Low-frequency, Repetitive Transcranial Magnetic Stimulation for the Treatment of Patients with Posttraumatic Stress Disorder: a Double-blind, Sham-controlled Study

Dong-Hyun Nam, Chi-Un Pae, Jeong-Ho Chae, Dong-Hyun Nam, Chi-Un Pae, Jeong-Ho Chae

Abstract

Objective: Several studies have suggested that repetitive transcranial magnetic stimulation (rTMS) of the right prefrontal cortex may be useful in the treatment of posttraumatic stress disorder (PTSD). The aim of this study was to compare the effect of rTMS on the right prefrontal cortex with that of sham stimulation among patients with PTSD.

Methods: In total, 18 patients with PTSD were randomly assigned to the 1-Hz low-frequency rTMS group or the sham group for 3 weeks. Primary efficacy measures were the Clinician-Administered PTSD Scale (CAPS) and its subscales, assessed at baseline and at 2, 4, and 8 weeks.

Results: All CAPS scores improved significantly over the study period. We found significant differences in the re-experiencing scores (F=7.47, p=0.004) and total scores (F=6.45, p=0.008) on the CAPS. The CAPS avoidance scores showed a trend toward significance (F=2.74, p=0.055), but no significant differences in the CAPS hyperarousal scores were observed.

Conclusion: The present study showed low-frequency rTMS to be an effective and tolerable option for the treatment of PTSD. Trials using variable indices of rTMS to the right prefrontal cortex and explorations of the differences in the effects on specific symptom clusters may be promising avenues of research regarding the use of rTMS for PTSD.

Keywords: Clinician-Administered Posttraumatic Stress Disorder Scale; Posttraumatic stress disorder; Repetitive transcranial magnetic stimulation.

Figures

Fig. 1
Fig. 1
Effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of 100% of motor threshold over right prefrontal cortex for 3 weeks comparing with sham stimulation in patients with posttraumatic stress disorder (re-experiencing subscale scores of Clinician-Administered Posttraumatic Stress Disorder Scale [CAPS]): repeated measures of analysis of variance; time effect (df=1.707, F=146.0, p<0.001), time by treatment group effect (df=1.707, F=7.47, p=0.004), treatment group effect (df=1, F=3.86, p=0.07).
Fig. 2
Fig. 2
Effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of 100% of motor threshold over right prefrontal cortex for 3 weeks comparing with sham stimulation in patients with posttraumatic stress disorder (avoidance subscale scores of Clinician-Administered Posttraumatic Stress Disorder Scale [CAPS]): repeated measures of analysis of variance; time effect (df=3, F=120.3, p<0.001), time by treatment group effect (df=3, F=2.74, p=0.055), treatment group effect (df=1, F=0.04, p=0.846).
Fig. 3
Fig. 3
Effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of 100% of motor threshold over right prefrontal cortex for 3 weeks comparing with sham stimulation in patients with posttraumatic stress disorder (hyperarousal subscale scores of Clinician-Administered Posttraumatic Stress Disorder Scale [CAPS]): repeated measures of analysis of variance; time effect (hypothesis df=3, error df=12, F=64.73, p<0.001), time by treatment group effect (df=1.356, F=1.35, p=0.273), treatment group effect (df=1, F=2.18, p=0.162).
Fig. 4
Fig. 4
Effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of 100% of motor threshold over right prefrontal cortex for 3 weeks comparing with sham stimulation in patients with posttraumatic stress disorder (total scores of Clinician-Administered Posttraumatic Stress Disorder Scale [CAPS]): repeated measures of analysis of variance; time effect (df=1.674, F=387.67, p<0.001), time by treatment group effect (df=1.674, F=6.45, p=0.008), treatment group effect (df=1, F=2.36, p=0.147).

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