Table 1.
rTMS studies in patients with PTSD
| rTMS for the treatment of PTSD | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Study | PTSD (n) | Group (n) | Methodology | rTMS parameters | Outcomes | ||||
| Site | Frequency (Hz) | Intensity (% MT) | Total sessions | Total pulses | Post rTMS – pre rTMS | ||||
| Nam et al28 | 16 | (A) active (7) (B) sham (9) |
RCT 90° off sham | R DLPFC | 1 | 100 | 15 | 18,000 | [CAPS] ↓ total PTSD severity (A)>(B) – ↓ re-experiencing (A)>(B) |
| Kozel et al29 | 103 | (A) active + CPT (54) (B) sham + CPT (49) |
RCT sham coil | R DLPFC | 1 | 110 | 12–15 | 21,600–27,000 | [CAPS] ↓ PTSD symptoms (A)>(B) |
| Osuch et al30 | 9 | (A) active + imaginal ET (9) (B) sham + imaginal ET (9) |
RCT sham- controlled 45° off sham cross-over | R DLPFC | 1 | 100 | 20 | 36,000 | [CAPS/IES] – ↓ hyperarousal (A)>(B) [↑ 24-hour urinary NE, ↑ T4, ↓ serum prolactin] (A)>(B) |
| Isserles et al31 | 26 | (A) active DTMS + traumatic SI + ET (9) (B) active DTMS + non-traumatic SI + ET (8) (C) sham DTMS + traumatic SI + ET (9) |
RCT sham coil | R & L mPFC | 20 | 120 | 12 | 20,160 | [CAPS] ↓ PTSD severity (A)>(B)>(C) – ↓ intrusion (A)>(B)>(C) [HR] ↓ response to traumatic script (A)>(B)>(C) |
| Boggio et al32 | 26 | (A) active, R DLPFC (9) (B) active, L DLPFC (9) (C) sham (8) |
RCT double-blind sham coil | (A) R DLPFC (B) L DLPFC | 20 | 80 | 10 | 16,000 | [PCL/TOP] ↓ core PTSD symptoms (A)>(B)>(C) – ↓ avoidance (A)>(B) – re-experiencing (A)=(B) – ↓ hyperarousal (A)<(B) [HDRS] ↓ mood (B)>(A) [HARS] ↓ anxiety (A)>(B) |
| Cohen et al33 | 24 | (A) active, 1 Hz, R DLPFC (8) (B) active, 10 Hz, R DLPFC (10) (C) sham, R DLPFC (6) |
RCT double-blind 90° off sham | R DLPFC | (A) 1 (B) 10 |
80 | 10 | (A) 1,000 (B) 4,000 |
[PCL/TOP/CAPS] ↓ core PTSD symptoms (A)=(B)>(C) – ↓ re-experiencing (A)=(B)>(C) – ↓ avoidance (A)=(B)>(C) [HARS] ↓ anxiety (B)>(A)>(C) |
| George et al34 | + mTBI (41) | (A) active (20) (B) sham (21) |
RCT double-blind sham coil | L DLPFC | 10 | 120 | 9 | 54,000 | [SIS] ↓ suicidal ideation Day 1 (A)>(B) Day 2, 3 (A)=(B) |
| Watts et al35 | + PD/OCD (20) | (A) active (10) (B) sham (10) |
RCT double-blind sham coil | R DLPFC | 1 | 90 | 10 | 4,000 | [PCL] ↓ core PTSD symptoms, (A)>(B) – re-experiencing=avoidance=hyperarousal [BDI] ↓ depression symptoms, (A)>(B) [STAI] ↓ anxiety symptoms, (A)>(B) [BNCE] cognitive improvement, (A)=(B) |
Note: The ↑ and ↓ symbols indicate an increase and a decrease, respectively.
Abbreviations: BDI, Beck Depression Inventory; BNCE, Brief Neuropsychological Cognitive Examination; CAPS, Clinician-Administered Posttraumatic Stress Disorder Scale; CPT, cognitive processing therapy; DLPFC, dorsolateral prefrontal cortex; DTMS, deep transcranial magnetic stimulation; ET, exposure therapy; HARS, Hamilton Anxiety Rating Scale; HDRS, Hamilton Depression Rating Scale; HR, heart rate; IES, Impact of Event Scale; L, left; MT, motor threshold; NE, norepinephrine; OCD, obsessive compulsive disorder; PCL, Posttraumatic Stress Disorder Checklist; PD, panic disorder; mPFC, medial prefrontal cortex; PTSD, posttraumatic stress disorder; R, right; RCT, randomized-controlled trial; SI, script-driven imagery; STAI, State-Trait Anxiety Inventory; SIS, Suicide Intention Scale; T4, thyroxine; TOP, Treatment Outcome Posttraumatic Stress Disorder Scale; mTBI, mild traumatic brain injury; rTMS, repetitive transcranial magnetic stimulation.