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Theta Burst 20 Hz

TMS is highly desirable over ECT (Electroconvulsive Therapy or “Shock Therapy”) as ECT treatment requires general anesthesia, is usually accompanied by long-term side effects such as memory loss, and costs significantly more. However, conventional TMS falls short in matching the remission rates demonstrated with ECT treatment.

Theta burst stimulation, a patterned form of TMS administered as pulse triplets typically at a frequency of 50 Hz (50 pulses per second), has consistently produced longer lasting results than conventional TMS with fewer side effects. Dr. Stubbeman has further enhanced this robust form of TMS by applying a novel Theta Burst 20 Hz (20 pulses per second) protocol to improve clinical effectiveness, as visualized in the two graphs at right. On average, only one out of three of patients will completely recover from their depression after treatment with conventional or deep TMS, whereas more than two out of three patients completely recover after treatment with Theta Burst 20 Hz TMS. The efficacy and proven superior safety of Theta Burst 20 Hz TMS treatment make it the optimal treatment choice for patients who cannot take medication or who have failed other types of treatments for depression.

For more on Theta Burst TMS, please read our paper published in Brain Stimulation Journal, and Dr. Stubbeman’s interview in Magventure News.

Carpenter LL, Janicak PG, Aaronson ST, Boyadjis T, Brock DG, Cook IA, et al. Transcranial Magnetic Stimulation (Tms) For Major Depression: A Multisite, Naturalistic, Observational Study Of Acute Treatment Outcomes In Clinical Practice. Depression and Anxiety 2012;29:587–96. doi:10.1002/da.21969.
Daly EJ, Singh JB, Fedgchin M, Cooper K, Lim P, Shelton RC, et al. Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression. JAMA Psychiatry 2018;75:139. doi:10.1001/jamapsychiatry.2017.3739.
Dunner DL, Aaronson ST, Sackeim HA, Janicak PG, Carpenter LL, Boyadjis T, et al. A Multisite, Naturalistic, Observational Study of Transcranial Magnetic Stimulation for Patients With Pharmacoresistant Major Depressive Disorder. The Journal of Clinical Psychiatry 2014:1394–401. doi:10.4088/jcp.13m08977.
Huang Y-Z, Edwards M, Rounis E, Rothwell J. Theta burst stimulation on human motor cortex. Clinical Neurophysiology 2007;118. doi:10.1016/j.clinph.2006.07.224.
Husain MM, Rush AJ, Fink M, Knapp R, Petrides G, Rummans T, et al. Speed of Response and Remission in Major Depressive Disorder With Acute Electroconvulsive Therapy (ECT). The Journal of Clinical Psychiatry 2004;65:485–91. doi:10.4088/jcp.v65n0406.
Kellner CH, Knapp R, Husain MM, Rasmussen K, Sampson S, Cullum M, et al. Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. British Journal of Psychiatry 2010;196:226–34. doi:10.1192/bjp.bp.109.066183.
Lingeswaran A. Repetitive transcranial magnetic stimulation in the treatment of depression: A randomized, double-blind, placebo-controlled trial. Indian Journal of Psychological Medicine 2011;33:35. doi:10.4103/0253-7176.85393.
Olgiati P, Serretti A, Souery D, Dold M, Kasper S, Montgomery S, et al. Early improvement and response to antidepressant medications in adults with major depressive disorder. Meta-analysis and study of a sample with treatment-resistant depression. Journal of Affective Disorders 2018;227:777–86. doi:10.1016/j.jad.2017.11.004.
Plewnia C, Große S, Zwissler B, Fallgatter A. Treatment of major depression with bilateral theta burst stimulation: A randomized controlled pilot trial. Clinical Neurophysiology 2013;124. doi:10.1016/j.clinph.2013.04.190.
Rapinesi C, Kotzalidis GD, Ferracuti S, Girardi N, Zangen A, Sani G, et al. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex in depressive episodes of patients with major depressive disorder, bipolar disorder I, and major depressive with alcohol use disorders. Neuroscience Letters 2018;671:128–32. doi:10.1016/j.neulet.2018.02.029.
Stubbeman W, Ragland V, Khairkhah R, Vanderlaan K. Efficacy of novel twenty hz theta burst pulse parameter in the TMS treatment of refractory depression. Brain Stimulation 2015;8:397–8. doi:10.1016/j.brs.2015.01.269.
Stubbeman WF, Zarrabi B, Bastea S, Ragland V, Khairkhah R. Bilateral neuronavigated 20Hz theta burst TMS for treatment refractory depression: An open label study. Brain Stimulation 2018;11:953–5. doi:10.1016/j.brs.2018.04.012.
Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, et al. Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice. American Journal of Psychiatry 2006;163:28–40. doi:10.1176/appi.ajp.163.1.28.
Zarate CA, Singh JB, Carlson PJ, Brutsche NE, Ameli R, Luckenbaugh DA, et al. A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Archives of General Psychiatry 2006;63:856. doi:10.1001/archpsyc.63.8.856.


 

Neuronavigation Brain MapNeuronavigation

Dr. Stubbeman utilizes neuronavigated TMS, a precision targeting system which results in the most effective form of TMS treatment (Langguth et al., 2010). A patient’s digital MRI scan is used to create a 3D image of the brain. Next, the patient’s head is spatially correlated with the newly created 3D brain image using a series of reference points. An infrared camera then tracks these positions in order to represent the patient’s head relative to the TMS treatment coil, allowing the clinician to visualize in real-time where on the brain the electromagnetic pulses are delivered.

Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G. rTMS for the treatment of tinnitus: the role of neuronavigation for coil positioning. Neurophysiol Clin. 40(1):45-58, 2010.


 

Tinnitus Partient Results QEEGQuantitative Electroencephalography (QEEG)

Dr. Stubbeman administers quantitative electroencephalography (QEEG), which is used to measure electrical patterns on the scalp that reflect brain activity. Not only are the brain waves recorded, but their sources are also overlaid onto the patient’s MRI using a method called swLORETA. This essentially quantifies the intensity of a patient’s tinnitus (Ashton et al., 2007).


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