Description:

Abstract:

Many returning OEF/OIF Veterans with concussion histories report cognitive problems that may last for months or even years. Co-morbid conditions such as post-traumatic stress disorder (PTSD) and depression may prolong the symptoms of TBI resulting in lowered attention, processing speed, learning and memory. This study evaluated the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) as a promising therapeutic treatment for executive function (EF) deficits seen in mild to moderate Traumatic Brain Injury (TBI) Veterans. Thirty-Three Veterans with TBI (age 20-69 years; mild (n = 27) and moderate (n = 6) enrolled in either the treatment (n = 17) or the sham (n = 16) arm in a randomized clinical trial conducted at VA Palo Alto. The parameters currently FDA approved for Major Depressive Disorder (MDD) were utilized (Location: Left Dorsolateral Prefrontal cortex (DLPFC); Power: 120% of motor threshold; Pulse frequency: 10 Hz; Length of each pulse train: 5 seconds; Time between pulse trains: 10 seconds; Length of treatment: 20 mins; Total 4000 pulses/session, 5 days/week, 20 sessions). Preliminary analysis showed no difference between Sham and Active groups in one of the primary executive function change scores (Trails B; p > .1). Further analysis revealed a strong influence of PTSD. Resting state fMRI analysis revealed a decrease in connectivity between stimulation site (LDLPFC) and cingulo-opercular network (CON) with a standardized beta effect size of -0.81 (p =.036) which was slightly associated with the digit coding task (p=0.046, beta=0.34). Biomarker data analysis further showed an increase in the ratio of BDNF/Pro-BDNF in Active vs. Sham groups from baseline to 10th and 20th treatment with the largest difference observed after 10th treatment. These compelling results are preliminary and significant specifically in the neural and biochemistry mechanisms underlying the relationships between stimulation sites and networks heavily implicated in attention in this population.

Speaker Info:

Dr. Adamson is the senior scientific research director for DVBIC at the VA Palo Alto Health Care System. She is also the clinical associate professor of Neurosurgery and Psychiatry and Behavioral Sciences at Stanford University. Dr. Adamson completed her undergraduate degrees in neurobiology and women studies at University of California, Irvine. She completed her Ph.D. in neuroscience from the University of Southern California and a postdoctoral fellowship in Psychiatry and Behavioral Sciences at Stanford School of Medicine. Dr. Adamson’s expertise and interests span employing translational neuroscience methodologies for diagnostic and therapeutic treatments (mainly repetitive Transcranial Magnetic Stimulation (rTMS) in mild and moderate Traumatic Brain Injury (TBI), including structural and functional changes in the brain in both Veteran, active military and civilian population.