The current study aims to better understand the efficacy of intermittent theta-burst stimulation (iTBS) treatment in patients diagnosed with post-concussion syndrome (PCS) and to explore changes in brain networks after undergoing iTBS to assess its safety and feasibility in treating PCS.
This open-label pilot study aims to investigate the potential of a non-invasive brain stimulation technique, accelerated intermittent theta-burst stimulation (iTBS) repetitive transcranial magnetic stimulation (rTMS), for treating post- concussive syndrome (PCS) in persons with mild traumatic brain injury (mTBI). PCS is characterized by symptoms like cognitive impairment, mood dysregulation, fatigue, and headaches, with limited treatment options. Previous research has indicated brain network dysfunction in mTBI patients and suggested the potential of conventional once daily high frequency rTMS for treating PCS symptoms. Our proposal builds on these findings by utilizing the expertise and resources of Sunnybrook's Harquail Centre for Neuromodulation, which has extensive experience in delivering rTMS and theta-burst stimulation for treatment-resistant depression. This pilot study will implement an accelerated iTBS rTMS protocol, offering shorter treatment duration, as well as MRI-guided stimulation for precise targeting. The investigators will also explore changes in brain function following rTMS using a technique called functional magnetic resonance imaging. The investigators ultimately aim to understand how iTBS may alter the post-concussive brain and the extent to which these changes may improve PCS.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Accelerated course of left dlPFC iTBS, consisting of 600 pulses/session, 50 minutes intersession interval, 8 session/day for 5 days) at 90% resting motor threshold (MT)
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
RECRUITINGRivermead Post-Concussion Symptoms Questionnaire
A validated measure of subjective global PCS symptoms
Time frame: Baseline, immediately before the first iTBS treatment
Rivermead Post-Concussion Symptoms Questionnaire
A validated measure of subjective global PCS symptoms
Time frame: 5 days
Rivermead Post-Concussion Symptoms Questionnaire
A validated measure of subjective global PCS symptoms
Time frame: 1 month post-treatment
Montgomery-Asberg Depression Rating Scale
Montgomery-Åsberg Depression Rating Scale is a widely used clinician-rated measure of depressive severity
Time frame: Baseline, post treatment day 5, and Study endpoint
Repeatable Battery for the Assessment of Neuropsychological Status
Repeatable Battery for the Assessment of Neuropsychological Status is a brief, individually administered battery to measure cognitive decline or improvement
Time frame: Baseline and post treatment 1 month
The Behavior Rating Inventory of Executive Function
The Behavior Rating Inventory of Executive Function-A is a standardized measure that captures views of an adult's executive functions or self-regulation in his or her everyday environment.
Time frame: Baseline, post treatment day 5, and post treatment 1 month
Headache Impact Test
Headache Impact Test is a tool used to measure the impact headaches have on one's ability to function on the job, at school, at home and in social situations.
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Time frame: Baseline and post treatment 1 month