Theta burst transcranial magnetic stimulation (TBS) is a potential new treatment for post-traumatic stress disorder (PTSD). We previously reported active intermittent TBS (iTBS) was associated with superior clinical outcomes for up to 1-month, in a sample of fifty veterans with PTSD, using a crossover design. In that study, participants randomized to the active group received a total of 4-weeks of active iTBS, or 2-weeks if randomized to sham. Results were superior with greater exposure to active iTBS, which raised the question of whether observed effects persisted over the longer-term. This study reviewed naturalistic outcomes up to 1-year from study endpoint, to test the hypothesis that greater exposure to active iTBS would be associated with superior outcomes. The primary outcome measure was clinical relapse, defined as any serious adverse event (e.g., suicide, psychiatric hospitalization, etc.,) or need for retreatment with repetitive transcranial magnetic stimulation (rTMS). Forty-six (92%) of the initial study's intent-to-treat participants were included. Mean age was 51.0 ± 12.3 years and seven (15.2%) were female. The group originally randomized to active iTBS (4-weeks active iTBS) demonstrated superior outcomes at one year compared to those originally randomized to sham (2-weeks active iTBS); log-rank ChiSq = 5.871, df = 1, p = 0.015; OR = 3.50, 95% CI = 1.04-11.79. Mean days to relapse were 296.0 ± 22.1 in the 4-week group, and 182.0 ± 31.9 in the 2-week group. When used, rTMS retreatment was generally effective. Exploratory neuroimaging revealed default mode network connectivity was predictive of 1-year outcomes (corrected p < 0.05). In summary, greater accumulated exposure to active iTBS demonstrated clinically meaningful improvements in the year following stimulation, and default mode connectivity could be used to predict longer-term outcomes.

中文翻译：

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θ爆裂刺激后用于创伤后应激障碍的一年临床结果。

θ爆裂经颅磁刺激（TBS）是创伤后应激障碍（PTSD）的潜在新疗法。我们先前曾报道，使用交叉设计的50名PTSD退伍军人样本中，主动间歇性TBS（iTBS）与长达1个月的优异临床疗效相关。在该研究中，随机分为活动组的参与者总共接受了4周的活动iTBS，如果随机分组，则接受了2周。活性iTBS暴露量越大，结果越好，这就提出了观察到的效果是否能长期持续存在的问题。这项研究回顾了从研究终点开始长达1年的自然结果，以检验以下假设：活动iTBS的更多暴露与更好的结果相关。主要结局指标是临床复发，定义为任何严重的不良事件（例如自杀，精神病住院等）或需要通过重复经颅磁刺激（rTMS）进行再治疗。最初研究的意向治疗参与者中有46（92％）人被纳入研究。平均年龄为51.0±12.3岁，其中七名（15.2％）为女性。与最初随机分组的假人（2周主动iTBS）组相比，最初随机分配给活动iTBS（4周活动iTBS）的组在一年后表现出更好的结局。对数秩ChiSq = 5.871，df = 1，p = 0.015; OR = 3.50，95％CI = 1.04-11.79。4周组的平均复发天数为296.0±22.1，而2周组的平均复发天数为182.0±31.9。当使用时，rTMS再治疗通常​​是有效的。探索性神经影像检查显示默认模式网络连通性可预测1年结局（校正后的p <0.05）。