A French multicenter randomized and double blinded shamed controlled study recruiting patients who present resistant PTSD. The aim of this trial is to assess the efficacy of cerebral modulation by rTMS with simultaneous reactivation of traumatic memory on the PTSD symptoms at M1.
Detailed Description : PTSD is considered as one of the top 10 public health concerns. Most patients with PTSD receive pharmacologic treatment and traumatic reactivation therapy. However, to date, the optimal treatment alternatives for non-responders PTSD patients are unknown. Functionally, the metabolic activity of the prefrontal-amygdala cortex circuit in PTSD is significantly altered. Repetitive Transcranial Magnetic Stimulation (rTMS) provides focused, non-invasive stimulation of cortical areas of the central nervous system and could correct cortical defective activation of the prefrontal cortex seen in PTSD Patient (FDA has already approved rTMS for depression and acoustic-verbal hallucinations treatment). Pairing rTMS with cues relevant to the trauma may be a novel approach to treat PTSD patient. The study will enroll 102 subjects with resistant PTSD. After screening and inclusion phase, the treatment phase with 12 sessions of rTMS and simultaneous reactivation of traumatic memory or sham rTMS and simultaneous reactivation of traumatic memory will be performed (3 to 4 weeks). Antidepressant treatment will be maintained. The follow up phase consist of 3 visits at M1, M3 and M6 to follow the evolution of the PTSD symptoms.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
102
rTMS with simultaneous reactivation of traumatic memory will be performed 3 to 4 times a week for 3 to 4 weeks through 12 sessions. A traumatic script will be prepared by the patient at the inclusion visit, which will be used to reactivate the traumatic memory after every rTMS or sham rTMS sessions.
sham rTMS with simultaneous reactivation of traumatic memory will be performed 3 to 4 times a week for 3 to 4 weeks through 12 sessions. A traumatic script will be prepared by the patient at the inclusion visit, which will be used to reactivate the traumatic memory after every rTMS or sham rTMS sessions.
Saint Antoine Hospital, Psychiatry department, Assistance Publique- Hôpitaux de Paris
Paris, France
RECRUITINGPTSD severity score measured at M1 after 12 sessions of rTMS or sham rTMS and simultaneous reactivation of traumatic memory
CAPS-5 total severity score at M1 post treatment will be compared between groups (cerebral modulation by rTMS with simultaneous reactivation of traumatic memory VS sham rTMS with simultaneous reactivation of traumatic memory)
Time frame: Month 1 after 12 sessions of rTMS
PTSD severity scores at M3 and M6 measured with CAPS-5
The different dimensions of PTSD (assess by CAPS-5): Severity, repetition, avoidance, neurovegetative activation at M3 and M6 post treatment
Time frame: At inclusion (v1), Month 3 and Month 6 post treatment
The severity of PTSD assessed by PCL-5 at each visit.
PTSD severity score measured with the PTSD Checklist (PCL-S self-questionnaire) at once a during TMS sessions, M1, M3 and M6 post treatment
Time frame: at once a during TMS sessions, Month1, Month 3 and Month 6 post treatment.
Dissociative symptoms severity scores (1)
Dissociative symptoms severity score measured with the Clinician Administered Dissociative States Scale (CADSS)
Time frame: at inclusion (V1), up to 4 weeks (V13) (end of treatment), Month 1, Month 3, Month 6 post treatment
Dissociative symptoms severity scores (2)
The Multidimensional Assessment of Interoceptive Awareness (MAIA)
Time frame: at inclusion (V1), up to 4 weeks (V13) (end of treatment), Month 1, Month 3, Month 6 post treatment
Dissociative symptoms severity scores (3)
The Dissociative Experiences Scale (DES)
Time frame: at inclusion (V1), up to 4 weeks (V13) (end of treatment), Month 1, Month 3, Month 6 post treatment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
The severity scores of the dimensions of anxiety at V13 (end of treatment), M1, M3, M6 post treatment.
The severity scores of the dimensions of anxiety measured with HAM-A at V13 (end of treatment), M1, M3 and M6.
Time frame: Up to 4 weeks (V13) (end of treatment), Month 1, Month 3, Month 6 post treatment.
Symptoms of depression at V13 (end of treatment), M1, M3, M6 post treatment.
The severity scores of the dimensions of depression measured with HAM-D at V13 (end of treatment), M1, M3 and M6.
Time frame: at V13 (end of treatment), Month 1, Month 3, Month 6 post treatment.
Evolution of social cognition at M3 post treatment.
Evolution of social cognition at M3 post treatment by a neuropsychologist
Time frame: at Month 3 post treatment
Quality of life
Quality of life evolution post treatment and M6 assessed by WHOQOL EuroQol Health Measure
Time frame: post treatment and Month 6
Quality of life
Quality of life evolution post treatment and M6 assessed by EQ-5D-5L
Time frame: post treatment and Month 6
Proportion of adverse events during the active treatment phase and during the follow-up
Number and description of adverse events during the active treatment phase and during the follow-up
Time frame: through study completion, up to 6 months