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.
Carpenter, L. L., Janicak, P. G., Aaronson, S. T., et al. (2012). Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and anxiety, 29(7), 587-596.
Huang, Y. Z., Edwards, M. J., Rounis, E., et al. (2005). Theta burst stimulation of the human motor cortex. Neuron, 45(2), 201-206.
Husain, M. M., Rush, A. J., Fink, M., et al. (2004). Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a Consortium for Research in ECT (CORE) report. Journal of Clinical Psychiatry.
Levkovitz, Y., Isserles, M., Padberg, F., et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry, 14(1), 64-73.
Plewnia, C., Pasqualetti, P., Große, S., et al. (2014). Treatment of major depression with bilateral theta burst stimulation: a randomized controlled pilot trial. Journal of affective disorders, 156, 219-223.
Stubbeman, W. F., Ragland, V. E., Khairkhah, R., & Vanderlaan, K. H. (2015). Efficacy of novel twenty hz theta burst pulse parameter in the TMS treatment of refractory depression. Brain Stimulation, 2(8), 397-398.
Trivedi, M. H., Rush, A. J., Wisniewski, S. R., et al. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR* D: implications for clinical practice. American journal of Psychiatry, 163(1), 28-40.
Zarate, C. A., Singh, J. B., Carlson, P. J., et al. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of general psychiatry, 63(8), 856-864.
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.
Quantitative 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).