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Article

Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion

by
Milan T. Makale
1,*,
Chad Nybo
2,
Jason Keifer
3,
Kenneth Blum
4,5,6,7,
Catherine A. Dennen
8,
David Baron
7,
Keerthy Sunder
9,
Igor Elman
10,
Miles R. Makale
11,
Panayotis K. Thanos
12,13 and
Kevin T. Murphy
14,*
1
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92093, USA
2
CrossTx Inc., Bozeman, MT 59715, USA
3
Brain Health Hawaii, Honolulu, HI 96816, USA
4
Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, 1075 Budapest, Hungary
5
Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH 45324, USA
6
Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel 40700, Israel
7
Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
8
Department of Family Medicine, Jefferson Health NE, Philadelphia, PA 19107, USA
9
School of Medicine, University of California Riverside, Riverside, CA 92521, USA
10
Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02143, USA
11
Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
12
Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Clinical Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
13
Department of Psychology, State University of New York at Buffalo, Buffalo, NY 14203, USA
14
PeakLogic Inc., Del Mar, CA 92130, USA
 
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*
Authors to whom correspondence should be addressed.
Brain Sci. 2023, 13(8), 1179; https://doi.org/10.3390/brainsci13081179
Submission received: 16 June 2023 / Revised: 2 August 2023 / Accepted: 8 August 2023 / Published: 9 August 2023
(This article belongs to the Section Neurotechnology and Neuroimaging)
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Abstract

There are no FDA-approved treatments for the chronic sequelae of concussion. Repetitive magnetic transcranial stimulation (rTMS) has been explored as a therapy but outcomes have been inconsistent. To address this we developed a personalized rTMS (PrTMS) protocol involving continual rTMS stimulus frequency adjustment and progressive activation of multiple cortical sites, guided by spectral electroencephalogram (EEG)-based analyses and psychological questionnaires. We acquired pilot clinical data for 185 symptomatic brain concussion patients who underwent the PrTMS protocol over an approximate 6 week period. The PrTMS protocol used a proprietary EEG spectral frequency algorithm to define an initial stimulation frequency based on an anteriorly graded projection of the measured occipital alpha center peak, which was then used to interpolate and adjust regional stimulation frequency according to weekly EEG spectral acquisitions. PrTMS improved concussion indices and normalized the cortical alpha band center frequency and peak EEG amplitude. This potentially reflected changed neurotransmitter, cognitive, and perceptual status. PrTMS may be a promising treatment choice for patients with persistent concussion symptoms. This clinical observational study was limited in that there was no control group and a number of variables were not recorded, such as time since injury and levels of depression. While the present observations are indeed preliminary and cursory, they may suggest further prospective research on PrTMS in concussion, and exploration of the spectral EEG as a concussion biomarker, with the ultimate goals of confirmation and determining optimal PrTMS treatment parameters.
Keywords: repetitive transcranial magnetic stimulation (rTMS); concussion; electroencephalogram (EEG); power spectrum; Rivermead Post Concussion Symptoms Questionnaire (RPQ); regression repetitive transcranial magnetic stimulation (rTMS); concussion; electroencephalogram (EEG); power spectrum; Rivermead Post Concussion Symptoms Questionnaire (RPQ); regression

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MDPI and ACS Style

Makale, M.T.; Nybo, C.; Keifer, J.; Blum, K.; Dennen, C.A.; Baron, D.; Sunder, K.; Elman, I.; Makale, M.R.; Thanos, P.K.; et al. Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion. Brain Sci. 2023, 13, 1179. https://doi.org/10.3390/brainsci13081179

AMA Style

Makale MT, Nybo C, Keifer J, Blum K, Dennen CA, Baron D, Sunder K, Elman I, Makale MR, Thanos PK, et al. Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion. Brain Sciences. 2023; 13(8):1179. https://doi.org/10.3390/brainsci13081179

Chicago/Turabian Style

Makale, Milan T., Chad Nybo, Jason Keifer, Kenneth Blum, Catherine A. Dennen, David Baron, Keerthy Sunder, Igor Elman, Miles R. Makale, Panayotis K. Thanos, and et al. 2023. "Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion" Brain Sciences 13, no. 8: 1179. https://doi.org/10.3390/brainsci13081179

APA Style

Makale, M. T., Nybo, C., Keifer, J., Blum, K., Dennen, C. A., Baron, D., Sunder, K., Elman, I., Makale, M. R., Thanos, P. K., & Murphy, K. T. (2023). Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion. Brain Sciences, 13(8), 1179. https://doi.org/10.3390/brainsci13081179

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