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

Background:

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.

Methods:

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.

Results:

Following 9 days of 18HZ and 3 days of iTBS her depression remitted (BDI 2512, CGI-S 72) and treatments were decreased to twicea week. OCDsymptoms and anxiety remained unchanged.

Conclusions:

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.