TMS Treatment in the Use of mild TBI with Comorbid Depression

 

The use of Transcranial Magnetic Stimulation (TMS) is a rapidly advancing therapeutic technique in variety of pathologies in the central nervous system. Recently the Siddiqi group has done work on TMS therapies for TBI and comorbid depression. In relation to Dr. Pape’s work with comatose TBI patients, she saw preliminary success from TMS stimulation. This is furthered due to the fact that TMS is FDA approved for depression (3). Taken together applying Dr. Pape’s work to TBI and depression patients can be very beneficial for targeted therapies.

Recently, NBC news published an article reviewing recent advances in patients with TBI having different depression pathology sheds light on TMS being a possible therapeutic approach. Generally, more severe TBIs depression is not a main concern so the focus of this study was on mild traumatic brain injuries (mTBI), such as a concussion (1). They used functional MRI (fMRI) to map these depression pathways in both non-TBI depression and TBI related depression. The findings were intriguing, both groups (control and experimental) used the same neural pathways, but the activation was the opposite. For example, the DAN-subgenual cingulate connectivity was decreased in TBI and depression patients and increased in non-TBI depression patients (2).  Previous research said common pharmaceutical and therapeutic approaches for non-TBI depression are not effective for TBI with comorbid depression. Therefore, new treatment protocols can be utilized considering the new understanding of pathway’s excitation and inhibition.

Dr. Pape’s research can be applied to these new findings in mTBI depression. Although her work has been primarily focused on minimally conscious states, three months to two years post TBI, it can be applied to mTBI (4). She performed a study on mTBI with comorbid PTSD using TMS at 600 pluses in three minutes (5). The results were not published, but during a talk she said it was promising. TMS is not currently approved for severe TBI or mTBI, but it is for depression (3). TMS has the unique ability to both excite and inhibit neuronal pathways in a neuromodulatory manner. With the opposite activation patterns found in TBI depression this unique quality of TMS can target any pathway affected. Dr. Pape also found different pathways using diffuse tensor imaging, to generate high quality images of functionally connected pathways of interest in minimal conscious state patients. This allows for more targeted use of TMS therapy. Dr. Pape’s work on TMS and different levels of TBS have been extremely valuable in extending its use to other comorbid conditions to TBI’s.

Taking these two works together it is possible to use both teams imaging data to apply targeted TMS to treat mTBI and depression. The diffuse tensor imaging could be applied to the fMRI pathways found to be implicated in mTBI depression for a different view of these pathways. Due to mTBI depression varying pathology to non-TBI depression, understanding the neural pathway can provide insight into targeted TMS approaches. The TMS therapy cannot use the same protocols as non TBI depression because of the imaging data done by the Siddiqi group, showing the opposite activation for each pathway. Between the imaging data and techniques combined with new TMS protocols promising relief for TBI depression can potentially be standard treatment for all mTBI patients that develop depression symptoms.

References:

1. NBCUniversal News Group. (2023, July 5). Depression after TBI is a distinct condition, study finds. that could change how it’s treated. NBCNews.com. https://www.nbcnews.com/health/mental-health/depression-tbi-distinct-condition-study-finds-change-treated-rcna92753

2. Siddiqi SH, Kandala S, Hacker CD, Bouchard H, Leuthardt EC, Corbetta M, Morey RA, Brody DL. Precision functional MRI mapping reveals distinct connectivity patterns for depression associated with traumatic brain injury. Sci Transl Med. 2023 Jul 5;15(703):eabn0441. doi: 10.1126/scitranslmed.abn0441. Epub 2023 Jul 5. PMID: 37406139.

3. Rizvi S, Khan AM. Use of Transcranial Magnetic Stimulation for Depression. Cureus. 2019 May 23;11(5):e4736. doi: 10.7759/cureus.4736. PMID: 31355095; PMCID: PMC6649915.

4. Bender Pape TL, Herrold AA, Guernon A, Aaronson A, Rosenow JM. Neuromodulatory Interventions for Traumatic Brain Injury. J Head Trauma Rehabil. 2020 Nov-Dec;35(6):365-370. doi: 10.1097/HTR.0000000000000643. PMID: 33165150.

5. Bender Pape, T. L. (2023, October). Neuromodulation ​ in Neurorehabilitation: ​ Now and the Future. Loyola Neuroscience Seminar​. Chicago; Loyola University Chicago.