Music and rTMS; Novel combination approach for the treatment of depression

Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation intervention used to treat mental illness1; it has been approved by the UK National Institute of Clinical Excellence as safe and clinically effective2. This study aimed to investigate the incidence of side effects (SE) of rTMS in patients receiving low and high-frequency treatment. Methods: 115 participants were selected from a patient-data system. Ages ranged from 18-85. Patients were treated across 7 clinics in the UK and Ireland. All patients had a diagnosis of depression with anxiety or OCD from a registered clinician. Patients had at least five rTMS sessions [Depression: F4 cTBS 40 seconds 80% rMT and F3 or Fz 10hz 20 minutes 3200 pulses 120% rMT] [OCD: F4 cTBS 40 seconds 80% rMTand FCz 1hz 20 minutes 100% rMT 1200 pulses or just FP1 intermittent 1hz 19 minutes 720 pulses]. An opportunistic retrospective chart review was conducted on 115 patient logs. An initial qualitative content analysis was used to assimilate all noted side effects into 12 concise categories. Percent averages of incidence were calculated for the low-frequency sub-group (23 patients), high-frequency sub-group (92 patients) and overall (115 patients), for each SE. Multiple Pearson’s Chi-Squared tests calculated if the differences between the two groups were significant. Results: Overall the three most prevalent SE were headache (20%), fatigue (16.5%) and scalp discomfort (6.0%). Every other SE had between 0.8%-3.5% prevalence. Every SE was more prevalent in the high Hz group compared to the low Hz group except nausea, light-headed, and tooth-pain. Conclusions: The intergroup differences were not statistically significant. Statistical significance was not found because the low-frequency group had a low sample size. This highlights the need for further SE research and data on rTMS patients. MUSIC AND RTMS; NOVEL COMBINATION APPROACH FOR THE TREATMENT OF DEPRESSION Irakli Mania, Jagdeep Kaur. Keystone Health, Chambersburg PA * Corresponding author. E-mail address: mania@keystonehealth.org (I. Mania). Abstract: Background: Standard treatments are often ineffective in Major Depressive Disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) is effective in treatment resistant MDD. Music therapy is an established health profession with proven benefits in depression and anxiety. Combining treatments with rTMS often improves outcomes. We introduce proof of concept for novel combination approach, music with rTMS. Methods/Design: Nine adult patients with treatment resistant MDD were treated. TMS was delivered using H1-coil to left dorsolateral prefrontal cortex using standard high frequency parameters. Patients listened to music simultaneously with stimulation every session for 20 minutes. The type of music played was based on the patient’s preference. They were asked to choose something that induces positive emotions in them, possibly chills or Goosebumps (i.e intense pleasure). Response was measured with Hamilton Depression Rating Scale (HAM-D). Results: Response and remission rates were 89% and 56% respectively. Mean change in total HAM-D score was e15.3 (SD1⁄43.6). There were no treatment emergent side effects. Conclusion: We demonstrate the feasibility of combining music with rTMS in this open label proof of concept series. This method is easy to set up and deliver.We encouragemore research into this area for finding proof of efficacy. Disclosures e None A STUDY OF BILATERAL PREFRONTAL REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) TO TREAT THE SYMPTOMS OF MILD TBI (MTBI) AND PTSD: PRELIMINARY TOLERABILITY AND EFFECTIVENESS Background: Standard treatments are often ineffective in Major Depressive Disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) is effective in treatment resistant MDD. Music therapy is an established health profession with proven benefits in depression and anxiety. Combining treatments with rTMS often improves outcomes. We introduce proof of concept for novel combination approach, music with rTMS. Methods/Design: Nine adult patients with treatment resistant MDD were treated. TMS was delivered using H1-coil to left dorsolateral prefrontal cortex using standard high frequency parameters. Patients listened to music simultaneously with stimulation every session for 20 minutes. The type of music played was based on the patient’s preference. They were asked to choose something that induces positive emotions in them, possibly chills or Goosebumps (i.e intense pleasure). Response was measured with Hamilton Depression Rating Scale (HAM-D). Results: Response and remission rates were 89% and 56% respectively. Mean change in total HAM-D score was e15.3 (SD1⁄43.6). There were no treatment emergent side effects. Conclusion: We demonstrate the feasibility of combining music with rTMS in this open label proof of concept series. This method is easy to set up and deliver.We encouragemore research into this area for finding proof of efficacy. Disclosures e None A STUDY OF BILATERAL PREFRONTAL REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) TO TREAT THE SYMPTOMS OF MILD TBI (MTBI) AND PTSD: PRELIMINARY TOLERABILITY AND EFFECTIVENESS J.S. Garland , O. Gbade-Alabi , J.A. Taylor , N. Atwal , P.F. Pasquina . 1 The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed National Military Medical Center, Bethesda, MD; 3 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. Background: Traumatic brain injuries (TBIs) have affected nearly 380,000 service members since 2000. Comorbid PTSD may result from, and exacerbate, various sequelae of mTBI. Conventional treatments for mTBI/PTSD symptoms have found limited effectiveness and are associated with undesirable side effects. rTMS is untested as a therapy for comorbid mTBI/ PTSD but has shown efficacy in treating PTSD symptoms and been identified as a potential mTBI therapy. Design/Methods: This study is a double-blinded, prospective randomized, sham-controlled trial consisting of 30 treatment sessionsdfive weeks of daily sessions followed by a two week taper of three and two sessions, respectively. Each session consists of 3500 pulses administered to the left dorsolateral prefrontal cortex (DLPFC) at 10 Hz and 1500 pulses administered to the right DLPFC at 1 Hz (session time: 70 minutes). Approximately 60-80 participants will be randomized to receive either active or sham TMS. Results: Thus far, 28 participants have been enrolled in this research. Preliminary data shows, despite the presence of minor discomforts such as neck soreness and headache, high overall tolerability and low pain ratings during and after treatment sessions. Interim analysis of results indicate that participants in the active condition experienced decreased PTSD and mTBI symptomology and increased cognitive ability compared to sham condition participants, although more data are required to achieve significance. Conclusions: Preliminary data indicates rTMS is a tolerable therapy for peoplewithmTBI and PTSD. This ongoing studywill provide guidance as to whether rTMS is an efficacious therapy for alleviating symptoms of mTBI and PTSD. Conflicts of Interest: None to report Funding: This study was funded through the Center for Rehabilitation Sciences Research. TWO CYCLES OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AS A PROTECTIVE MEASURE AGAINST EARLY-ONSET ALZHEIMER’S DISEASE: A CASE REPORT Garland JS , O. Gbade-Alabi , Tsui M , Swanberg M, Pasquina PF . 1 The Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD; Walter Reed National Military Medical Center, Bethesda, MD; 3 The Brain Fitness Center, Walter Reed National Military Medical Center, Bethesda, MD; 4 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda,