Results Show Personalized Approach May Help PTSD Sufferers Receive the Right Treatment, Sooner
Cohen Veterans Bioscience (CVB), a translational research organization dedicated to fast-tracking personalized diagnostics and therapeutics for brain health, today announces findings from a study which identifies a critical brain imaging biomarker that may help guide people who suffer from PTSD towards the most effective treatment.
The study, entitled Using fMRI Connectivity to Define a Treatment-Resistant Form of Post-Traumatic Stress Disorder” and funded in part by CVB, appears in the journal Science Translational Medicine.
The study is the first to demonstrate that PTSD patients can be reproducibly stratified into distinct groups based only on their biological signature, or biotype. The study examined the brain network known as the Ventral Attention Network (VAN), known for its key role in thought and memory using resting-state functional magnetic resonance imaging (rs-fMRI) scans, which measure changes in blood flow that follow changes in brain activity. This analysis also revealed that patients with this biotype may not respond as well to first-line PTSD treatments of behavioral therapy. The findings also set the stage for future non-invasive brain stimulation treatment, transcranial magnetic stimulation (TMS), as a potential treatment for PTSD.
This work constitutes the first step in a comprehensive roadmap of development that will allow us to establish clinical practice guidelines that inform a precision medicine approach to treating PTSD at the individual level,” says Dr. Magali Haas, Chief Executive Officer & President of CVB. We will continue to push towards an understanding of the role of this biomarker as a marker of response to brain stimulation and psychotherapeutics as well.”
This publication includes results from two studies conducted with demographically and clinically distinct patient populations. In the first VA study, 112 participants, 76 of whom had been diagnosed with PTSD, underwent behavioral and clinical assessments, as well as functional magnetic resonance imaging, or fMRI, to measure brain activity. The participants also completed a test of their ability to recall words. In the test, they were asked to memorize blocks of 20 words and then recall them immediately, and then recall them again 15 minutes later. Sixty-six of the participants with PTSD continued on to a second part of the trial, in which they received either prolonged exposure therapy or no treatment. The majority of those participants then completed a clinical assessment of their PTSD symptoms. The researchers observed that participants with PTSD, who had both reduced verbal memory and VAN functioning, did not respond to therapy, whereas the other participants with PTSD did respond.
The second study, the Cohen Veterans Center Study, included 245 combat veterans, 117 of whom were trauma-exposed but healthy, and 128 of whom had been diagnosed with PTSD. They underwent behavioral and clinical assessments, including the verbal memory test, as well as an fMRI scan. In both studies, the findings revealed that a subgroup of participants with PTSD had both more reduced verbal memory and VAN functioning than both the rest of the PTSD participants and the healthy participants controls.
The veterans also underwent a direct brain activity test that used simultaneous transcranial magnetic stimulation (TMS), and electroencephalography (EEG), a test that measures brain waves. TMS is used to noninvasively manipulate activity in a targeted brain region and the networks to which it’s connected. Unlike fMRI, which shows a correlation between a certain behavior and brain activity, TMS allows scientists to temporarily disrupt information processing in a particular brain region through magnetic pulses and see exactly which behavior or brain function is affected. To detect these effects, participants were also hooked up to an EEG machine, which picks up the communication between neurons using sensors that are placed on the patient’s scalp.
The TMS and EEG tests revealed that the brains of veterans with poor connectivity in their VAN took twice as long to recover from the TMS magnetic pulse than the brains of patients with good communication in their VAN, indicating a deficiency in information flow within this brain network.
These preliminary results require validation, which we consider part of the translational roadmap at CVB, and led to our funding a larger follow-on prospective study called Biomarker Establishment for Superior Treatment of PTSD (BEST PTSD)” which will be completing enrollment in the second quarter of 2019,” says Dr. Andreas Jeromin, Chief Scientific Officer of CVB.
Cohen Veterans Bioscience is a non-profit 501(c)(3) biomedical research and technology organization dedicated to advancing brain health by fast-tracking precision diagnostics and tailored therapeutics.
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