Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Personalized repetitive Transcranial Magnetic Stimulation (PrTMS): A Case Report on Tailored Neuromodulation for

Treatment Resistant Depression Kanika Dunn, PharmD, MBS, OMSIII 1 , Don DuBose, MD, MS 2 1. Edward Via College of Osteopathic Medicine. Spartanburg, SC 2. Future Psych Solutions. Psychiatry. Columbia, SC

Introduction

Results

Discussion

Pre- treatment EEG and Scores

References 1. McIntyre RS, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. World Psychiatry. (2023); 22(3). 394-412. 2. Nora R, et al. The neurobiology of treatment-resistant depression: A systematic review of neuroimaging studies. Neuroscience & Biobehavioral Reviews. (2022); 132. 433-448. 3. Pigott HE. The STAR*D Trial: It Is Time to Reexamine the Clinical Beliefs That Guide the Treatment of Major Depression. Can J Psychiatry. 2015 Jan;60(1):9-13 The author acknowledges the patient for her participation in the report, Dr. DuBose, MD with case report conceptualization, supervision and assistance. Acknowledgements Conclusions • In this case, PrTMS not only improved her depression, but also significantly alleviated her anxiety and sleep disturbances, underscoring its advantages over traditional TMS, which primarily targets depression. • PrTMS represents a step toward precision medicine in psychiatry, where individualized brainwave mapping can replace the one-size-fits-all model of conventional TMS. • It provides an alternative for patients with TRD who do not respond to pharmacotherapy or who cannot tolerate medication side effects. • Research is currently underway to explore the use of PrTMS in other neuropsychiatric disorders such as autism, ADHD, PTSD and post-concussion syndrome to name a few. • Future research is needed to evaluate long term efficacy. • Enhanced brainwave efficiency and improved neuronal function. • Final scan showed slight reductions in alpha waves, potentially linked to treatment interruptions. • Results showcase benefit of PrTMS over standard TMS protocols. • The patient’s PH9, GAD and SCI scores revealed notable improvement over the 9-week treatment period. • These findings highlight ability of PrTMS to address multiple symptoms by targeting specific brain areas. • The patient’s EEG showed improved parietal brainwave activity and sharper alpha waves.

• Treatment-resistant depression (TRD) is a debilitating condition with high medical costs, increased illness burden, and reduced quality of life. The STAR*D trial revealed that only 33% of patients achieve remission after their first antidepressant, with decreasing success in subsequent treatments, underscoring the need for innovative approaches. 1,2,3 • Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses magnetic pulses to stimulate brain activity. However, standard TMS often overlooks individual variations in brain anatomy, limiting its effectiveness. • Personalized repetitive TMS (PrTMS) uses EEG-guided brainwave analysis and symptom tracking to create tailored treatment plans. Benefits include targeted stimulation, lower energy levels, fewer side effects, and better patient tolerability. • This case highlights a female patient with TRD, generalized anxiety, and sleep disruption, who experienced significant improvements with PrTMS. • This patient is a 36-year-old female with a medical history of treatment resistant depression, anxiety, borderline personality disorder, PTSD, prior head trauma, and hypertension. Having tried multiple medications, such as fluoxetine, citalopram, bupropion and ketamine with partial results, she sought additional help and responded to the Future Psych Solutions clinic’s public email advertisement about PrTMS. • During her initial visit, she received a free brain scan as part of the clinic’s promotional offer. After thorough consultation and discussion with the physician, she decided to proceed with PrTMS treatment. • Brain regions treated : Cz, Fz, F3, FPz, F4 • Patient received daily PrTMS for 9 weeks, with treatment plan adjusted based on EEG completed after every 5 treatments. • Assessments were performed at each visit Methods

Figure 2. Pre-Treatment initial SpectroEEG.

Figure 1. Adapted from Personalized rTMS (PrTMS) guided by qEEG provides improved outcome in a patient suffering from concussion, depression, and anxiety following a surfing accident by Hiroi, R. (2022), University of Hawaii

Table 1. Initial neurocognitive scores . Patient Health Questionnaire-9 (PHQ9). Generalized Anxiety Disorder (GAD). Sleep Condition Indicator (SCI)

Post-Treatment EEG and Scores

Figure 4. Week 9 SpectroEEG .

Figure 3 . Week 6 SpectroEEG.

Table 2 . Post-Treatment neurocognitive scores .

2025 Research Recognition Day

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