Repetitive Transcranial Magnetic Stimulation of the Right Dorsolateral Prefrontal Cortex in Posttraumatic Stress Disorder: A Double-Blind, Placebo-Controlled Study

Cohen, Hagit; Kaplan, Zeev; Kotler, Moshe; Kouperman, I.; Moisa, Regina; Grisaru, Nimrod

doi:10.1176/appi.ajp.161.3.515

Cited by 280 publications

(217 citation statements)

References 76 publications

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“…Accordingly, we determined whether rTMS, a well-established therapeutic method PTSD treatment, offered benefits as early intervention after stress. Prior studies have indicated that administration of high-frequency rTMS to the right dorsolateral prefrontal cortex is beneficial for ameliorating PTSD symptoms [26,27]. Our data presented herein demonstrated for the first time that chronic administration of rTMS has anxiolytic effect on stressrelated anxiety-like behaviors without affecting control rats.…”

Section: Discussionsupporting

confidence: 58%

“…Therefore, non-pharmacologic treatment approaches have been developed. Repetitive transcranial magnetic stimulation (rTMS) is a safe and non-invasive method, and studies have indicated that administration of high-frequency rTMS to the right dorsolateral prefrontal cortex is beneficial for ameliorating PTSD symptoms [26,27]. Although it was primarily utilized for treatment, we hypothesized that rTMS might also provide benefits as an early prevention measure.…”

Section: Introductionmentioning

confidence: 99%

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Repetitive transcranial magnetic stimulation ameliorates anxiety-like behavior and impaired sensorimotor gating in a rat model of post-traumatic stress disorder

et al. 2017

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Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation ameliorates anxiety-like behavior and impaired sensorimotor gating in a rat model of post-traumatic stress disorder

et al. 2017

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“…Our findings of a higher HPA-system sensitivity in more anxious individuals after HF-rTMS applied over the right DLPFC might be especially germane in light of the therapeutic applications of rTMS as a treatment for anxiety disorders and/or posttraumatic stress disorder (PTSD) (Cohen et al, 2004;Pallanti and Bernardi, 2009;Zwanzger et al, 2009;Handwerger, 2009;Yue et al, in press). Because of the overwhelming evidence that GABAergic mechanisms regulate neuroendocrine stress responses (Herman et al, 2002;Herman et al, 2004;Kovács et al, 2004;Cullinan et al 2008;Radley et al, 2009) and the importance of GABA receptor involvement in the pathophysiology and treatment of anxiety disorders (Lydiard, 2003;Nemeroff, 2003;Kalueff and Nutt., 2007), it is tempting to assume that in our study the observed HPA-axis sensitivity to one HF-rTMS session in more anxious females was mediated by the GABA system.…”

Section: Discussionmentioning

confidence: 86%

Baseline ‘state anxiety’ influences HPA-axis sensitivity to one sham-controlled HF-rTMS session applied to the right dorsolateral prefrontal cortex

Baeken¹,

Vanderhasselt²,

Raedt³

2011

Psychoneuroendocrinology

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2 SummaryAlthough negative results have been reported, an important aspect of the physiology of repetitive Transcranial Magnetic Stimulation (rTMS) could be related to the endocrinological response of the hypothalamic-pituitaryadrenal (HPA) axis, such as cortisol secretion. Because endocrinological responses are influenced by anxiety states, this could influence the effect of rTMS in healthy individuals. In this sham-controlled, "single blind" crossover study, we examined whether one session of HF-rTMS could affect the HPA-system, when taking into account individual state anxiety scores based on the State-Trait Anxiety Inventory (STAI). Twenty-four healthy rTMS naïve females received one sham-controlled high frequency (HF)-rTMS session delivered on the right dorsolateral prefrontal cortex (DLPFC). The Profile of Mood States (POMS) questionnaire, together with salivary cortisol samples, was collected before, just after and 30 minutes post HF-rTMS. To examine whether state anxiety could influence endocrinological outcome measurements, we administered the STAI-state just before each HF-rTMS experiment started. Based on the POMS questionnaire, no mood changes were observed.Without taking individual state anxiety scores into account, one sham-controlled right-sided HF-rTMS session did not influence the HPA-system. When taking into account individual STAI-state scores, we found that healthy women scoring higher on the STAI-state displayed a significantly more sensitive HPA-system, resulting in salivary cortisol concentration increases after real HF-rTMS, compared to those scoring lower on this anxiety scale. Our results indicate that healthy women scoring high on state anxiety display a more sensitive HPAsystem when receiving one right-sided HF-rTMS session. Our findings suggest that the incorporation of individual anxiety states in experimental rTMS research could add further information about its neurobiological influences on the HPA-system.

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“…Interestingly, the neurobiological modulation of stress responses seems to be lateralized to the right prefrontal cortex [14]. Animal models also indicate that stress-regulatory systems such as the HPA-axis are predominantly regulated by the right prefrontal cortex [54].…”

Section: Discussionmentioning

confidence: 99%

Right prefrontal HF-rTMS attenuates right amygdala processing of negatively valenced emotional stimuli in healthy females

Baeken

Raedt

Schuerbeek

et al. 2010

Behavioural Brain Research

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Repetitive Transcranial Magnetic Stimulation (rTMS) studies investigating brain imaging correlates of emotion modulation in healthy volunteers can improve our understanding of the 'affective' impact of this application. In this fMRI study, we focused on lateralized amygdala functioning when processing salient emotional visual stimuli after one high-frequency (HF)-rTMS session. In a 'uniform sample' of 20 right-handed, non-depressed, healthy female subjects we examined whether one HF-rTMS session applied to the left (n=10) or right (n=10) dorsolateral prefrontal cortex (DLPFC) would influence amygdala responses to positively and negatively valenced baby faces. Subjects were given no other instructions than to focus on the emotion the visual stimuli elicited during scanning. One HF-rTMS session did not result in a conscious mood change. Whereas one left-sided HF-rTMS session did not affect amygdala processing of the positive or negative stimuli, after a single rightsided HF-rTMS session we found a significant right amygdala activity attenuation during the processing of negatively valenced baby faces. This finding provides additional evidence supporting the role of the right anterior hemisphere in the processing of negative emotional information, and increases our understanding of HF-rTMS treatment effects in mental disorders.3

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Repetitive Transcranial Magnetic Stimulation of the Right Dorsolateral Prefrontal Cortex in Posttraumatic Stress Disorder: A Double-Blind, Placebo-Controlled Study

Abstract: This double-blind, controlled trial suggests that in PTSD patients, 10 daily sessions of right dorsolateral prefrontal rTMS at a frequency of 10 Hz have greater therapeutic effects than slow-frequency or sham stimulation.

Cited by 280 publications

References 76 publications

Repetitive transcranial magnetic stimulation ameliorates anxiety-like behavior and impaired sensorimotor gating in a rat model of post-traumatic stress disorder

Repetitive transcranial magnetic stimulation ameliorates anxiety-like behavior and impaired sensorimotor gating in a rat model of post-traumatic stress disorder

Baseline ‘state anxiety’ influences HPA-axis sensitivity to one sham-controlled HF-rTMS session applied to the right dorsolateral prefrontal cortex

Right prefrontal HF-rTMS attenuates right amygdala processing of negatively valenced emotional stimuli in healthy females

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