has a high dropout rate.
BrainsWay’s noninvasive MeRT therapy uses magnetic stimulation of brain structures and networks associated with posttraumatic stress disorder (PTSD). Our device analyzes your brainwaves to ensure optimum treatment results – offering a safe yet effective approach to mental wellbeing improvement.
Jon Warren, a former Marine helicopter crew chief, relaxes comfortably at the Brain Treatment Center – a nonprofit offering free sessions to veterans – in a medical suite. Warren has experienced remarkable transformation since spending most of his life wracked with guilt over failing to rescue fellow soldier from burning Humvee that crushed them during Iraq deployment 2006.
No longer plagued by nightmares or flashbacks, he no longer harbors suicidal thoughts and can spend long days with his wife. Additionally, his 10-year-old son with autism no longer requires one-on-one aide at school and is reading at a high school level, passing spelling tests effortlessly.
Even with impressive clinical trial results, researchers are still exploring optimal TMS settings for treating PTSD. Studies have examined frequency, pulse duration and intensity as well as delivery modes including sTMS and TBS; yet only few have explored long-term outcomes of PTSD symptom improvement.
Treatment
Neuroimaging and electroencephalogram (EEG) studies indicate that altered cortical excitability contributes to the pathogenesis of posttraumatic stress disorder (PTSD). Particularly, the ventromedial prefrontal cortex (vmPFC) and amygdala are implicated. Furthermore, several animal and human clinical studies demonstrate how noninvasive brain stimulation such as rTMS or tDCS to these regions may alleviate PTSD symptoms (12-17). One rTMS treatment to the vmPFC reduced symptoms while another using tDCS in amygdala improved symptoms as well as normalized EEG activity (18-20).
As well as psychotherapies such as CPT and PE, TMS combined with these treatments has been explored through some RCTs (21). One such RCT employed a modified version of the imaginal exposure protocol which involved self-guided exploration of trauma-related imagery while speaking aloud while receiving weekly TMS sessions; its results were similar to that of using just the imaginal exposure protocol alone, yet greater than using PE alone.
More recent research has made use of resting-state fMRI to measure predictors of clinical response to TMS (23-28). Results from two studies suggested that participants who responded well had increased within-network connectivity within the DMN as measured by resting-state fMRI; by contrast, those who didn’t respond had reduced within-network connectivity and displayed poorer PTSD symptom reduction on the CAPS scale.
sTMS, the second-generation TMS modality, uses three rotating magnets to deliver relatively low energy triplet bursts of pulses at more precise frequency levels (synchronized to each participant’s intrinsic alpha frequency). A pilot RCT randomized veterans with both PTSD and MDD to either active sTMS treatment or placebo for one month follow-up; active sTMS was found to significantly reduce both symptoms simultaneously.
Jin has been using off-label sTMS treatments to treat veterans for PTSD since 2013. According to his estimates, about 100 veterans have undergone treatments; most had given up with traditional approaches offered through VA such as behavioral therapy and medications. Many reported their PTSD symptoms have significantly reduced or been entirely eliminated and this improvement has continued at least since 2013. Going forward, researchers hope to assess sTMS’ potential in treating other disorders such as depression anxiety addiction and tinnitus.
Results
TMS uses an electromagnet to deliver pulses of magnetic energy that stimulate brain cells and increase their activity, approved by the U.S. Food and Drug Administration for treating depression but researchers have also discovered it can alleviate PTSD symptoms in veterans. TMS differs from other treatments by not requiring surgery or medications – the results from studies indicate it’s effective as either monotherapy or in combination with psychotherapies.
Studies have demonstrated the efficacy of TMS for relieving combat-related PTSD symptoms, such as depressive and anxiety symptoms. One such study involved coexisting PTSD and MDD patients receiving 10 sessions of either 1 Hz or 5 Hz TMS to the left DLPFC; those receiving TMS showed greater improvements in both depression (though not anxiety) symptoms than a control group; another recent retrospective case series study demonstrated 1Hz bilateral DLPFC TMS improved these same areas, though its effect size was smaller.
Another small pilot RCT randomly assigned nine participants to either active versus sham rTMS of their right DLPFC during an imaginal exposure protocol. Participants experienced significant decreases in PTSD symptoms on CAPS assessments that were sustained through follow-up.
These studies provide encouraging findings, yet further investigation is required to identify optimal stimulation parameters and laterality, and identify predictive biomarkers of response. FMRI and EEG measurements may help detect patterns of network connectivity that correlate with clinical responses; an increase in salience network (SN) connectivity has been linked with posttraumatic stress disorder (PTSD).
Future research may examine the effects of different rTMS protocols on different symptoms clusters associated with PTSD and determine which targets are more or less effective than others. Furthermore, conducting a large-scale controlled trial would allow researchers to ascertain its safety and efficacy among PTSD veterans from multiple populations. One group of scientists is raising funds for such an endeavor with plans to use two MRT devices that cost around $50,000 each in double-blind clinical trials of TMS devices for treating PTSD veterans.
