Abstracts / Brain Stimulation 7 (2014) e17ee26e24

bipolar (n¼1) depression. Patients received acute dTMS fivedays/week (at least 30 sessions) plus maintenance treatments.Five patients received unilateral and three received bilateraltreatments.Results: A repeated measures ANOVA comparing baseline to ses-sion 20 revealed a significant effect (p¼0.000), with a 52 percentdecrease in depressive symptoms and 25 percent of patientsreporting remission (BDI < 10). After an additional ten acute-phasetreatments, 6 of 8 patients reported further gains (a subsequent26 percent decrease in depressive symptoms), with 50 percentreporting remission. During maintenance, 3 of 8 patients continuedto experience a further decrease in depressive symptoms; one pa-tient achieved remission. In the unilateral group, overall remissionrate was 66% and response (>50 percent reduction in BDI) rate was80 percent. In the bilateral group, 66% of patients achieved remis-sion, and 100% responded.Conclusion: The majority of improvement occurred during thefirst 20 treatments; however, extending the acute phase to 30treatments resulted in clinically significant gains. Response andremission rates were similar in the unilateral and bilateral groups.However, studies with larger sample sizes are required to reachfirm conclusions.

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Clinical Efficacy of Novel 20HZ Theta Burst Parameter in theTranscranial Magnetic Stimulation Treatment of DepressionWilliam F. Stubbeman MD, Victoria Ragland BS, Raya Khairkhah BA,Kathryn Vanderlaan MS, JD

Background: Conventional depression treatments fail to bringmost patients to remission. Transcranial Magnetic Stimulation(TMS) is a promising alternative, but results using current param-eters remain suboptimal. Novel TMS parameters providing greaterefficacy are needed.Objective/Hypothesis: We report on the safety, efficacy anddurability of a novel 20Hz Theta Burst Stimulation (TBS-20Hz)parameter in the TMS treatment of depression.Methods: Four consecutive unipolar depressed treatment-re-fractory patients received neuro-navigated TMS. Weekly BeckDepression Inventory II (BDI-II) rating scales assessed depressionseverity. Two patients with significant anxiety began treatmentwith bilateral TBS-50Hz (bursts of three 50Hz pulses at 5 Hz in-tervals) and two patients beganwith unilateral followed by bilateralTBS-50Hz. After non-remission to TBS-50Hz, all patients receivedunilateral TBS-20Hz (bursts of three 20Hz pulses at 5Hz intervals)followed by, in the case of persistent non-remission, bilateral TBS-20Hz. Protocols were switched if two consecutive weeks passedwithout BDI-II score improvement.Results: Treatment was well tolerated without adverse effects.Following TBS-50Hz (mean 38.3 sessions), one patient responded(BDI-II decrease > 50%) but none remitted, with average BDI-IIscores decreasing from 33.3 to 19.3 (p¼.015). However, followingTBS-20Hz (mean 39.8 sessions), all four patients remitted withaverage BDI-II scores decreasing from 26.0 to 6.8 (p¼.037). Re-missions persisted through follow-up (mean 8 months) withoutadditional treatment.Conclusion: Four consecutive treatment-refractory depressed pa-tients remitted to TBS-20Hz after non-remission to TBS-50Hztreatment. Although replication in larger randomized controlledtrials is warranted, TBS-20Hz could significantly improve TMS ef-ficacy for depression.

Conflicts of interest: Dr. Tendler, Dr Zangen, Dr. Roth have financial interest inBrainsway.

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Deep Repetitive Transcranial Magnetic Stimulation (dTMS)Treatment of Chronic Neuropathic Back Pain: Case SeriesAron Tendler MD C.BSM a, Heather Allsup AAS a, Marilyn Turcone BA a

, Kaylin Raggi BA a, Elyssa Sisko BA a, Yiftach Roth PhD b,Abraham Zangen PhD c

aAdvanced Mental Health Care IncbBrainsway LtdcBen Gurion University

Background: dTMS over the motor cortex with the sagittalHMCCPN coil has been successfully used to reduce symptoms inpatients with diabetic neuropathic foot pain.Objective: We utilized dTMS over the motor cortex with theHMPCC coil, a more coronal H coil, in two patients with chronicneuropathic back pain that failed current pain management in-terventions and multiple pharmacotherapies.Methods: dTMS was administered daily for three weeks using theHMPCC coil 20HZ 100%MT of the leg, 2.5sec train, 30 sec intertraininterval, 30 trains, 1500 total pulses. Patients were administered acomparative pain scale (CPS) daily before and after each treatmentand during weekly evaluations with the physician.Results: The first patient was a 63-year-old man with constantvibration and pain in his lower back going down into his legs withfailed back syndrome (four previous back surgeries), failed in-jections, rhizotomies, spinal cord stimulator and pharmacotherapy.His starting CPS was consistently a 5. His CPS dropped to a 2 and atfour months and it remains at a 3 with no vibrations. At fivemonthshis pain score escalated to a 6 but the vibrations never returned.

The second patient was a 60-year old womanwith cervicalgia forfourteen years from herniated and degenerative cervical discs. Shefailed nerve blocks, trigger point injections, epidural steroid in-jections and pharmacotherapy. Her CPS decreased from a 7-5-3-0 where she remains at six weeks.Conclusions: This is the first report using dTMS in the treatment ofneuropathic back pain, demonstrating efficacy and durability.

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Deep Repetitive Transcranial Magnetic Stimulation (dTMS) forMultiple Sclerosis (MS) Fatigue, Irritability and Parasthesias:Case ReportAron Tendler MD C.BSM a, Elyssa Sisko BA a, Heather Allsup AAS a,Laura DeLuca MD a

aAdvanced Mental Health Care Inc

Background: Conventional rTMS has demonstrated efficacy inreducing MS associated fatigue and spasticity. The H1 dTMS coil iscurrently FDA approved for the treatment of depression has neverbeen tested in MS patients.Objective: We report on dTMS treatment of a 55-year-old physi-cian with MS associated fatigue, irritability, tingling and numbnesson ulnar aspects of both of his hands effecting his instrumentation.His concomitant medications were Escitalopram 15mg and Inter-feron beta 1b.Methods: dTMS was administered using the H1 Coil over themotor cortex 10HZ, 80%MT, 2 second stimulation, 1 second inter-train interval, 70 trains, 1400 total pulses, followed by the movingthe H1 coil over the prefrontal cortex 18HZ, 120%MT, 2 secondstimulation, 20 second inter train interval, 39 trains, 1404 totalpulses.Results: After nine treatments he was in complete remission, withnormal energy, resolution of his parasthesias and subjectiveimprovement of his psychomotor speed. He stayed in remission for

Conflicts of interest: Dr. Tendler and Dr. DeLuca have financial interest inBrainsway.