stanford neuromodulation therapy (snt) for non-suicidal self-injury (nssi)

Conditions: Transcranial Magnetic Stimulation; Non-suicidal Self-injury

Summary: to investigate the treatment effect of stanford neuromodulation therapy (snt) on patients with non-suicidal self-injury (nssi) and the underlying neural mechanism.

this was a open-label clinical trial to assess the efficacy and underlying neural mechanism of snt among patients with nssi. 80 patients with nssi diagnosed by dsm-5 were recruited from the second hospital of anhui medical university. after meeting the inclusion criteria and obtaining informed consent, all the participants were randomized (1:1) into two groups: snt group and rtms group. before the treatment, the adolescent non-suicidal self-injury assessment questionnaire (ansaq) was obtained by a trained investigator to assess baseline severity. the patients had receiving a battery measure of neuropsychological tests(hamilton depression/anxiety scale, health questionnaire-15) and magnetic resonance imaging (mri) scan in multimodalities. for snt group, the treatment was performed once a day for 5 consecutive days. a brainsight neuronavigation system was used to position the tms coil over the individualized stimulation target at each session. ten sessions of itbs were delivered daily, for a total of 18,000 pulses per day. stimulation was delivered at 90% of resting motor threshold (rmt). for rtms group, the treatment was also performed once a day for 5 consecutive days. two sessions of rtms were delivered daily. each rtms session comprised 100 trains of 4s duration at 10 hz with inter-train intervals of 26 s (i.e., 4000 pulses per session). stimulation was delivered at 90% of rmt. in the second day after the last treatment, all the tests and mri were reassessed. patients were instructed to focus their answers on the past 1 week. the clinical symptom and cognition of participants were followed in one week and one month after the last treatment.

Eligibility criteria:
inclusion criteria: * the patients were diagnosed by 2 or more senior clinical psychiatrists, meeting dsm-v criteria, and having 1 or more non-suicidal self-injurious behaviors in the last 6 months * 12-18 years of age * the medicine has not changed in the 4 weeks prior to or after this study, and if it has to be changed, the treatment medication is required to be at a subtherapeutic dosage level exclusion criteria: * the patients has suicidal ideation, or have committed suicidal behavior * t1 or t2 weighted phase magnetic resonance images show focal brain lesions * patients had neurological disorders such as epilepsy, or serious physical illnesses * patients had history of substance abuse and drug dependence in the last 6 months or use of anticonvulsant drugs in the last 3 months * patiens had received radial cranial electrical stimulation or magnetic stimulation treatment in the last 3 months, or received electroconvulsive therapy in the last 6 months * patients had previous significant head trauma or with eeg abnormality in the last 1 month * body-mounted devices unsuitable for treatment, such as pacemakers, artificial valves and other metal implants.

Keywords: transcranial magnetic stimulation non-suicidal self-injury