Repetitive transcranial magnetic stimulation in trauma-related conditions

Journal: Neuropsychiatric Disease and Treatment 15:701-712 (2019)

Authors: E Namgung, M Kim, S Yoon

Background:

Some of trauma-exposed individuals develop posttraumatic stress disorder (PTSD), an incapacitating psychiatric disorder that is characterized by intrusion, avoidance, negative changes in mood and cognition, and hyperarousal. A number of other trauma-related conditions are very frequently found in individuals with PTSD. Traumatic brain injury (TBI) is one of the most frequently observed trauma-related conditions that trauma-exposed individuals with PTSD may experience. TBI refers to transient or permanent brain dysfunction that results in a wide range of neurological, cognitive, and psychiatric symptoms. These trauma-related conditions significantly affect one’s quality of life, leading to substantial disability and socioeconomic burden. As the prevalence of PTSD with comorbid TBI is increasing in the general population along with the rates of crimes and accidents, effective prevention and intervention strategies are necessitated. However, a definitive treatment for PTSD with comorbid TBI is still lacking, resulting in high rates of treatment resistance and chronicity.

Objective:

Thisarticle reviews rTMS studies in trauma-related conditions, mainly focusing on PTSD and PTSD with TBI as one of the comorbidities.

Methods:

The review focuses on the applications of rTMS in reducing PTSD symptoms with and without comorbidities based on differential parameters and effects of rTMS as well as concomitant clinical conditions. The section on PTSD with comorbidities focuses on TBI with neurological, cognitive, and psychiatric symptoms.

Results:

Although there were some inconsistencies in the clinical outcomes and optimized parameters of rTMS applied in PTSD and TBI, low frequency stimulation over the hyperactive frontal regions and/or high frequency stimulation over the hypoactive frontal regions generally improved the clinical symptoms of PTSD and TBI. Lastly, the limitations of the rTMS studies in PTSD and TBI as well as potential directions for future research are discussed.

Conclusions:

Taken together, rTMS studies reviewed in this article generally demonstrated therapeutic efficacy on PTSD symptoms with multiple comorbidities as well as neurological, cognitive, and psychiatric symptoms related to TBI without serious adverse events. rTMS has been mostly applied to normalize the frontal dysfunction related to PTSD and TBI through HF over the hypoactive or LF over the hyperactive brain regions. This may provide a clue regarding the optimized rTMS parameters for the trauma-exposed individuals with comorbid PTSD and TBI.