Personalized Brain Stimulation to Treat Chronic Concussive Symptoms

Conditions studied

Post-Concussion Syndrome, Concussion, Brain, Mild Traumatic Brain Injury, Head Injury, Headache, Dizziness, Cognitive Symptom, Dysautonomia, Anxiety, Irritability; Syndrome, Depression, Post-traumatic Stress Disorder

About this study

The goal of this study is to investigate a new treatment for chronic symptoms after concussion or mild traumatic brain injury in people aged 18-65 years old. Chronic symptoms could include dizziness, headache, fatigue, brain fog, memory difficulty, sleep disruption, irritability, or anxiety that occurred or worsened after the injury. These symptoms can interfere with daily functioning, causing difficulty returning to physical activity, work, or school. Previous concussion therapies have not been personalized nor involved direct treatments to the brain itself. The treatment being tested in the present study is a noninvasive, personalized form of brain stimulation, called transcranial magnetic stimulation (TMS). The investigators intend to answer the questions: 1. Does personalized TMS improve brain connectivity after concussion? 2. Does personalized TMS improve avoidance behaviors and chronic concussive symptoms? 3. Do the improvements last up to 2 months post-treatment? 4. Are there predictors of treatment response, or who might respond the best? Participants will undergo 14 total visits to University of California Los Angeles (UCLA): 1. One for the baseline symptom assessments and magnetic resonance imaging (MRI) 2. Ten for TMS administration 3. Three for post-treatment symptom assessments and MRIs Participants will have a 66% chance of being assigned to an active TMS group and 33% chance of being assigned to a sham, or inactive, TMS group. The difference is that the active TMS is more likely to cause functional changes in the brain than the inactive TMS.

Interventions

• Device: Active cTBS — 600 active cTBS pulses will be delivered continuously (3 pulses at 50 hertz (Hz), repeated at 5 Hz, 15 pulses/sec, continuously for 40 seconds) twice/day for 1,200 pulses/day. The MagVenture MagPro active/sham system will be used to enable double blinding by universal serial bus (USB) key in which a current will be delivered through surface electrodes on the skin beneath the coil to mimic the sensory experience of cTBS for active and sham groups.
• Device: Inactive/Sham cTBS — 600 inactive, or sham, cTBS pulses will be delivered continuously (3 pulses at 50 hertz (Hz), repeated at 5 Hz, 15 pulses/sec, continuously for 40 seconds) twice/day for 1,200 pulses/day. The MagVenture MagPro active/sham system will be used to enable double blinding by universal serial bus (USB) key in which a current will be delivered through surface electrodes on the skin beneath the coil to mimic the sensory experience of cTBS for active and sham groups.
• Behavioral: Imaginal exposure — Personalized recordings about participants' descriptions of triggering or neutral stimuli or activities

Primary outcomes

• Central target engagement, modulation, and durability (Change from baseline across all subsequent time points until completion of the study, an average of 4 months)
• Peripheral target engagement, modulation, and durability (Change from baseline across all subsequent time points until completion of the study, an average of 4 months)
• Persistent post-concussive symptoms modulation and durability (Change from baseline across all subsequent time points until completion of the study, an average of 4 months)
• Fear avoidance modulation and durability (Change from baseline across all subsequent time points until completion of the study, an average of 4 months)

Eligibility information

Study locations

• UCLA, Westwood, Los Angeles, California 90095 United States