Brain stimulation in posttraumatic stress disorder

Abstract

Posttraumatic stress disorder (PTSD) is a complex, heterogeneous disorder that develops following trauma and often includes perceptual, cognitive, affective, physiological, and psychological features. PTSD is characterized by hyperarousal, intrusive thoughts, exaggerated startle response, flashbacks, nightmares, sleep disturbances, emotional numbness, and persistent avoidance of trauma-associated stimuli. The efficacy of available treatments for PTSD may result in part from relief of associated depressive and anxiety-related symptoms in addition to treatment of core symptoms that derive from reexperiencing, numbing, and hyperarousal. Diverse, heterogeneous mechanisms of action and the ability to act broadly or very locally may enable brain stimulation devices to address PTSD core symptoms in more targeted ways. To achieve this goal, specific theoretical bases derived from novel, well-designed research protocols will be necessary. Brain stimulation devices include both long-used and new electrical and magnetic devices. Electroconvulsive therapy (ECT) and Cranial electrotherapy stimulation (CES) have both been in use for decades; transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), transcranial Direct Current Stimulation (tDCS), and vagus nerve stimulation (VNS) have been developed recently, over approximately the past twenty years. The efficacy of brain stimulation has been demonstrated as a treatment for psychiatric and neurological disorders such as anxiety (CES), depression (ECT, CES, rTMS, VNS, DBS), obsessive-compulsive disorder (OCD) (DBS), essential tremor, dystonia (DBS), epilepsy (DBS, VNS), Parkinson Disease (DBS), pain (CES), and insomnia (CES). To date, limited data on brain stimulation for PTSD offer only modest guidance. ECT has shown some efficacy in reducing comorbid depression in PTSD patients but has not been demonstrated to improve most core PTSD symptoms. CES and VNS have shown some efficacy in reducing anxiety, findings that may suggest possible utility in relieving PTSD-associated anxiety. Treatment of animal models of PTSD with DBS suggests potential human benefit. Additional research and novel treatment options for PTSD are urgently needed. The potential usefulness of brain stimulation in treating PTSD deserves further exploration.

Limbic Neuromodulation

“…PTSD is characterized by hyperarousal, intrusive vivid reliving of memories, and persistent avoidance of trauma-associated stimuli. 19–24,35 The estimated lifetime prevalence of PTSD in the United States is approximately 6.8%, and the 12-month prevalence is about 3.8%. 36,37 Unfortunately, 30% of patients still suffer from PTSD at least 10 years after the initial trauma despite the best current medical therapy.…”

Neuro-stimulation Techniques for the Management of Anxiety Disorders: An Update

“…Epicranial stimulation (EpCS), is a minimally invasive technique of neuro-stimulation, where the electrode is placed over a cranial nerve (like occipital nerve) or over the dura mater and is electrically stimulated by the pulse generator 14). It has been utilized in refractory headache 15).…”

“…The areas of brain connected to vagus nerve which includes locus ceruleus, hippocampus, orbito-frontal cortex, amygdala and insular cortex are also responsible for processing the psycho-somatic elements of anxiety, making VNS to be a potential therapeutic modality in anxiety management 14,17). George et al .,17) in their pilot study of VNS in anxiety disorders, studied the short-term as well as long-term efficacy of VNS in patients of treatment resistant OCD, panic disorder and PTSD and found favorable outcomes.…”

tDCS for Memory Enhancement: Analysis of the Speculative Aspects of Ethical Issues

“…Indeed, recent research on different memory disorders and symptomatic memory loss identified the beneficial effects of tDCS for memory disorders such as Alzheimer’s disease (Ferrucci et al, 2008; Bystad et al, 2016), post-traumatic stress disorder (Novakovic et al, 2011), psychiatric disorders which entail working memory loss, and memory loss resulting from brain damage induced by trauma or first-stroke episode (Jo et al, 2009; Clark and Parasuraman, 2014). In healthy subjects, use of tDCS in laboratory settings seems to improve both implicit and explicit memory (Coffman et al, 2014).…”