Authors (including presenting author) :
Ip CK (1), Chan F (2), Hon CH (2), Tai WK (1), Choy, HY (1), Wong WT (1), Wong K (1)
Affiliation :
(1) Department of Psychiatry, North District Hospital
(2) Department of Psychiatry, Tai Po Hospital
Keyword 1: :
accelerated iTBS
Introduction :
Transcranial Magnetic Stimulation (TMS) has emerged as a promising non-invasive neuromodulation technique for treating various psychiatric and neurological conditions. Intermittent Theta Burst Stimulation (iTBS), a patterned form of TMS, presents accelerated protocols capable of delivering therapeutic effects more rapidly than traditional repetitive TMS (rTMS). This case study explores the use of an accelerated iTBS protocol in a patient with hypnotic abuse.
Objectives :
1.Assess the efficacy and tolerability of an accelerated iTBS protocol in reducing craving for hypnotics and improving sleep quality in a 67-year-old female with hypnotic dependence.
2.Evaluate the sustainability of treatment effects after therapy and examine patient-reported barriers
Methodology :
The patient, a 67-year-old female with hypnotic dependence participated in 30 sessions of accelerated iTBS over 10 consecutive days, with three sessions administered daily. Treatment assessments included the Chinese version of the Craving Beliefs Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and a semi-structured interview. Follow-up evaluations were conducted at the end of treatment and one-month post-treatment, utilizing quantitative measurements and detailed semi-structured interviews.
Result & Outcome :
Before treatment, the patient expressed significant concerns regarding potential discomfort, efficacy, and long-term effects. These worries were alleviated through clear explanations provided by the multidisciplinary team, including nurses and a TMS psychiatrist. During the initial session, none of the anticipated worries manifested; only a mild and transient headache was reported, which resolved without intervention. Sleep quality progressively improved, with notable enhancements observed after 24 sessions, as indicated by a reduction in the craving score from 94 to 64 and PSQI score from 11 (poor sleep) to 7 (fair sleep). Upon completion of treatment, the patient experienced deeper sleep without reliance on hypnotics. One month after treatment, these effects were sustained, with the PSQI stabilizing at 7 and no return to hypnotic use, despite occasional cravings during sleep difficulties at home. No serious adverse events occurred, demonstrating the protocol’s tolerability for this patient.
This case illustrates the potential of accelerated iTBS as a safe and effective alternative for individuals with hypnotic abuse, offering rapid benefits and sustained improvements. These results support the need for larger-scale studies to further validate efficacy and optimize protocols for vulnerable populations.
