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Transcranial Magnetic Stimulation Treatment of Tinnitus with Sound Paired 20 Hz Theta Burst Stimulation
Abstracts / Brain Stimulation 8 (2015) e1ee6
13 Neuroplasticity possibly induced by a series of prefrontal rTMS for major depression Motoaki Nakamura a,b,c,e, Yoshihiro Noda a,d, Takashi Saeki a,b, Shunsuke Hayasaka a,b, Takuji Izuno a,c, Takuya Yoshiike a, Yoshio Hirayasu b a Laboratory of Neuromodulation, Kanagawa Psychiatric Center, Yokohama, Japan b Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan c Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan d Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada e Computational Neuroscience Laboratories, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan Introduction: Prefrontal rTMS-induced neuroplastic changes remain unknown so far. Objectives: Structural and functional neuroplasticity possibly induced by repetitive transcranial magnetic stimulation (rTMS) on dorsolateral prefrontal cortex (DLPFC) were longitudinally investigated in major depression, using MRI, diffusion tensor imaging (DTI), and quantitative EEG (qEEG). Methods: Patients with major depression underwent 10 daily 20Hz rTMS sessions over left DLPFC during two weeks. Efficacy was evaluated with the Hamilton Depression Rating Scale 17-item (Ham-D17). Results: Voxel-based morphometry (VBM) (n¼38) revealed that rTMS on left DLPFC could increase gray matter volume in left DLPFC (t¼5.53, PFWE¼0.034). Responders (n¼27) showed gray matter volume increase in left DLPFC (t¼6.73, PFWE¼0.002) and left anterior cingulate cortex (t¼4.52, PFWE¼0.021), left subgenual cingulate cortex (t¼3.61, PFWE¼0.05) compared to non-responders (n¼11), who showed less than 25% improvement from baseline score of Ham-D17. Voxel-based analyses of DTI (n¼21) revealed that rTMS could decrease “gray matter” mean diffusivity in bilateral DLPFC (left: t¼8.21, PFWE¼0.002, right: t¼7.37, PFWE¼0.009). Resting-state qEEG (n¼31) showed longitudinal enhancement of spectral power of gamma band oscillations at left frontal region (t¼3.09, P¼0.004) and the modulation index which reflects theta-gamma coupling (t¼2.48, P¼0.019) over 10 rTMS sessions. Conclusion: Following 10 rTMS sessions over two weeks, gray matter showed increased volume with decreased mean diffusivity around the stimulation site and increased gamma power and thetagamma coupling at resting-state. Key Message: The present findings suggest that a series of rTMS sessions may induce structural neuroplasticity in the stimulation site as well as associated para-limbic region, and functional neuroplasticity related to resting-state gamma band activity.
14 Objective Improvement in ADHD Symptoms Following dTMS To The Right Prefrontal Cortex: Two Cases Holly LaSalle-Ricci PhD, Aron Tendler MD C.BSM, Marilynn Turcone BA, Elyssa Sisko BA CCRC, Kaylin Raggi BA, Noelia Rodriguez Advanced Mental Health Care Inc Background: Deep transcranial magnetic stimulation (dTMS) has been proposed as a treatment method for patients with Attention Deficit/Hyperactivity Disorder (ADHD). We report on the treatment of two unmedicated patients with severe ADHD, combined type, using the dTMS H7 coil over the right prefrontal cortex.
e5
Methods: dTMS was administered 6 cm anterior to the motor strip on the right prefrontal cortex using the H7 coil at 120% of the motor threshold of the left hand at 20 Hz, 2 second stimulation, 20 second intertrain interval for 3000 total pulses. Patients completed an objective computerized measure (IVA+) before and after treatment. The IVA+ has two primary diagnostic scales, the response control quotient and the attention quotient. Response control is a measure of impulsivity, consistency, and reaction time and the attention quotient measures inattention and mental processing speed. Results: Both patients demonstrated significant improvement in response control scores indicating substantial improvement in impulsivity, consistency and reaction time. The male patient received 22 treatments and his response control scores moved from the moderately impaired range to above average range with twoweek durability. The female patient received 10 treatments and her response control scores improved from the moderately impaired range to the average range. Both patients had some improvement in attention, but their scores continued to be in the impaired range. Conclusion: dTMS with the H7 coil over the right prefrontal cortex is efficacious in treating response control symptoms of ADHD including impulsivity, consistency, and reaction time. Dr. Tendler has a financial interest in Brainsway.
15 Transcranial Magnetic Stimulation Treatment of Tinnitus with Sound Paired 20 Hz Theta Burst Stimulation William F. Stubbeman MD, Victoria Ragland BS, Raya Khairkhah BA William F Stubbeman, Brain Stimulation Institute, Los Angeles, CA Background: Tinnitus, the perception of sound frequencies without an external source, is a debilitating and currently untreatable disorder afflicting 10% and disabling 1-3% of the general population. Conventional theta burst stimulation or TBS 50 Hz (50 Hz pulse triplets recurring at 5 Hz intervals) has shown some efficacy in the transcranial magnetic stimulation (TMS) treatment of this condition. We present the results of a tinnitus treatment using the alternative theta burst parameter TBS 20 Hz (20 Hz pulse triplets recurring at 5 Hz intervals). Methods: A tinnitus patient received three sequential TMS treatments five days per week for 13 weeks. Excitatory (intermittent) TBS 20 Hz over the left dorsolateral prefrontal cortex was paired with auditory stimulation using white noise notched around the principal tinnitus frequencies. Bilateral inhibitory (continuous) TBS 20 Hz was then applied over auditory cortex. Neuronavigated TMS based on the patient’s structural brain magnetic resonance imaging (MRI) was delivered at 90% of motor threshold. Results: Tinnitus Handicap Inventory (THI) scale scores decreased by 82.6% from 46 to 8; Tinnitus Reaction Questionnaire (TRQ) scores decreased by 84.3% from 51 to 8; left side loudness Visual Analog Scale (VAS, 0-10) scores decreased by 57.1% from 7 to 3; and right side loudness VAS scores decreased by 66.7% from 6 to 2. Gains persisted at one year follow up. Conclusion: TMS with sound paired TBS 20 Hz safely and effectively treated a single patient’s tinnitus. Further trials are warranted.
16 Objective Improvement in ADHD Symptoms Following dTMS To The Right Prefrontal Cortex: Two Cases Aron Tendler MD C.BSM, Elyssa Sisko BA CCRC, Noelia Rodriguez , Marilynn Turcone BA, Holly LaSalle-Ricci PhD Advanced Mental Health Care Inc Background: Deep transcranial magnetic stimulation (dTMS) has been proposed as a treatment method for patients with Attention Deficit/Hyperactivity Disorder (ADHD).
13 Neuroplasticity possibly induced by a series of prefrontal rTMS for major depression Motoaki Nakamura a,b,c,e, Yoshihiro Noda a,d, Takashi Saeki a,b, Shunsuke Hayasaka a,b, Takuji Izuno a,c, Takuya Yoshiike a, Yoshio Hirayasu b a Laboratory of Neuromodulation, Kanagawa Psychiatric Center, Yokohama, Japan b Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan c Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan d Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada e Computational Neuroscience Laboratories, Brain Information Communication Research Laboratory Group, Advanced Telecommunications Research Institute International (ATR), Kyoto, Japan Introduction: Prefrontal rTMS-induced neuroplastic changes remain unknown so far. Objectives: Structural and functional neuroplasticity possibly induced by repetitive transcranial magnetic stimulation (rTMS) on dorsolateral prefrontal cortex (DLPFC) were longitudinally investigated in major depression, using MRI, diffusion tensor imaging (DTI), and quantitative EEG (qEEG). Methods: Patients with major depression underwent 10 daily 20Hz rTMS sessions over left DLPFC during two weeks. Efficacy was evaluated with the Hamilton Depression Rating Scale 17-item (Ham-D17). Results: Voxel-based morphometry (VBM) (n¼38) revealed that rTMS on left DLPFC could increase gray matter volume in left DLPFC (t¼5.53, PFWE¼0.034). Responders (n¼27) showed gray matter volume increase in left DLPFC (t¼6.73, PFWE¼0.002) and left anterior cingulate cortex (t¼4.52, PFWE¼0.021), left subgenual cingulate cortex (t¼3.61, PFWE¼0.05) compared to non-responders (n¼11), who showed less than 25% improvement from baseline score of Ham-D17. Voxel-based analyses of DTI (n¼21) revealed that rTMS could decrease “gray matter” mean diffusivity in bilateral DLPFC (left: t¼8.21, PFWE¼0.002, right: t¼7.37, PFWE¼0.009). Resting-state qEEG (n¼31) showed longitudinal enhancement of spectral power of gamma band oscillations at left frontal region (t¼3.09, P¼0.004) and the modulation index which reflects theta-gamma coupling (t¼2.48, P¼0.019) over 10 rTMS sessions. Conclusion: Following 10 rTMS sessions over two weeks, gray matter showed increased volume with decreased mean diffusivity around the stimulation site and increased gamma power and thetagamma coupling at resting-state. Key Message: The present findings suggest that a series of rTMS sessions may induce structural neuroplasticity in the stimulation site as well as associated para-limbic region, and functional neuroplasticity related to resting-state gamma band activity.
14 Objective Improvement in ADHD Symptoms Following dTMS To The Right Prefrontal Cortex: Two Cases Holly LaSalle-Ricci PhD, Aron Tendler MD C.BSM, Marilynn Turcone BA, Elyssa Sisko BA CCRC, Kaylin Raggi BA, Noelia Rodriguez Advanced Mental Health Care Inc Background: Deep transcranial magnetic stimulation (dTMS) has been proposed as a treatment method for patients with Attention Deficit/Hyperactivity Disorder (ADHD). We report on the treatment of two unmedicated patients with severe ADHD, combined type, using the dTMS H7 coil over the right prefrontal cortex.
e5
Methods: dTMS was administered 6 cm anterior to the motor strip on the right prefrontal cortex using the H7 coil at 120% of the motor threshold of the left hand at 20 Hz, 2 second stimulation, 20 second intertrain interval for 3000 total pulses. Patients completed an objective computerized measure (IVA+) before and after treatment. The IVA+ has two primary diagnostic scales, the response control quotient and the attention quotient. Response control is a measure of impulsivity, consistency, and reaction time and the attention quotient measures inattention and mental processing speed. Results: Both patients demonstrated significant improvement in response control scores indicating substantial improvement in impulsivity, consistency and reaction time. The male patient received 22 treatments and his response control scores moved from the moderately impaired range to above average range with twoweek durability. The female patient received 10 treatments and her response control scores improved from the moderately impaired range to the average range. Both patients had some improvement in attention, but their scores continued to be in the impaired range. Conclusion: dTMS with the H7 coil over the right prefrontal cortex is efficacious in treating response control symptoms of ADHD including impulsivity, consistency, and reaction time. Dr. Tendler has a financial interest in Brainsway.
15 Transcranial Magnetic Stimulation Treatment of Tinnitus with Sound Paired 20 Hz Theta Burst Stimulation William F. Stubbeman MD, Victoria Ragland BS, Raya Khairkhah BA William F Stubbeman, Brain Stimulation Institute, Los Angeles, CA Background: Tinnitus, the perception of sound frequencies without an external source, is a debilitating and currently untreatable disorder afflicting 10% and disabling 1-3% of the general population. Conventional theta burst stimulation or TBS 50 Hz (50 Hz pulse triplets recurring at 5 Hz intervals) has shown some efficacy in the transcranial magnetic stimulation (TMS) treatment of this condition. We present the results of a tinnitus treatment using the alternative theta burst parameter TBS 20 Hz (20 Hz pulse triplets recurring at 5 Hz intervals). Methods: A tinnitus patient received three sequential TMS treatments five days per week for 13 weeks. Excitatory (intermittent) TBS 20 Hz over the left dorsolateral prefrontal cortex was paired with auditory stimulation using white noise notched around the principal tinnitus frequencies. Bilateral inhibitory (continuous) TBS 20 Hz was then applied over auditory cortex. Neuronavigated TMS based on the patient’s structural brain magnetic resonance imaging (MRI) was delivered at 90% of motor threshold. Results: Tinnitus Handicap Inventory (THI) scale scores decreased by 82.6% from 46 to 8; Tinnitus Reaction Questionnaire (TRQ) scores decreased by 84.3% from 51 to 8; left side loudness Visual Analog Scale (VAS, 0-10) scores decreased by 57.1% from 7 to 3; and right side loudness VAS scores decreased by 66.7% from 6 to 2. Gains persisted at one year follow up. Conclusion: TMS with sound paired TBS 20 Hz safely and effectively treated a single patient’s tinnitus. Further trials are warranted.
16 Objective Improvement in ADHD Symptoms Following dTMS To The Right Prefrontal Cortex: Two Cases Aron Tendler MD C.BSM, Elyssa Sisko BA CCRC, Noelia Rodriguez , Marilynn Turcone BA, Holly LaSalle-Ricci PhD Advanced Mental Health Care Inc Background: Deep transcranial magnetic stimulation (dTMS) has been proposed as a treatment method for patients with Attention Deficit/Hyperactivity Disorder (ADHD).