Release time ：2024-05-14
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Clinical Support Department of Shenzhen Yingchi Technology Co.,Ltd.
Repetitive transcranial magnetic stimulation (rTMS) can induce lasting changes in brain activity and cortical excitability, and it has been widely used in the treatment of psychiatric and neurological diseases. With the continuous development of TMS technology, researchers have developed more treatment modes. Theta burst stimulation (TBS) is a mode of repetitive stimulation, characterized by 3 pulses per cluster, an intra cluster frequency of 50Hz, and an intercluster frequency of 5Hz. Compared with traditional TMS, it has lower stimulation intensity, shorter stimulation time, and better stimulation effect. It's an optimized mode of stimulation.
A large amount of current clinical medical evidence shows that depression and anxiety are often comorbid. Patients with comorbid anxiety and depression usually have more severe symptoms, longer duration of illness, increased difficulty in treatment, and higher suicide rate.
Functional near-infrared spectroscopy (fNIRS) was used to evaluate the effect of iTBS mode on TMS treatment on anxiety and depression disorder. The study found that after stimulation by iTBS mode, cerebral blood flow and functional connectivity in some brain areas of patients were enhanced, and anxiety and depression symptoms were significantly relieved. This study provides new evidence for the development of TMS treatment for mental disorders.
Current drug treatments for post-traumatic stress disorder (PTSD) are not very effective, resulting in at least one-third of patients experiencing no relief from their symptoms. Neurostimulation therapy, especially the use of TMS, has been shown to be an effective treatment for PTSD.
A randomized controlled study compared the intervention effects of two treatment modes, rTMS and iTBS, on PTSD. The data showed that both can significantly improve PTSD symptoms, and the treatment time of iTBS mode is much shorter, which has the effect of improving treatment efficiency, Advantages such as reduced waiting time are worthy of promotion in the treatment of PTSD.
The advantages of the iTBS mode make multiple TMS treatments a day a reality. Stanford Neuromodulation Therapy (SNT) is an accelerated, high-dose iTBS treatment protocol guided by resting-state functional MRI (FCMRI), and is currently approved by the US FDA for the treatment of major depression (MDD).
On the premise of demonstrating the efficacy of SNT in treatment-resistant depression, a recent study explored the clinical value of SNT in patients with recurrent symptoms. In this study, the majority of patients who had recurrent symptoms after receiving SNT therapy chose to receive the same treatment again, and the satisfaction was that the majority of patients again achieved response and remission levels. The high-dose iTBS mode, SNT, may be a new hope for MDD patients.
There is limited evidence of efficacy of rTMS in bipolar disorder. The current study has demonstrated the efficacy of SNT in major depressive disorder, and it is also effective in patients with relapse. The researchers therefore conducted a pilot study to evaluate the efficacy and safety of SNT in the treatment of bipolar disorder. Seven patients with bipolar type I or type II who experienced major depressive episodes received SNT. The results showed that after treatment, the patient's depressive symptoms improved significantly and the efficacy was maintained for at least 4 weeks. In terms of safety, there were no serious adverse events, and no (mild) mania symptoms were observed during treatment.
This pilot study not only provides preliminary evidence that SNT can improve depressive symptoms in patients with bipolar disorder, but also serves as a starting point for an expanded indication for SNT.
Currently, published literature supports the use of TMS in the treatment of geriatric depression. However, due to certain characteristics of this special population (brain atrophy, response and dose relationship), the efficacy of conventional protocols is unclear. Therefore, in recent years, researchers have gradually adopted high-dose accelerated iTBS protocol based on functional connectivity navigation. Numerous studies have shown the potential benefits of the iTBS mode on the prefrontal cortex in improving cognition and possibly delaying dementia, on the other hand, the use of navigation systems for precise positioning and intensity regulation can minimize the effects of brain atrophy in older patients.
Not only limited to the field of geriatric depression, accelerated iTBS mode can also improve some cognitive deficits in Alzheimer's patients. In this randomized controlled study, patients who received iTBS treatment targeting the left dorsolateral prefrontal lobe three times a day showed improvements in associative memory coding function and continued to be effective for 8 weeks after the end of treatment. This also shows that the protocol has broad application prospects and potential benefits for other neuropsychiatric disorders in the elderly.
In recent years, the development of TMS related fields is full of vitality, we have witnessed the in-depth exploration and research of TBS protocol in innovative stimulation mode, long-term impact, clinical application and other aspects, so that its application scope in clinical treatment has been further expanded, not only limited to conventional depression and other fields, but also began to involve in the treatment of more mental and neurological disorders. The research of accelerated treatment protocol has gradually become the focus.
In addition, the integration of TMS technology with other brain imaging technologies has become a research hotspot. Through the joint application with electroencephalography, near-infrared brain functional imaging and other technologies, the understanding of the therapeutic mechanisms of rTMS and TBS can be deepened. In terms of further accumulation of data support, more studies based on large samples and multi-centers are underway to provide more sufficient and comprehensive verification of the therapeutic effects and mechanisms of TBS protocols. Looking forward, we look forward to seeing more innovative research and discoveries in the clinical application of TBS protocols.
1.This content is organized by the Clinical Support Department of Shenzhen Yingchi Technology Co.,Ltd. Criticisms and corrections are welcome. For reprint, please indicate the source.
2.Reference:?
[1]Zhang, Y., Li, L., Bian, Y., Li, X., Xiao, Q., Qiu, M., ... & Wang, P. (2023). Theta-burst stimulation of TMS treatment for anxiety and depression: A FNIRS study. Journal of Affective Disorders.
[2]Yuan, H., Liu, B., Li, F., Jin, Y., Zheng, S., Ma, Z., Wu, Z., Chen, C., Zhang, L., Gu, Y., Gao, X., & Yang, Q. (2023). Effects of intermittent theta-burst transcranial magnetic stimulation on post-traumatic stress disorder symptoms: A randomized controlled trial. Psychiatry research, 329, 115533.?
[3]Geoly, A. D., Kratter, I. H., Toosi, P., Cole, E. J., Sahlem, G. L., & Williams, N. R. (2024). Sustained efficacy of Stanford Neuromodulation Therapy (SNT) in open-label repeated treatment. American Journal of Psychiatry, 181(1), 71-73.
[4]Raj, K. S., Geoly, A. D., Veerapal, C., Gholmieh, M., Toosi, P., Espil, F. M., ... & Williams, N. R. (2024). Pilot study of stanford neuromodulation therapy (SNT) for bipolar depression. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation.
[5]McDonald, W. M. (2024). Theta burst TMS technology: great promise and a lot to learn. American Journal of Psychiatry, 181(1), 14-15.
[6]Wu, X., Ji, G. J., Geng, Z., Wang, L., Yan, Y., Wu, Y., ... & Wang, K. (2022). Accelerated intermittent theta-burst stimulation broadly ameliorates symptoms and cognition in Alzheimer's disease: A randomized controlled trial. Brain stimulation, 15(1), 35-45.
