Abstract Details

Title Accelerated High-dose rTMS for Post-stroke Apathy: A Pilot Trial

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S42 - Perspectives on Non-Alzheimer's Dementia Diagnostics and Therapeutics (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective

To evaluate the safety, feasibility, tolerability, and preliminary efficacy of accelerated high-dose repetitive transcranial magnetic stimulation (rTMS) targeting the dorsomedial prefrontal cortex (dmPFC) to reduce apathy in adults with chronic stroke.

Background

Apathy, diminished motivation for goal-directed behavior, is a common and disabling neuropsychiatric consequence of stroke, contributing to poorer rehabilitation outcomes, reduced quality of life, and increased caregiver burden. While rTMS targeting the dorsolateral prefrontal cortex is effective for depression, apathy involves distinct neural circuits including the dorsal medial prefrontal and anterior cingulate cortices. This pilot study tested a novel accelerated, high-dose rTMS protocol targeting the dmPFC in post-stroke apathy (PSA).

Design/Methods Fourteen adults with chronic stroke and clinically significant apathy completed baseline structural and resting-state MRI for individualized targeting, along with validated assessments of apathy, cognition, and neuropsychiatric symptoms. Participants received open-label intermittent theta burst stimulation (iTBS)-rTMS to the left dmPFC: 600 pulses per session, 12 sessions per day over three treatment days within one week (36 sessions total; 21,600 pulses). Assessments were repeated immediately post-treatment and weekly for one month. All procedures were approved by the MUSC Institutional Review Board, and written informed consent was obtained (ClinicalTrials.gov NCT05878457).

Results All 14 participants completed treatment. The protocol was well tolerated, with no adverse neurocognitive, neuropsychiatric, or neuroradiological effects and >80% retention. Significant improvements from baseline to one month were observed in apathy measures: Apathy Evaluation Scale (AES; Cohen’s d = 0.70, p = 0.024), AES-informant (d = 0.63, p = 0.037), and Lille Apathy Rating Scale (d = 0.78, p = 0.012). Secondary outcomes showed gains in cognitive performance (NIH toolbox, d = 0.62, p = 0.050), improved stroke-specific quality of life (p = 0.037), and reduced caregiver burden (Zarit, p = 0.027).

Conclusions

Accelerated high-dose iTBS-rTMS targeting the dmPFC appears safe, feasible, and well tolerated in PSA, with promising preliminary efficacy.

Authors/Disclosures
Parneet K. Grewal, MD PRESENTER	The institution of Dr. Grewal has received research support from Bristol Myer Squibb Foundation. The institution of Dr. Grewal has received research support from IPSEN Global.
Michael B. Seidman, MD	Dr. Seidman has nothing to disclose.
Colin Bowyer, PhD	Dr. Bowyer has nothing to disclose.
Ivy Dickens, BS, BA	Miss Dickens has nothing to disclose.
Carol Joseph, Student	Ms. Joseph has nothing to disclose.
Kevin A. Caulfield, PhD	Dr. Caulfield has nothing to disclose.
Lisa McTeague (Medical University of South Carolina)	No disclosure on file

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