Personalized Dosing of Noninvasive Brain Stimulation Using fNIRS-TMS Technology
Abstract
The overall goal of this project is to demonstrate the utility of transcranial magnetic stimulation - functional near-infrared spectroscopy (TMS-fNIRS) technology as a direct measure of frontal brain activity, replacing the indirect motor threshold procedure that can lead to improper dosing of TMS. Personalized TMS-fNIRS technology will guide therapy for depression, post-traumatic stress disorder (PTSD), and/or traumatic brain injury (TBI). TMS is a non-invasive medical device that safely stimulates the brain. The device is placed on the head and creates magnetic pulses that reach the brain surface. TMS is FDA-cleared for treating depression, and TMS is rapidly growing as a treatment option for Veterans in the VA system. Depression and PTSD share some overlapping symptoms, and patients often suffer from both conditions. TMS is a promising potential therapy for PTSD, and the technology developed in this project will help advance research and clinical practice for PTSD, depression, and other brain-based disorders. The dose (strength of the magnetic pulses) must be personalized for each person receiving TMS. Individuals have differences in anatomy (e.g., skull thickness) and brain function (e.g., brain activity levels) that require different doses. If the dose is too weak, TMS will not generate a therapeutic effect in the brain. If the dose is too strong, a patient may experience unnecessary pain and an increased risk for seizure. There are no simple methods to verify TMS dose for the frontal brain locations where depression and PTSD are treated. The current standard uses an indirect proxy measure based on stimulating the brain region that controls hand movement. As hand movement is a flawed proxy for the frontal brain dysfunction involved in PTSD, we will develop a technology to directly measure the TMS effect. We are using fNIRS to measure brain activity. fNIRS technology has small light sources and optical sensors that are relatively small and inexpensive to translate for clinical practice. Thus, the brain measure technology (light spectrum) does not interact with the brain stimulation method (electromagnetic spectrum). This is important for safety and disruption of the measured signal. In this project, we will characterize the feasibility and validity of this TMS-fNIRS technology for personalized dosing. We plan to conduct this research with volunteers suffering from PTSD, as this technology will guide future clinical research for this population. Many traumatic events result in both mental (PTSD) and physical (TBI) brain injury. Thus, we also plan to characterize this technology with volunteers suffering from TBI. This proposal is applicable to the Treat FY22 TBIPHRP TRA Focus Area. The technology developed will allow for personalized interventions that can account for variable features of PTSD and TBI. The technology may secondarily contribute to other focus areas, providing a research tool to readily understand and assess brain function. This technology will have short-term and long-term benefits for individuals suffering with depression, PTSD, and/or TBI. All of these conditions significantly impair the mission readiness of the armed forces and have devastating impact on Service Members and their Families. In the short term, this technology could quickly translate to improve outcomes for veterans receiving TMS treatment for depression in the VA system. It will also allow Service Members with hand injuries to be treated, as they would otherwise be ineligible. Further out, this technology will improve clinical trials of TMS as well as our understanding and treatment of PTSD and/or TBI.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311006
Entities
People
- F. Andrew Kozel
Organizations
- Florida State University
- United States Army