Recently, researchers and doctors have been promoting noninvasive treatment methods to treat traumatic brain injury (TBI) and Post-Traumatic Stress Disorder (PTSD). These noninvasive methods involve neuromodulation, which alters brain activity by stimulating specific regions to modulate or control dysfunction. An emerging treatment method that utilizes neuromodulation is transcranial magnetic stimulation (TMS). This targeting of specific regions modulates dysfunctional and functional pathways as a means of helping the brain repair itself in order to repair the neural circuitry impacted. TMS is versatile in that it cannot only target specific regions of the brain, but also fire frequencies at varying rates, at varying intensities.
Dr. Theresa Pape chronicles the current research related to TBI in the article "Neuromodulatory Interventions for Traumatic Brian Injury," exploring the mechanisms of neuromodulation, arguing for the further use of transcranial magnetic stimulation in research and medicine. Traumatic Brain Injury is not internal, but external, and is caused by physical force, for instance a car crash. There are also varying levels of TBI that can of course have varying effects on patients, meaning that treatment methods must be flexible to these differences. To account for the heterogenous expression of mild and severe and TBI in patients, Theresa Pape utilizes and promotes heterogenous forms of treatment for those who have experienced TBI, particularly emphasizing the need to integrate traditional treatment methods with TMS in order to maximize results. Both TMS and traditional psychological methods of treatment can stimulate and retrain pathways in the brain that are essential for functioning, increasing plasticity in regions of the brain that are damaged from external trauma.
Pape et al. discovered that engaging in these psychological training exercises while plasticity is induced by TMS optimizes rehabilitation. She also paired the drug amantadine with TMS treatment and saw more statistically significant improvements over time compared to the just the implementation of TMS alone. This study heavily suggests that the integration of multiple treatments is more beneficial than implementing one treatment method, and the literature review heavily emphasizes the gaps in information that exist when it comes to optimally treating TBI. In particular, the impacts of different frequencies and the rate of firing of these frequencies in relation to different disorders has not been studied nearly enough.
In 2021, Harris & Reese researched the impact of different frequencies stimulation via TMS on PTSD patients. They tested the effects of high-frequency TMS and low-frequency TMS on individuals with PTSD. They found that high frequency TMS had a significantly stronger treatment effect, and reduced PTSD symptoms in patients, but higher treatment doses are not associated with more improvement in treatment. Despite these results, researchers indicated that both high and low frequency TMS can be beneficial, depending on the region of the brain stimulated. High-frequency TMS excites neurons, whereas low-frequency TMS inhibits neurons. Therefore, high-frequency stimulation can be used to stimulate inhibited pathways, and low frequency stimulation can be used to inhibit stimulation of overly excited pathways. However, in this study, high-frequency TMS appeared to produce the best treatment outcomes for patients with PTSD. This study illustrates that specific frequencies of firing also matter when it comes to stimulation and modulation of different regions of the brain impacted by the disorder.
There are, of course, risks associated with these non-invasive methods of neuromodulation. The specific long-term effects of TMS on different patients for both TBI and PTSD are, for the most part, not known. The scale of alteration of brain activity over time is not known, and the optimal time of application is still poorly understood. In addition, many of the studies conducted have smaller sample sizes, and they often only test one method of treatment as opposed to integrating multiple styles of treatment, which can limit our understanding of how to best integrate the tried-and-true methods of treatment, and more novel forms of treatment.
In short, while we have collected detailed results on the general impact of TMS in the short term, we need to collect more specific information and the impact of different frequencies on different conditions of neural dysfunction. We also need to define the treatment parameters more specifically, for TBI and PTSD.
References:
Harris, A. D., & Reece, J. (2021). Transcranial magnetic stimulation as a treatment for posttraumatic stress disorder: A meta-analysis. Journal of Affective Disorders, 289, 55–65. https://doi.org/10.1016/j.jad.2021.04.003
Pape, T., Herrold, A. A., Guernon, A., Aaronson, A., & Rosenow, J. M. (2020). Neuromodulatory interventions for traumatic brain injury. Journal of Head Trauma Rehabilitation, 35(6), 365–370. https://doi.org/10.1097/htr.0000000000000643
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