SA researchers studying new PTSD treatment, improvements in depression treatment

A groundbreaking study going on in San Antonio right now just might lead to the widespread use of magnetic pulses to help treat Post Traumatic Stress Disorder (PTSD).

But even if that part of the research doesn't pan out, there's a strong chance that some of the high-tech advancements developed here could dramatically improve the effectiveness of an already-approved treatment for depression.

And if that works, then someday robotically-guided lasers could become a standard appliance in psychiatrists' offices, used to treat millions of people who battle debilitating depression.

Yes, that's a lot of 'ifs' and 'coulds' and 'maybe somedays,' but Dr. Peter Fox, of UT Health San Antonio, the lead researcher on the project, has very high hopes.

"To make their lives better." he said. "We worked for a long time on developing this treatment and so my fingers are crossed. I'm hoping that this would really prove to be a beneficial thing for patients."

TMS - Transcranial Magnetic Stimulation

Fox and his fellow researchers are spending more than a year on a randomized, double-blind study of about 100 patients testing something called 'Transcranial Magnetic Stimulation' (TMS) for the treatment of Post-Traumatic Stress Disorder (PTSD).

TMS uses a sealed magnetic coil about the size of your hand to direct pulses through your skull to a small target area of your brain which is about an inch behind the top right part of your forehead.

The electromagnet sends a mild pulse 20 times a second into an area called the dorso-lateral prefrontal cortex.

Dr. Fox says stimulating that area of the brain - in turn - stimulates a whole network.

"This figure-eight shaped coil is making a treatment vector, an electromagnetic vector... that will interact with a small area of the brain.

"It will create circuits flowing through the neurons and fire them... in regions called limbic areas that regulate emotions. So we are trying to do this in a way that is pathway-based, circuitry-based."

Doctors say the repetitive stimulation of these brain pathways, given for 30 minutes a day, for 20 days, help 're-train' the brain.

"It's really training the system," Dr. Fox said. "So when you practice doing something, you do it over and over. You're re-training those neurons. You're changing their firing patterns. And so we're changing the firing patterns in this circuit."

The FDA approved the use of TMS in 2008 for treating depression, and Fox believes his study will prove it is also effective in lessening the symptoms of PTSD.

Testing hi-tech TMS delivery

While that's the main goal of the study, it is also helping prove the effectiveness of their specific, very targeted techniques to deliver TMS.

Dr. Fox and others at the Research Imaging Institute, which is based at UT Health San Antonio, have been working on that for more than two decades.

"When we first saw the results and realized how specific the TMS effects were and that they were network-based, that if you stimulate one area, you would activate and change remote areas [of the brain], we realized the implications of this. And we have been funded my multiple organizations, by Veterans Affairs, by the National Institutes of Health, by the Department of Defense, by private foundations to develop this technology."

"So we are now on our fifth generation of robots. We have been steadily perfecting the technology, the software that controls the robot. We've been working on this for quite a while."

For the current study, Fox's researchers are funded by the Department of Defense and the Department of Veterans Affairs through another UT Health San Antonio-based group called the Consortium to Alleviate PTSD , or CAP.

They're also partnering with San Antonio's Laurel Ridge Treatment Center, which houses an in-patient program for active-duty members of the military and veterans with PTSD.

Fox says Laurel Ridge is the largest provider of psychiatric care for the Department of Defense.

"So this is a really good place to do the study."


The research project is using more than 100 volunteers from Laurel Ridge, all of whom suffer from combat-related PTSD.

And for each of them, it all begins with Magnetic Resonance Images (MRI's) of their brains, a process done at UT Health San Antonio.

The detailed mappings of the specific anatomical structures and neuronal pathways of each individual brain are then used to create a very specific, customized treatment model for each person.

Each model is then programmed into a computer at Laurel Ridge. There, technicians strap a patient's head into a padded headrest in a treatment chair, and take precise measurements to make sure everything lines up with the MRI-based plan.

All of it is so the robot can be as precise as possible in stimulating the exact targeted spot in the brain.

While TMS is already being used by some psychiatrists to treat depression, Dr. Fox says current techniques are much more haphazard than the MRI-mapped, individually-customized, robotically-guided treatment they're developing.

"Yes [current TMS technique] is very hit-and-miss. They're not image-guided, there's really no assurance that you're hitting the area [of the brain] that you want to hit."

"Typically, TMS is delivered in a handheld manner and it is aimed just by the instincts of the person delivering the treatment, usually a technologist.

Dr. Fox and his colleagues are preparing to apply for patents on their much more high-tech TMS delivery techniques, which they believe will lead to a big leap forward in treatment and results.

"That's the idea. That we are targeting very precisely and so we should increase the percentage of patients that have a significant response to this treatment."

"I've done it!"

And Dr. Fox surprised me when I asked whether he ever had the magnetic pulses directed into his skull.

"Do you ever want to try it on yourself?"

"I've had it done to me many times," he said. "Not in treatment mode, but in developing the aiming. We can aim at language areas and make you not speak," he laughs.

So I ask if he's basically his own 'lab rat.'

"Absolutely. Yes. And the other people in the lab have done this as well. It's not something that we report in journals. It's just proof of principle, just developmental."

"And then when we're ready to do something that is publishable, we get normal volunteers and sort through all of that."

So what does it feel like to have an electromagnet send pulses into the neural network in your brain that regulates emotions?

Dr. Fox says it actually doesn't seem like much at all when you're going through it.

"It feels mostly like a tapping," he said. "When you have interrupting behavior, when it interrupts speech, the most common thing is people laugh. Because you know what you want to say and you're trying to say it and when the stimulator is off you're talking just fine. But when it's on you can't speak and it just comes out garbled, then people laugh."

"Because it's so unexpected it's actually funny when you hear yourself."

All of the volunteers in the study are already undergoing other inpatient treatment for PTSD at Laurel Ridge.

As part of this formal, randomized controlled trial (RCT), half of them are undergoing real TMS treatments, the other half 'fake' or placebo treatments.

But until the study is over later this year, only the computer knows who is getting real and who is getting placebo treatments.

FDA approval is next, then maybe study on adolescents

And if the results show it works, they'll be submitted to the FDA for possible approval of TMS as a recognized treatment for PTSD.

While the subjects of the study suffer from 'combat-related' PTSD, Dr. Fox believes the targeted TMS treatment could someday be used on millions more people, including young people.

"I am very interested in moving this to adolescents because adolescents have very limited treatment options for multiple disorders. The most common would be depression, where standard drugs produce an increase in suicidal ideation."

Dr. Fox also says PTSD is also common in children who have been abused.

"So having another treatment option for PTSD in children is quite important. If the trial that we're doing now is successful in adults, that would make it much more acceptable to the Institutional Review Board (IRB) and to the FDA to move this technology into adolescents."

Dr. Fox suggested it could take two to three years to get a clinical trial like that up and running. But that depends on the success of the current study.

Of course we'll keep tabs on the results and let you know about any future developments on News 4 San Antonio.

So stay tuned.

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