Neural Noise

VA Precision Neuromodulation Clinic

3 min read

  • The VA hosts a Precision Neuromodulation Clinic, reflecting real-world rollout of neuromodulation (VA.gov, September 2025).
  • The clinic is relevant to adoption and veteran BCI/neuroprosthetics (tier-2). 1

Gardner updates

  • The VA Precision Neuromodulation Clinic reflects real-world rollout of neuromodulation relevant to adoption and veteran BCI/neuroprosthetics. 1

Weekly enrichment (2026-07-20)

  • The VA Palo Alto Precision Neuromodulation Clinic (PNC) treats treatment-resistant depression with repetitive TMS targeting the dorsolateral prefrontal cortex (DLPFC); it is staffed by nurses, psychologists, psychiatrists, and brain scientists, and access requires a consult referral from a mental health or primary care provider.2
  • VA Palo Alto also serves as the coordinating site for the national VA Clinical TMS Program through its Mental Illness Research, Education and Clinical Center (MIRECC), making the PNC a hub for VA-wide neuromodulation practice and training.3
  • The nationwide VA program (Madore et al., 2021) delivered high-frequency TMS — typically 10 Hz to the left DLPFC at 120% of resting motor threshold for up to 30 sessions plus a 6-session taper — with outcomes tracked via the PHQ-9 and the PTSD checklist.4
  • Of 770 veterans who received at least one session, TMS produced clinically meaningful (Cohen’s d>1.0) and statistically significant (p<.001) reductions in depression and PTSD; among 340 veterans with an adequate number of treatments, the MDD response rate was 41.4% and remission 20%.4
  • In veterans with comorbid PTSD, TMS yielded a 65.3% clinically meaningful symptom reduction, and 46.1% no longer met PTSD threshold criteria afterward; note that VA lists TMS as indicated for MDD and OCD, with PTSD treated off-label when comorbid with depression.4
  • Accelerated protocols are being deployed: an off-label VA accelerated course used intermittent theta-burst stimulation (iTBS) of 1,800 pulses five times daily (50-minute intersession interval) for five business days — 45,000 total pulses — with individualized Beam/F3 scalp targeting of the left DLPFC.3
  • A multisite, propensity-matched VA effectiveness analysis of TMS for PTSD drew on data from over 30 VA sites, using predominantly Magstim devices (with some MagVenture, Neuronetics, and Brainsway dTMS systems) and centralized training at VA Palo Alto.5
  • To reach rural veterans, Montana VA launched the VHA’s first TMS Mobile Medical Unit; among 27 veterans treated in the unit, 55.6% met response and 37% remission criteria for depression, while PTSD response reached 95.2% and remission 71.4%.6
  • Other VA sites run parallel neuromodulation clinics: the Philadelphia VA offers both rTMS and esketamine, reporting treatment of roughly 4 veterans per day with rTMS and 3 concurrently with esketamine, with stated plans to expand capacity.7

Footnotes

  1. https://news.google.com/rss/articles/CBMiiwFBVV95cUxNU1ZvQmVhV290MDlyeV92M09ma2EwWm5Kd0FNYWNhSld5UzE4NzhvVENDTVIzN011UzlJdXpieG8tYW51U29HMTdSNjNZQnpFaXllM0pfUUFGU2R5dUhESmFYUVlXcEJzaURGSVFPRk94dU5mLXZUcVgxdW5iejc0bnpucTY5d2xTZmtR?oc=5 ↩ ↩2

  2. https://www.va.gov/palo-alto-health-care/programs/precision-neuromodulation-clinic/ ↩

  3. https://doi.org/10.1016/j.brs.2025.05.007 ↩ ↩2

  4. https://www.va.gov/COMMUNITYCARE/docs/providers/CDI/IVC-CDI-00026.pdf ↩ ↩2 ↩3

  5. https://doi.org/10.1016/j.brs.2025.11.007 ↩

  6. https://doi.org/10.1016/j.transm.2026.100313 ↩

  7. https://www.va.gov/philadelphia-health-care/stories/new-hope-for-treatment-resistant-depression-at-vas-neuromodulation-clinic/ ↩

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