ETMS4Stress: Electroencephalogram (EEG) Enhanced Transcranial Magnetic Stimulation (eTMS) for Chronic Trauma and Stressor-Related Disorders (TSRD)
Study Details
Study Description
Brief Summary
The goal of this clinical trial is to learn about the safety, feasibility, and preliminary efficacy of EEG-enhanced transcranial magnetic stimulation (eTMS) as an adjunct to standard-of-care therapies for chronic trauma and stressor related disorders (TSRD) among US military veterans.
The main questions the study aims to answer are:
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Is it safe to provide 30 sessions of eTMS for veterans with chronic TSRD?
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Is it feasible to provide 30 sessions of eTMS as an adjunct to standard-of-care therapies for veterans with chronic TSRD?
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Does health-related quality of life improve among veterans after 30 sessions of eTMS as an adjunct to standard-of-care therapies for chronic TSRD?
Participants will undergo 30 sessions of eTMS as an adjunct to standard-of-care therapies for veterans with chronic TSRD, weekly reassessment during treatment, and intermittent follow-up for 36 weeks post-enrollment.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2/Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Adjunctive eTMS treatment (no delay) 6 weeks (30 sessions) of daily eTMS as an adjunct to standard of care TSRD treatment |
Device: Adjunctive, midline prefrontal, lower intensity, shorter session, EEG-enhanced, repetitive transcranial magnetic stimulation (eTMS)
Approximately 2000 pulses per session (x30 sessions) of midline prefrontal, repetitive transcranial magnetic stimulation at 50% or less of motor threshold, calibrated via EEG to a resonant alpha frequency of the participant, and given over approximately 12 minutes. Given as an adjunct to standard of care and integrative treatment for TSRD.
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Outcome Measures
Primary Outcome Measures
- Number of participants with device-related serious adverse events [6 weeks]
To address safety of the procedure, the study investigators will report number of participants (of 30 initial cohort) with expected, device-related serious adverse events (SAE's) or unexpected, device-related SAE's during treatment
- Rate of participants completing 80% of scheduled visits [6 weeks]
To assess feasibility of the procedure, the study investigators will report the rate of participants (for initial cohort of 30) completing >= 80% of the 30 scheduled eTMS sessions
Secondary Outcome Measures
- Mean change in Veterans RAND 36-item health survey (VR-36) mental component scores (MCS) [6 weeks]
To assess efficacy of the procedure to improve health related quality of life, the study investigators will report the mean change from baseline to week 6 in mental component score (MCS) on Veterans RAND 36-item health survey (VR-36) for participants (in initial cohort of 30) who completed >=80% of eTMS sessions
Eligibility Criteria
Criteria
Inclusion Criteria:
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Positive identification as a Veteran per discharge paperwork (DD-214, DD-215, NGB-22, NGB-22A) and photo ID, or Veterans Health Administration Veteran Health Identification Card (VHIC)
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Presence of deployment-related stressful events (as defined by the Deployment Risk & Resilience Inventory-2, DRRI-2)
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Trauma event(s) (defined on the Life Experiences Checklist for DSM-5, LEC-5)
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Presence of 6 months or more of 6 or more "moderate" or worse symptoms from any of the five categories associated with stress disorders as operationalized on the PTSD Checklist for DSM-5 (PCL-5; intrusion, altered mood and cognitions, dissociation, avoidance, and arousal).
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Informed consent for study participation, off label-eTMS, and data use
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Enrollment in addiction services, if meets standard addiction treatment criteria
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Enrollment in opioid reduction services, if dependent on opioids and morphine equivalent daily dose exceeds 50 mg (50 morphine equivalent daily dose, MEDD)
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Agreement to limit daily alcoholic beverage consumption to no more than 2 servings
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Signed pain contract, if MEDD >= 80, per State of Ohio prescribing guidelines
Exclusion Criteria:
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Uncontrolled medical, psychological or neurological conditions including, but not limited to:
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Uncontrolled psychosis or mania
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Uncontrolled seizure disorder or EEG abnormalities that indicate risk of seizure, i.e., epileptiform discharges during the EEG recording
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Uncontrolled cardiac, pulmonary, or endocrine disorder (e.g., diabetes)
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Acute pain or illness
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Active, untreated addiction to prescription drugs, alcohol or illicit substances (not including cannabis or derivatives, which are available in many states under medical prescription or for recreational use)
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Clinically significant medical condition or abnormality that in the Investigator's judgment might pose a potential safety risk to the subject or limit the interpretation of the trial results
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Pregnant, or female unwilling to use effective birth control during the course of the trial (unless cleared for participation by obstetrician/gynecologist)
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Absolute contraindications to TMS: Presence of aneurysm clips or coils, cochlear or ocular implant, cortical epidural stimulator, deep brain stimulator, pacemaker or defibrillator, retained intracranial metal foreign body (bullets, shrapnel - excluding titanium and oral implants), steel stents or shunts, active vagal nerve stimulator, ventriculoperitoneal (VP) shunt.
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Prior TMS treatment
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Unwilling or unable to adhere to the study treatment, data collection schedule, or study procedures
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | BEP Medical Group LLC | Columbus | Ohio | United States | 43221 |
Sponsors and Collaborators
- Marcia Bockbrader, MD PhD
Investigators
None specified.Study Documents (Full-Text)
More Information
Additional Information:
Publications
None provided.- BEP-001