accelerated, theta-burst stimulation for the treatment of post-concussion syndrome

Conditions: Post Concussion Syndrome

Summary: tms has been safely and reliably delivered at the harquail centre for over 5 years, with a primary focus on conventional rtms protocols for treatment-resistant depression. recently, the investgator team has gained the capability to deliver sham-controlled intermittent theta-burst stimulation (itbs) rtms. unlike conventional high frequency rtms, which was used in the previous sham-controlled rtms pcs pilot study, itbs is a patterned form of stimulation that recapitulates endogenous activity patterns of neural circuits pairing gamma frequency (50hz) burst pulses coupled in a theta frequency rhythm (5hz).12 itbs delivers 600 pulses in just over 3 minutes with similar or greater effects on neural plasticity compared to conventional rtms (taking over 30-45 minutes) and similar tolerability and efficacy in trials of depression. furthermore, novel accelerated itbs protocols stimulating the left dorsolateral prefrontal cortex (dlpfc) over 8-10 treatments, 50 minutes apart over a 5 day interval has recently demonstrated robust efficacy in depression and received recent fda approval. thus, accelerated itbs can be delivered in a single week of treatment compared to 6 weeks with conventional rtms methods. finally, the investigators recently acquired the technology to integrate mri neuroimage-guided stimulation, which would allow to target specific brain regions/networks implicated in pcs at high spatial resolution. no studies to date have investigated image-guided accelerated itbs rtms for the treatment of pcs.


Eligibility criteria:
inclusion criteria: * documented evidence of head trauma sufficiently severe to result in loss of consciousness, post-traumatic amnesia and/or acute altered mental status. * at least three symptoms including headache, dizziness, fatigue, irritability, insomnia, memory difficulties, concentration difficulties, mood dysregulation. * onset of symptoms within 4 weeks following the head trauma. * age 18-60, inclusive. * persistence of pcs symptoms for at least 3 months but less than 12 months * able to provide informed consent and comply with the study protocol * patients will not be excluded solely on the basis of communication (i.e., non-english speaking) unless they have exclusion criteria that is the cause of the communication difficulties. exclusion criteria: * evidence of major structural neuroimaging abnormalities (e.g., intracranial hemorrhage, skull fracture or a large intracranial lesion) * history of prior rtms therapy, * contraindications to mri (e.g., pacemaker, metallic implants etc.). * ferromagnetic, non-removable metallic implants from above the clavicle with the exception of dental work. * active personal injury litigation * history of seizure disorder, not including febrile seizures in childhood * substance dependence within the last 6 months * pregnant * currently taking more than lorazepam 2 mg daily (or benzodiazepine equivalent) or any dose of an anticonvulsant (due to the potential to reduce rtms efficacy) * currently taking an antiepileptic medication * mild and major comorbid medical conditions (as determined by investigators - e.g., neurological diseases, uncontrolled hypertension or diabetes, malignancy) * a major comorbid psychiatric disorder (as determined by investigators - e.g., schizophrenia or bipolar disorder) and/or psychosis at the time of study enrollment