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Neuroscience

Investigating clinical profiles in a repetitive transcranial magnetic stimulation intervention on affective ratings in PTSD and trauma-exposed depression

(PS4-95) Investigating Clinical Profiles in a Repetitive Transcranial Magnetic Stimulation Intervention on Affective Ratings in PTSD and Trauma-exposed Depression

Friday, November 15, 2024

1:00 PM – 2:00 PM EST

Location: Franklin Hall, Level 4, Marriott Downtown

Author(s)

SG

Sarai D. Garcia, B.S., B.A.

PREP Student
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Co-Author(s)

DO

Desmond Oathes, Ph.D.

Director, Center for Brain Imaging and Stimulation
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
RD

Romain Duprat, Ph.D.

Staff Scientist
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
AF

Almaris Figueroa-Gonzalez, B.S.

Clinical Research Coordinator
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
CB

Camille Blaine, B.S.

Clinical Research Coordinator
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States
JG

Julie Grier, B.S.

Data Analyst
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania, United States

Abstract Text: Major Depressive Disorder and Post Traumatic Stress Disorder are highly comorbid and are the leading mental health consequences of trauma exposure. About 50% of those with PTSD also suffer from MDD. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool used for the treatment of MDD, OCD, and smoking cessation. This treatment modulates neural activity by delivering magnetic pulses that induce electrical activity in targeted brain regions. Neurocircuitry underlying these disorders is highly variable and is further complicated by trauma experience. Data from our group shows that using functional MRI (fMRI) to guide rTMS produces significantly stronger effects than with traditional scalp-based targets. This study compared the efficacy of fMRI-guided rTMS to two cortical areas in individuals with trauma-exposed depression. We examined the use of fMRI to guide the location of stimulation over cortical areas functionally connected to the Subgenual Anterior Cingulate Cortex (sgACC), selected for its implication in both MDD and PTSD. This research aims to deepen our understanding of the use of neuroimaging tools in non-invasive brain stimulation treatment of psychiatric disorders by exploring other factors thought to impact clinical response to TMS by 1) examining trauma preponderance and 2) manipulating brain activation during neuromodulation using tasks to differentially induce high or low-arousal brain state. We hypothesized that when compared to standard targeting methods, fMRI-guided rTMS would produce a greater benefit to patients and that a low-arousal state would facilitate clinical response, based on studies linking positive mood improvement to stimulation over the subgenual cingulate cortex during a low arousal state. Preliminary data supports our hypotheses, demonstrating a significantly greater improvement in positive affect for participants who received neuromodulation over the fMRI-guided target compared to those stimulated over the standard target. Conversely, participants engaging in the high-arousal task exhibited significantly greater improvement compared to those in the low-arousal condition. However, when examining the interactions between time, site of stimulation, and task conditions, we observed different effects; revealing a significantly greater improvement in positive affect for participants who received neuromodulation over the standard target in the low-arousal condition compared to participants stimulated over the fMRI-guided target in the high arousal condition. These findings led to our interest in discerning profiles of patients that might derive maximal benefits from each arousal condition. Specifically, we are interested in identifying a subgroup of patients that might benefit from a relaxed state. Further analyses are being conducted on the influence of brain state and trauma preponderance on self-report ratings of anhedonia and avoidance, dimensions of depression and PTSD often predictive of worse clinical outcomes. The goal of this research is to better understand individualized neural networks in patients with comorbidities that often complicate treatment to continuously inform the optimization of imaging-guided neuromodulation techniques.