Abstract
Treatment-resistant posttraumatic stress disorder (PTSD) often persists despite evidence based treatments. Novel neuromodulation approaches may address this critical unmet need. To describe the feasibility, observed tolerability, and clinical course associated with a sequential multimodal neuromodulation protocol of a sequential multimodal neuromodulation protocol combining transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and transcranial pulse stimulation (TPS) in a patient with chronic, treatment-resistant PTSD. A single adult patient with treatment resistant PTSD underwent three sequential neuromodulation phases: (1) tDCS over dorsolateral prefrontal cortex and greater occipital nerve for 12 sessions; (2) high-frequency TMS for 25 sessions; (3) TPS for 9 sessions. Symptom severity was assessed using the PTSD Checklist for DSM-5 (PCL-5) and Hospital Anxiety and Depression Scale (HADS) at baseline, post-each phase, and 3-month follow-up. Symptom reductions exceeded clinical significance after combined treatment: PCL-5 decreased by 60%, anxiety by 23.81%, and depression by 61.9 %. Reductions were maintained at 3 months. No serious adverse events occurred; tolerability was excellent. The Patient Global Impression of Change score was 75%, and the Patient Acceptable Symptom State was reported at 85%, reflecting a high level of patient satisfaction and perceived benefit. Sequential multimodal neuromodulation was safe, well-tolerated, and associated with substantial, sustained symptom improvement in this treatment-resistant PTSD case. These findings warrant controlled trials to optimize protocol synergy and individualize treatment.