The goal of this clinical trial is to test whether a type of rapid outpatient brainstimulation that uses magnetic fields, called accelerated intermittent theta burststimulation (iTBS), can treat symptoms such as brain fog, depression, and anxiety inpatients with Long COVID. The main questions it aims to answer are: - Is iTBS effective and feasible for reducing Long COVID symptoms? We will measure these symptoms using the Symptom Burden Questionnaire. - Are there changes in inflammatory brain chemicals associated with treatment with iTBS? We will be looking at levels of choline in the brain, which is thought to be related to inflammation.Researchers will compare sham versus active forms of iTBS to see if the active group hasgreater improvement in symptoms.Participants will complete symptom surveys, cognitive tests, and magnetic resonanceimaging scans at the beginning, middle, and end of treatment.
Chronic neuropsychiatric symptoms of post-acute sequelae of COVID-19 (neuro-PASC) can
lead to disability, loss of function, and reduced quality of life, but there are
currently no validated effective treatments. We propose a randomized sham-controlled
trial of "Magnetic Resonance Analysis of Neural Inflammatory Factors and External
Stimulation (MANIFEST)." We will deliver active or sham accelerated iTBS (5x/day, 10
days, 25 blinded sessions followed by 25 open-label sessions) to each participant's brain
target. We will assess neuro-PASC symptoms, mood, anxiety, cognition, and quality of life
from baseline to end-of-treatment. We will correlate symptom improvement with clinical
and imaging variables.
Device: accelerated intermittent theta burst stimulation
Intermittent theta burst stimulation (iTBS), a FDA-approved form of noninvasive
neuromodulation, can reduce neuropsychiatric symptoms and modulate inflammation in the
thalamus as detected using dMRS, suggesting a potentially effective and efficient
treatment approach with a pathophysiological component that is readily quantifiable.
Inclusion Criteria:
1. aged 18-80
2. a documented diagnosis of PASC with evidence of ongoing symptoms as demonstrated by
score of 12 on the NIH RECOVER Symptom List
3. have "brain fog" or cognitive difficulties as one of the ongoing symptoms
4. are fluent in English
5. if taking psychotropic medications, have been on stable doses for the past month.
Exclusion Criteria:
1. a prior history of other neurological disease, or any history of seizures, so as to
reduce risk of exacerbation of epilepsy or other neurological symptoms;
2. history of a psychotic disorder, such as schizophrenia or bipolar disorder, so as to
reduce risk of psychiatric decompensation
3. history of ongoing substance/alcohol dependence, to reduce confounding effects on
diagnosis and brain imaging
4. presence of any implanted electrical device (e.g., pacemaker), to reduce risk of
device malfunction from rTMS
5. recent medical hospitalization (within four weeks), to reduce risk of medical
decompensation during the study
6. any condition that would prevent the subject from completing the protocol
7. appointment of a legal representative, to avoid coercion of a vulnerable population
8. any ongoing litigation related to medical diagnosis, or disability, to prevent
interference with legal proceedings
9. any contraindication to MRI
10. membership in an identified vulnerable population, including minors, pregnant women,
and prisoners, so as to prevent coercion.
University of New Mexico Health Science Center
Albuquerque, New Mexico, United States
Investigator: Crystal Garcia
Contact: 505-272-9552
crabaca@salud.unm.edu
Investigator: Davin Quinn, MD
Crystal Garcia
505-272-9552
crabaca@salud.unm.edu
Davin Quinn, MD, Principal Investigator
University of New Mexico