Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder

Abstract

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that causes significant functional impairment and is related to altered stress response and reinforced learned fear behavior. PTSD has been found to impact three functional networks in the brain: default mode, executive control, and salience. The executive control network includes the dorsolateral prefrontal cortex (DLPFC) and lateral PPC. The salience network involves the anterior cingulate cortex, anterior insula, and amygdala. This latter network has been found to have increased functional connectivity in PTSD. Transcranial Magnetic Stimulation (TMS) is a technique used in treating PTSD and involves stimulating specific portions of the brain through electromagnetic induction. Currently, high-frequency TMS applied to the left dorsolateral prefrontal cortex (DLPFC) is approved for use in treating major depressive disorder (MDD) in patients who have failed at least one medication trial. In current studies, high-frequency stimulation has been shown to be more effective in PTSD rating scales posttreatment than low-frequency stimulation. The most common side effect is headache and scalp pain treated by mild analgesics. Seizures are a rare side effect and are usually due to predisposing factors. Studies have been done to assess the overall efficacy of TMS. However, results have been conflicting, and sample sizes were small. More research should be done with larger sample sizes to test the efficacy of TMS in the treatment of PTSD. Overall, TMS is a relatively safe treatment. Currently, the only FDA- approved to treat refractory depression, but with the potential to treat many other conditions.

Editorial: Case reports in anxiety and stress

“…Chang et al describe the successful use of accelerated theta-burst rTMS, applied over the dorsolateral prefrontal cortices (DLPFC), in a patient with treatment-resistant PTSD occurring in the context of emotional and physical abuse. This result is consistent with the existing literature, and highlights the importance of the DLPFC as a key component of the “executive control” network involved in anxiety and stress responses ( 35 , 36 ).…”

Neuropharmacological Modulation of N-methyl-D-aspartate, Noradrenaline and Endocannabinoid Receptors in Fear Extinction Learning: Synaptic Transmission and Plasticity

“…Furthermore, new cutting-edge avenues for clinical research would be to combine these treatments with non-invasive brain stimulation techniques (NIBS) that could target specific brain areas involved in fear acquisition and modulate the functional mechanisms behind aberrant fear learning (i.e., PTSD or anxiety) [ 6 , 13 , 29 , 61 ]. In particular, NIBS interventions with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have achieved optimal results in targeting brain nodes to selectively interfere with fear learning [ 13 , 26 , 29 , 203 , 204 , 205 , 206 ]. Currently, such techniques have been used to modulate cerebral activity during the consolidation and extinction of fear memories, with the ultimate goal of modulating these processes, which are aberrant in different pathological fear states caused by trauma, stress, and anxiety [ 6 ].…”

Electrical stimulation methods and protocols for the treatment of traumatic brain injury: a critical review of preclinical research

“…The therapeutic potential of rTMS is widely recognized, particularly in the field of psychiatry, and it is applied as a treatment option for depression [ 87 , 88 ] and obsessive–compulsive disorder [ 89 , 90 ]. Its efficacy was further tested as a treatment for a number of different neurological conditions, such as neuropathic pain [ 91 , 92 ], epilepsy [ 93 ], stroke [ 94 ], multiple sclerosis [ 95 ] and post-traumatic stress disorder [ 96 ], as well as Parkinsonian movement disorders [ 97 , 98 ].…”