College of Medicine

A Florida State University team investigating how to use brain stimulation technology to treat psychiatric conditions has been awarded a $1.44 million grant from the U.S. Department of Defense to further its research, particularly as it relates to the treatment of post-traumatic stress disorder.

Transcranial magnetic stimulation (TMS) is a medical procedure that uses magnetic fields to stimulate nerve cells in the brain. An electromagnetic coil is placed against the scalp and creates magnetic pulses that reach the brain surface. Its use has been approved by the U.S. Food and Drug Administration for treatment-resistant depression, obsessive compulsive disorder, anxious depression, migraines and to assist with smoking cessation. But Dr. Andrew Kozel from the FSU College of Medicine has been looking at how it can be further applied to treat other conditions.

“Depression and Post-Traumatic Stress Disorder (PTSD) share some overlapping symptoms and patients often suffer from both conditions,” said Kozel, director of the FSU Neuromodulation Lab, which is part of the College of Medicine, as well as the Mina Jo Powell Endowed Chair in Neurological Sciences at the college.  “TMS is a promising potential therapy for PTSD, and the technology developed in this project will help advance research and clinical practice for PTSD, depression and other brain-based disorders.”

Kozel’s study focuses on the personalization of TMS treatment in an effort to significantly improve clinical outcomes.

Retired Air Force Col. William “Billy” Francis, an FSU alumnus and director of the university’s Student Veterans Center, played a key role in securing the grant. Kozel said his willingness to collaborate aided the lab’s ability to compete for the highly competitive DoD grant.

Francis, who spent 26 years as a jet fighter pilot, said he is thankful for the support veterans are given at FSU and the university-wide commitment to their success. "I believe we have a responsibility to our veterans, to walk with them on their journey from the military into their post-service lives," Francis said. "Dr. Andy Kozel and FSU community are exploring therapies to give those with challenges, related to trauma, tools to use as options along the way toward their goals and dreams.

"Weaving our veterans back into the fabric of our society is our responsibility. I am thankful for this work and for the commitment FSU has made in actions like this."

Recent Articles on TMS from the FSU Neuromodulation Lab:

• Ramifications for Postpartum Depression
• Accelerated Treatment for Dysphoria in Neuropsychiatric Disorders

The research project seeks to personalize the proper dosage, or strength of the magnetic pulses, for each patient. Differences in anatomy and function, such as skull thickness and brain activity levels, mean that one dose does not fit all. If the dose is too weak, no therapeutic effect will be generated in the brain. If the dose is too strong, the patient will have an increased risk for a seizure.

This study builds on research by Kozel and colleague Kevin A. Johnson, Ph.D. and R.N., who is co-director of the FSU Neuromodulation Lab and a research faculty member in the College of Medicine’s Department of Behavioral Sciences and Social Medicine. Volunteers suffering from PTSD, as well as those with mild to moderate traumatic brain injuries (TBI), will be enrolled in this study.

“Over 20 years ago, we looked at adjusting the dose parameters related to age based on MRI scans, which was important to the successful development of this technology early on,” Kozel said. “Based on our prior success, we think that if we enhance the personalization for each individual, we will improve clinical outcomes, and that is the point.”

In collaboration with the lab, the FSU Neuromodulation™ clinical practice administered by the Florida Medical Practice Plan (FMPP) is also on-site to serve patients who can benefit from these treatments. There is some overlap in personnel between the lab and the clinic.

In addition to Kozel and Johnson, other members of the FSU Neuromodulation Lab team are Program Manager Isabelle Taylor and Research Assistant Megan Senda. Staff of the FSU Neuromodulation™ clinical practice – in addition to Kozel, who serves as its medical director, and Johnson, who serves as faculty clinician – are Officer Manager Catherine Moore and Medical Assistant Mariah Jensen.

Currently, TMS dosing of the intensity of treatment is indirect. The TMS coil is placed over the motor cortex, the part of the brain that moves the fingers, and you figure out how much energy it takes to move the fingers 50% of the time. The TMS coil is subsequently moved to a different location on the brain for the treatment. Typically, for depression and other neuropsychiatric disorders, the area stimulated is the front of the brain called the prefrontal cortex.

“Because there are no observable signals as to what is actually happening when stimulating the prefrontal cortex, you are forced to rely on the dose intensity determined for the motor cortex,” Kozel said.

The technology the team is developing and submitted for a patent will allow researchers to measure what is happening in the prefrontal cortex directly, using TMS with functional near infrared spectroscopy (fNIRS). Because the fNIRS technology uses the light spectrum to measure brain function, it does not interact with the powerful electromagnetic energy created by the TMS pulses. This lack of interaction is important for safety and for accurate measurement of the dose for each patient.

Kozel credits Brent Edington, a senior licensing manager in FSU’s Office of Commercialization, for working with his lab to navigate the patent process.

“Cutting edge clinical research requires many moving parts to function efficiently and effectively together in order to be successful,” Kozel said. “We are demonstrating that Florida State University has the potential to compete for highly competitive grants and produce research findings that can have a profound impact on the clinical care of patients suffering from devastating neuropsychiatric disorders.”

Individuals interested in participating in research at the FSU Neuromodulation Lab can visit the lab website to complete a contact survey.

Photo captions

Spotlight photo on Home page:

FSU Neuromodulation Lab team members working on research funded by the U.S. Department of Defense, from left, Co-Director Kevin Johnson, Ph.D.; Research Assistant Megan Senda; and Professor F. Andrew Kozel, M.D. (Not pictured in this photo, Program Manager Isabelle Taylor.) To Dr. Kozel’s right are staff members of the FSU Neuromodulation™ clinical practice, Medical Assistant Mariah Jensen, CCMA, and Office Manager Catherine Moore, who also manages the FSU SeniorHealth™ clinical practice. Jensen will assist with the DoD research study.

Photo at top right on this page:

College of Medicine Professor and FSU Neuromodulation Director F. Andrew Kozel, M.D., demonstrates TMS technology with Co-Director Kevin Johnson, Ph.D., College of Medicine research faculty, playing the role of patient.