Personalized electrophysiology-guided transcranial magnetic stimulation in post-traumatic stress disorder: a randomized, double-blind, sham-controlled study

Objectives Post-traumatic stress disorder (PTSD) has been associated with disruptions in cortical oscillations and network connectivity. Alpha-guided repetitive-transcranial magnetic stimulation (⍺-rTMS) has been reported to modulate cortical activity and reduce PTSD clinical symptoms in open label studies. ⍺-rTMS was evaluated to improve PTSD clinical symptoms in a double-blind, sham controlled, randomized study within a two-week period. Material and methods Seventy-three veterans with a primary diagnosis of PTSD rendered by CAPS were randomized to receive active ⍺-rTMS versus sham stimulation for two weeks. PTSD Checklist – Military (PCL-M), Pittsburgh Sleep Quality Index (PSQI-A), and Hamilton Depression Rating Scale (HAMD) were collected at baseline and at the end of the treatment to monitor symptom severity. Safety and side effect data were collected from daily treatment notes. Results Significant differences were found for the change in PTSD severity as measured by PCL-M ( p corrected = 0.049), from baseline to post-treatment follow-up between active and sham groups. A clinically meaningful change in PCL-M scores was exhibited in significantly more of the active group compared to sham ( p = .01). Significant differences were found for the change in sleep quality (PSQI-A; p corrected = 0.030), from baseline to post-treatment between active and sham. No significant effects were observed in HAM-D scores. Reported side effects were mild and consistent with standard rTMS administration. Conclusions This pilot study demonstrated significant improvements in PTSD and sleep symptoms in veterans within a two-week period as compared to sham. ⍺-rTMS was reported to be a safe and effective treatment option for PTSD.