H1-coil Intermittent Theta Burst Stimulation For a Patient With a High Motor Threshold: Case Report

Journal: Brain Stimulation 10 (2017) e21ee45

Authors: A Tendler, E Sisko, M DeLuca, S Corbett-Methot, J Sutton-DeBord, J Brown, N Rodriguez

Introduction
Effective H1 coil stimulation for depression requires a dosage of 120% of the resting MT. However, some patients have high MTs and difficulty tolerating the high intensity that follows. Theta burst stimulation (TBS), compared to high-frequency stimulation, may accomplish the same effects with shorter stimulation durations at a lower intensity. Early evidence from figure-8-rTMS suggests that intermittent TBS (iTBS) at 80% of MT is not inferior to 10HZ at 120% of MT for the treatment of depression.
Methods
A 60-year-old woman with recurrent severe treatment resistant depression as well as a relapse of her OCD which made her unable to shower or brush her teeth for two and half months was referred for H1-coil dTMS. Her MT was 79, and she was unable to tolerate the 120% MT intensity. After 9 attempts with the 18HZ protocol, she was switched to an iTBS protocol at 80% of MT. dTMS pulses were administered at 50HZ in 3 pulse bursts, 10 bursts over two seconds (5HZ), followed by a five second interval, for 60 cycles (7second cycle), totaling 1800 pulses. After a 15-minute wait, the protocol was repeated for an accelerated effect.
Results
Following 9 days of 18HZ and 3 days of iTBS her depression remitted (BDI 25/12, CGI-S 7/2) and treatments were decreased to twice a week. OCD symptoms and anxiety remained unchanged.
Conclusions
iTBS with the H1 coil shows promise as an alternative treatment protocol for the treatment of depression in general, particularly in patients with high MTs.

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