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and adolescents with dyslexia with age range 9-15 years underwent
speech in noise perception test, auditory verbal memory test and LLAEP
assessment in a baseline condition without tDCS ,sham ( placebo) and after
20 min of exposure with 1 mA current to two different tDCS statuses:
anode electrode of tDCS on left STG / reference electrode on right shoulder
and anode electrode on the left STG/ reference electrode on right STG to
enhance left lateralization (offline) .Our results showed improved speech
in noise perception and memory and reduced latency and increased
amplitude of the waves P1, N1 and P2 with both electrodes arrangement (P
Keywords: transcranial direct current stimulation, dyslexia,central audi-
tory processing
730
MODULATING CUE-REACTIVITY WITH CONTINUOUS THETA BURST
STIMULATION TO THE FRONTAL POLE: A NOVEL TARGET WITH
TRANSDIAGNOSTIC RELEVANCE
C. Hanlon
1
, L. Dowdle
1
, D. Lench
1
, T. Kearney Ramos
1
, S. Hamilton
1
,I.
Contrereas
1
, J. Imperatore
1
, S. Snieder
2
, W. Bickel
2
, S. Book
1
, J. Smith
1
.
1
Medical University of South Carolina, USA;
2
Virginia Tech Carilion
Research Institute, USA
Background: Cue-reactivity is one of the most powerful predictors of
relapse among multiple addiction phenotypes. In these populations, cues
lead to consistent neural activity in multiple nodes of the salience network
including the anterior cingulate cortex (ACC), insula and ventral medial
prefrontal cortex (vMPFC). We have now performed a series of sham-
controlled, multiday clinical trials which have evaluated the efficacy of
continuous theta burst stimulation as a tool to dampen cue reactivity in
multiple populations.
Method: 76 treatment seeking individuals (cocaine, alcohol, nicotine
users, compulsive eaters) participated in 1 of 4 clinical trials wherein they
received a functional MRI assessment of cue-reactivity (tailored to their
drug of choice) before and after a 5 or 10 day course of real or sham
continuous theta burst stimulation (120% RMT, 3600 pulses;132 fMRI
scans total). Brain reactivity to cues was quantified in apriori defined nodes
of the salience and executive control networks. Multiple regression was
used to assess the impact of time, treatment, and addiction-phenotype on
cTBS related changes in cue-reactivity.
Results: There was a significant interaction between treatment and time in
the dorsolateral prefrontal cortex (F(1,142)¼7.38;p¼0.007), vMPFC
(F(1,142)¼6.43;p¼0.012), Insula (F(1,142)¼6.97;p¼0.009), and ACC
(F(1,142)¼5.42;p¼0.023). There was no significant effect of addiction-
phenotype on modulation of these regions other than the ACC
(F¼5.24;p¼0.023) wherein the effect was largest in the alcohol users.
There was also no significant interaction with the Occipital cortex response
to cues (control region).
Discussion: These data demonstrate, for the first time, that a multiday
course of real versus sham cTBS to the left frontal pole has a significant
effect cue-reactivity in multiple classes of patients. The feasibility and ef-
ficacy this approach opens a de novo therapeutic possibility for changing
cue reactivity with TBS.
Keywords: addiction, neuroimaging, theta burst stimulation, TBS
731
CLINICAL EFFECTIVENESS OF 5HZ TRANSCRANIAL MAGNETIC
STIMULATION APPLIED ON LEFT DORSOLATERAL PREFRONTAL
CORTEX AND DORSOMEDIAL PREFRONTAL CORTEX ON CLINICAL
DEPRESSED PATIENTS
G. Trejo Cruz
1
, J. Reyes L
opez
1
, J. Ricardo Garcell
2
, R. Rodríguez Vald
es
1
,S.
Alcauter Sol
orzano
3
, A. Rodríguez M
endez
1
, N. Camacho Calder
on
1
,J.
Gonz
alez Olvera
4
, G. Roque Roque
1
,
A. Calder
on Moctezuma
1
,H.
Hern
andez Montiel
1
.
1
Facultad de Medicina. Universidad Aut
onoma de
Quer
etaro, Mexico;
2
Instituto de Neurobiología UNAM Campus Juriquilla.
Unidad de Neurodesarrollo, Mexico;
3
Instituto de Neurobiología UNAM,
Campus Juriquilla, Mexico;
4
Instituto Nacional de Psiquiatría Juan Ram
on
de la Fuente, Mexico
Objective: 26 out of 50 participants (age: 18-45) diagnosed with MDD
(DSM-5 criteria) were accepted via informant consent; 18 women (age:
29.31±7.43) and 8 men (33.6±5.81) and were evaluated by Hamilton
Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating
Scale (MADRS), Beck Depression Inventory (BDI) and Hamilton Anxiety
Rating Scale (HARS). Patients were divided in two groups (Group 1: LDPFC
and Group 2: DMPFC), each group received 5Hz rTMS for 3 weeks.
Results: Students t and Wilcoxon Rank Test (p<0.0005), on Both groups
showed reduction in their depressive symptomatology, according to the
scales (Pre/Post treatment with rTMS). For Group 1 (LDLPFC, 13 partici-
pants): HDRS (Pre Treatment: 31.6±5.18. Post Treatment: 9.79±8.87),
MADRS (Pre Treatment: 35.26±5.18. Post Treatment: 9±9.21), BDI (Pre
Treatment: 41.2±14.56 Post Treatment: 15.73±16.74), HARS (Pre Treat-
ment: 28.86±8.1 Post Treatment: 12.93±9.65). For Group 2 (DMPFC, 13
Participants): HDRS (Pre Treatment: 31.57±6.15. Post Treatment:
11.5±9.10), MADRS (Pre Treatment: 35.07±6.25. Post Treatment:
8.92±8.04), BDI (Pre Treatment: 49.92±15.14 Post Treatment:
15.73±16.74), HARS (Pre Treatment: 32.14±7.94 Post Treatment:
11.14 ±9.56). Cohens d was applied to measure size effect on the most
statistically significative symptoms reduction, where Group 1 showed
statistically larger size effect on physical symptoms, anhedonia and sui-
cidal thoughts.
Conclusions: Results suggest efficacy in both groups, however Group 1
showed larger size effect tan group 2. We advice to carry out more studies
with a larger sample to obtain more statistically significative results and
also carry out more studies on the effect of 5 Hz rTMS over DMPFC.
Keywords: Transcranial Magnetic Stimulation Depression Psychology
Psychiatry
732
CASE REPORT: IMPROVED RTMS EFFICACY AFTER FMRI LOCALIZES
DLPFC TARGET TO NON-DOMINANT HEMISPHERE
J. Iovine
1
, N. Spivak
1
,
2
, S. Jordan
3
,
1
, K. Mahdavi
1
, J. Duncan
4
,
1
, S. Becerra
4
,
1
,
H. Packham
1
, N. Nicodemus
1
, S. Pereles
5
, M. Whitney
5
, A. Bystrisky
2
,T.
Kuhn
6
,
2
,
1
, M. Mamoun
4
,
7
,
1
.
1
Neurological Associates of West Los Angeles,
USA;
2
Dept of Psychiatry &Biobehavioral Sciences, UCLA, USA;
3
Dept of
Neurology, UCLA, USA;
4
CNS Health, USA;
5
RAD Alliance, USA;
6
Dept of
Research and Psychiatry VA Healthcare System, USA;
7
Dept of
Neurosurgery, UCLA, USA
Introduction: Repetitive transcranial magnetic stimulation (rTMS) to the
left DLPFC is used to treat major depressive disorder (MDD). Current
approximation of DLPFC location is done using a standardized rTMS po-
sition 5.5cm anterior to the left primary motor cortex, and generally results
in modest remission rates in the literature. However, this approach may
fail to account for variability in individualized localization of function. This
case report demonstrates the potential efficacy of using a stimulated fMRI
scan to determine the precise position of TMS targets in an attempt to
improve treatment outcomes.
Case description: The patient is a 43 year-old right-handed female with a
history of MDD, dysthymia and rumination, who presented with one year
of worsening depressive symptoms despite a robust course of psycho-
therapy and numerous medications. Following 7 sessions of traditional
rTMS targeting the left DLPFC localized via the standardized 5.5cm rule,
the patient reported feeling more depressive symptoms.
Methods: To acquire the precise location of her DLPFC target, the pa-
tient underwent a task-based fMRI to elicit DLPFC activity. Despite being
right-handed, the DLPFC activation localized to her right hemisphere.
Also, the DLPFC activation localized approximately 1.5cm anterior to
where the 5.5cm rule would have predicted. During an fMRI cognitive
reappraisal task, the patient’s right VLPFC showed activation with robust
consistency, suggesting its role in partially mediating reappraisal. The
patient then underwent a course of fMRI-guided rTMS using these
individualized right hemisphere targets. The Beck Depression Inventory
(BDI) was used to measure mood symptoms at the start of each week of
treatment.
Results: During and after the course of 20 sessions, the patient reported a
significantly increased mood, mental clarity, cognitive control of reactivity
to stressors, and a decrease in ruminative thoughts. Her BDI score
decreased considerably and at a two month follow-up, the patient re-
ported continued significant improvement.
Keywords: TMS, FMRI, Neuronavigation, Depression
Abstracts / Brain Stimulation 12 (2019) 385e592 527