Transcranial Magnetic Stimulation (TMS) Improvement in Depression, Insomnia, and Fatigue Associated with Multiple Sclerosis (MS)

Abstract

s Brain Stimulation 14 (2021) 1404e1417 The patient has completed three cycles of dTMSwith benefit each time but with a recurrence of symptoms. Her first cycle in May 2019 consisted of 31 treatments with improvement on her BDI of 33 to 9 and improved PHQ-9 of 23 to 6. Cycle #2 was in November 2019 and consisted of 32 treatments with an improvement on her BDI from 54 to 7 and PHQ-9 from 25 to 4. Cycle #3 occurred in October 2020. It consisted of 35 treatments with an improvement on her BDI from 46 to 21 and her PHQ-9 from 23 to 13. Insurance concerns have prevented maintenance treatment, and she has now started her 4th TMS cycle in less than two years. Conclusions This case demonstrates 1) the benefit of TMS in an elderly patient, 2) no seizure in>100 TMS treatments in a patient with a known seizure disorder, and 3) the possibility that maintenance TMS may have proven a better treatment alternative due to the recurrent nature and severity of her resistant depression. Conflict of Interest The authors have no conflicts of interest to report, and no funding was provided for this research. TRANSCRANIAL MAGNETIC STIMULATION (TMS) IMPROVEMENT IN DEPRESSION, INSOMNIA, AND FATIGUE ASSOCIATED WITH MULTIPLE SCLEROSIS (MS) Debra J. Stultz , Savanna Osburn, Tyler Burns, Robin Walton, Amy Cope, Sylvia Pawlowska-Wajswol. * Corresponding author. Stultz Sleep & Behavioral Health 6171 Childers Road, Barboursville, WV, 25504 304-733-5380 E-mail address: [email protected] (D.J. Stultz). Background This case presents a 60-year-old white female with a 30-year history of Secondary Progressive Multiple Sclerosis, a long history of depression, and frequent suicidal ideation. She had previously tried citalopram, venlafaxine, paroxetine, desvenlafaxine, fluoxetine, bupropion, and at the time of treatment initiation, she was on vilazodone. She had been on modafinil and methylphenidate for fatigue. The patient had complaints of chronic insomnia. Design/Methods Using the Brainsway dTMS system to the left dorsolateral prefrontal cortex (LDPFC) at 120% motor threshold and 18 Hz, the patient received 29 treatments while following the Beck Depression Inventory (BDI), the Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the Modified Fatigue Impact Scale (MFIS). Results At the start of treatment, her BDI was 44, with improvement after treatment to 6. Her PHQ-9 was elevated at 21 and decreased to 4. Her ISI improved from 14 to 6, and her PSQI decreased from 13 to 5. Her MFIS was initially 82 (with the max being 84) and improved to 25. At one month follow-up, her BDI was 2, her PHQ-9 was 3, her ISI was 3, her PSQI was 4, and her MFIS was 18. She appeared much improved and did not appear to be manic. Conclusions This patient with Multiple Sclerosis demonstrated improvement in mood, fatigue, and insomnia with TMS. As MS has a lifetime prevalence of depression in up to 50% and a 7.5x higher suicide rate than the general population, TMS may be a valuable treatment option. Conflict of Interest The authors have no conflicts of interest to report, and no funding was provided for this research. ITBS COMBINED WITH COGNITIVE BEHAVIORAL THERAPY FOR TREATMENT RESISTANCE DEPRESSION (TRD). Cruz Jos e , Reyes Lua , Zan Wang , Cruz Iv an , Bossano Fernando . Department of Neurology, The First Hospital of Jilin 1407 University, Changchun, China; Department of Neurology, Neuropsychiatry and Psychology, Neuroinnovation Center, Quito, Ecuador. South America Objective: Compare the level of effectiveness of iTBS vs a combination of iTBS + CBT for the treatment of TRD patients. Background: Transcranial magnetic stimulation has proven to be effective showing response and remission in patients with TRD diagnose. Adding to this, CBT is considered one of the most effective psychotherapies in the treatment of depression. A combination of these therapies (TMS+CBT) appears to be a better option for patients who have failed to achieve a satisfactory improvement from antidepressant medication rather than only TMS. Design / Methods: 14 patients (aged between 24 to 74 years old) diagnosed with treatment resistance depression (TRD). The therapy consisted of 30 TMS sessions with theta burst stimulation (iTBS). The patients were randomly divided into two groups. 7 patients received TMS therapy and the other half TMS combined with CBT. PHQ-9 scale was used for pre and post treatment evaluations. Results: All 14 patients completed the study without significant side effects. The iTBS + CBT group had a remission rate of 85,71%. The monotherapy group with iTBS had a remission rate of 42,85%. Conclusions: CBT adjunctive therapy to iTBS for treatment resistance depression appears to be well tolerated and seems feasible to apply. In this group of patients, the combination of iTBS and CBT shows better remission numbers than monotherapy with iTBS. Further search is needed to corroborate these findings. Conflicts of Interests: None to report. Funding: self-funding References 1. Vedeniapin, A., Cheng, L., & George, M. S. (2010). Feasibility of simultaneous cognitive behavioral therapy and left prefrontal rTMS for treatment resistant depression. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 3(4), 207-210. 2. Schiena, G., Maggioni, E., Pozzoli, S., & Brambilla, P. (2020). Transcranial magnetic stimulation in major depressive disorder: Response modulation and state dependency. Journal of affective disorders, 266, 793-801. 3. Salemi Khamene, A., Bakhtiaripour, S., Naderi, F., Heidari, A., & Ehteshamzadeh, P. (2019). Comparing the effectiveness of transcranial magnetic stimulation and cognitive-behavioral therapy on anxiety and depression. Journal of fundamentals of mental health, 22(1), 27-30. 4. Donse, L., Padberg, F., Sack, A. T., Rush, A. J., & Arns, M. (2018). Simultaneous rTMS and psychotherapy in major depressive disorder: clinical outcomes and predictors from a large naturalistic study. Brain stimulation, 11(2), 337-345. 5. George, M. S. (2010). Transcranial magnetic stimulation for the treatment of depression. Expert review of neurotherapeutics, 10(11), 1761-1772. REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN THE TREATMENT OF MAJOR DEPRESSION DURING PREGNANCY: A CASE SERIES Alexandra Yee , Emily Pedersen , Martha Koo . Neuro Wellness Spa Background: Research to date using repetitive transcranial magnetic stimulation (rTMS) for the treatment of major depressive disorder (MDD) during pregnancy investigated lower motor threshold (MT) percentages, reduced pulses per session and fewer total number of sessions compared to standard of care rTMS depression protocols. We present a case series of four pregnant women with MDD treated with full intensity rTMS. Methods: Four pregnant womenwere treated with 36 rTMS sessions. Each session included 5Hz continuous theta burst stimulation to the right dorsolateral prefrontal cortex at 80%MT for 1200 pulses, 5Hz intermittent theta burst stimulation to the left dorsolateral prefrontal cortex at 80%MT for 200 pulses and 10Hz intermittent single pulse stimulation to the left dorsolateral prefrontal cortex at 120%MT for 3000 pulses. Patient Health Questionnaire (PHQ-9) was assessed at baseline, and around sessions 10, 20 and 30. Neonatal records documenting gestational age, maternal/infant complications, and APGAR scores were reviewed. Abstracts Brain Stimulation 14 (2021) 1404e1417s Brain Stimulation 14 (2021) 1404e1417 Results: Four out of four (100%) women responded (50% or greater decrease in PHQ-9 scores). Two out of four (50%) women achieved remission (defined as a post-treatment PHQ-9 score 5). No adverse pregnancy or fetal outcomes were observed. Conclusions: Full intensity rTMS (standard of care MT percentages, total number of pulses per session and total number of sessions) was a safe and effective treatment for this sample of pregnant women with MDD. Continued research is needed to further assess the safety of full intensity rTMS for women with MDD during pregnancy and to compare efficacy outcomes with reduced intensity protocols. Conflicts of Interest: None to Report. Funding: Neuro Wellness Spa TRANSCRANIAL MAGNETIC STIMULATION OUTCOMES BY AGE: A RETROSPECTIVE CHART REVIEW IN A NATURALISTIC CLINIC SETTING Phillip Goldman , Emily Pedersen , Maximillian Bailey , Martha Koo . Neuro Wellness Spa; University of Colorado Boulder Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for major depressive disorder (MDD) in the general adult population. The effect of age on rTMS outcomes remains unclear. We evaluated rTMS response and remission rates by age in a naturalistic, clinical setting. Methods: A retrospective chart review was performed on 495 patients with MDD (baseline Patient Health Questionnaire (PHQ-9) 10) who underwent acute, bilateral rTMS therapy. Based on comorbid anxiety symptom severity patients were prescribed one of two protocols. Both protocols included 5Hz intermittent theta burst stimulation (TBS) to the left dorsolateral prefrontal cortex (LDPFCx) at 80% motor threshold (MT) for 200 pulses. Anxiety protocol added 1Hz continuous single pulse stimulation (SP) over the right dorsolateral prefrontal cortex (RDLPFCx) at 120% MT for 1500 pulses. Depression protocol added 10Hz intermittent SP to the LDPFCx at 120%MT for 3000 pulses and 5Hz continuous TBS to the RDLPFCx at 80%MT for 1200 pulses. PHQ-9 was assessed at baseline and at end of acute treatment. Patients were categorized by age: 15-25, 25-34, 3544, 45-54 and 55-78. Sex, baseline anxiety and baseline depression severity were analyzed to eliminate confounding variables. Results: All age categories showed significant improvement in depressive symptoms (mean PHQ-9 score change 1⁄4 -11.45, p1⁄44.4e-16). rTMS response and remission rates did not differ between age categories (p1⁄40.184). Conclusion: In this naturalistic, clinical setting rT