H-Coil Intermittent Theta Burst Stimulation For A Patient With A High Motor Threshold: Case Report
Journal: Brain Stimulation 10: e36-e37(2017)
Authors: A Tendler, E Sisko, M DeLuca, S Corbett-Methot, J Sutton-DeBord, J Brown, N Rodriguez
Effective H1 coil stimulation for depression requires a dosage of 120% of the resting motor threshold (MT). However, some patients have high MTs and difficultytolerating the high intensity that follows. Theta burst stimulation (TBS), compared to high-frequency stimulation, may accomplish the same effectswith shorter stimulation durations at a lower intensity. Early evidence from figure-8-rTMS suggests that intermittent TBS (iTBS) at 80% of MT isnot inferior to 10HZ at 120% of MT for the treatment of depression.Objective:Reporting a case study of an iTBS protocol at 80% MT using the H1 coil on a patient with high MT, who was unable to tolerate the 120% MT intensity.
A 60-year-old woman with recurrent severe treatment resistant depression as well as a relapse of her OCD which made her unable to shower or brush her teeth for two and half months was referred for H1-coil dTMS. Her MT was 79, and she was unable to toleratethe 120% MT intensity. After 9 attempts with the 18HZ protocol, she was switched to an iTBS protocol at 80% of MT. dTMS pulses were administered at 50HZ in 3 pulse bursts, 10bursts over two seconds (5HZ), followed by a five second interval, for 60 cycles(7second cycle), totaling 1800 pulses. After a 15-minute wait, theprotocol was repeated for an accelerated effect.
Following 9 days of 18HZ and 3 days of iTBS her depression remitted (BDI 2512, CGI-S 72) and treatments were decreased to twicea week. OCDsymptoms and anxiety remained unchanged.
iTBS with the H1 coil shows promise as an alternative treatment protocol for the treatment of depression in general, particularly in patients with high MTs.