Post Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a serious consequence occurring in large numbers of trauma survivors. With a 3.5% estimated 12 month prevalence and about a third of those affected presenting a severe form of the condition; this disorder poses a significant therapeutic challenge. Prevalence rates are much higher in areas of civil / military violence or after nature disasters.

Symptoms of PTSD include three distinct clusters: 1) intrusive re-experiencing of the traumatic event in the form of nightmares or flashbacks, with an exaggerated response to cues; 2) persistent avoidance of stimuli associated with the trauma and emotional numbing; 3) symptoms of hyper-arousal like exaggerated startle response, anger outbursts, sleeping problems and sustained preparedness for an instant alarm response.

Current mainstay of treatment for PTSD relies on psychopharmacological and trauma-focused exposure based psychological interventions. These interventions are effective and are provided at the Hadassah Psychiatric clinic. Significant fraction of patients however fail to respond or respond only partially. There have been recent studies which aim to facilitate exposure based psychological treatments applying means such as virtual reality or the partial NMDA agonist D-cycloserine.

The broadly accepted neurobiological model for PTSD considers it as a stress-induced fear circuitry disorder. The ability to achieve and preserve extinction of the acquired fear response is severed due to functional impairment in the medial prefrontal cortex (mPFC) control over the amygdala. This model has been corroborated by numerous animal and human studies although challenged by some.

Medial PFC hypo-activation is inversely correlated with hyper-activation in the amygdala of PTSD patients versus trauma exposed controls. mPFC activation was also found to be negatively correlated with PTSD symptom severity while successful treatment has been associated with increased mPFC activation. One possible way to amend this mPFC hypo-activation is Transcranial Magnetic Stimulation (TMS).

TMS enables non-invasive modulation of brain activity. While in depression TMS and deep TMS have been widely utilized in clinical studies as in regular clinics after receiving Israeli Ministry of Health, CE and FDA approval, few studies of TMS in PTSD patients were published thus far. Following a study done at the Hadassah Medical Center, the Israeli Ministry of Health and the European CE recently approved deep TMS for treatment of PTSD patients. This innovative treatment for PTSD is now available at the Hadassah Ein-Kerem campus.

The treatment is not covered by "sal habriut" and involves costs.

Written by Dr. Moshe Isserles