Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial
Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial
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DOI：
10.1016/j.jad.2017.12.046
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发表时间：
2018-03-15
影响因子：
6.6
通讯作者：
Hart, John, Jr.
中科院分区：
文献类型：
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作者：
Kozel, F. Andrew;Motes, Michael A.;Hart, John, Jr.
背景资料：目的是测试是否重复经颅磁刺激（rTMS）之前，认知加工治疗（CPT）将显着改善临床结果相比，假rTMS之前，CPT与PTSD的退伍军人。平行设计中，活性（rTMS+ CPT）与假（假+ CPT）rTMS的比例为1，每周进行一次CPT，持续12-15次。盲法评估者在基线、第5次和第9次治疗后以及治疗后1个月、3个月和6个月对退伍军人进行评估。临床医生管理的PTSD量表（CAPS）是主要的结局指标，PTSD量表（PCL）是次要的结局指标。TMS线圈（主动或假）被定位在右背外侧前额叶皮层（110%MT，1 Hz连续30 min，1800脉冲/治疗）。结果：在筛选的515名个体中，103名参与者被随机分配到主动（n = 54）或假rTMS（n = 49）。62名参与者（60%）完成了治疗，59名（57%）完成了6个月的评估。rTMS+ CPT组在CPT疗程和随访评估中显示CAPS和PCL症状较基线均有更大程度的缓解，t（df >= 325）=-2.01，p = 303）
Background: The objective was to test whether repetitive Transcranial Magnetic Stimulation (rTMS) just prior to Cognitive Processing Therapy (CPT) would significantly improve the clinical outcome compared to sham rTMS prior to CPT in veterans with PTSD.Methods: Veterans 18-60 years of age with current combat-related PTSD symptoms were randomized, using a 1: 1 ratio in a parallel design, to active (rTMS+ CPT) versus sham (sham + CPT) rTMS just prior to weekly CPT for 12-15 sessions. Blinded raters evaluated veterans at baseline, after the 5th and 9th treatments, and at 1, 3, and 6 months post-treatment. Clinician Administered PTSD Scale (CAPS) was the primary outcome measure with the PTSD Checklist (PCL) as a secondary outcome measure. The TMS coil (active or sham) was positioned over the right dorsolateral prefrontal cortex (110% MT, 1 Hz continuously for 30 min, 1800 pulses/treatment).Results: Of the 515 individuals screened for the study, 103 participants were randomized to either active (n = 54) or sham rTMS (n = 49). Sixty-two participants (60%) completed treatment and 59 (57%) completed the 6-month assessment. The rTMS+ CPT group showed greater symptom reductions from baseline on both CAPS and PCL across CPT sessions and follow-up assessments, t(df >= 325) = -2.01, p = 303)