Prospective Validation That Subgenual Connectivity Predicts Antidepressant Efficacy of Transcranial Magnetic Stimulation Sites
International Clinical TMS Certification Course
The Academy of Brain Stimulation
Background:
The optimal target in the dorsolateral prefrontal cortex for treating depression with repetitive transcranial magnetic stimulation (rTMS) remains unknown.
Better efficacy has been associated with stimulation sites that are:
1) more anterior and lateral
2) more functionally connected to the subgenual cingulate
In this study it was prospectively tested whether these factors predict response in individual patients.
?
Methods:
A primary cohort (Boston, n = 25) with medication-refractory depression underwent conventional open-label rTMS to the left dorsolateral prefrontal cortex.
A secondary cohort (Michigan, n = 16) underwent 4 weeks of sham followed by open-label rTMS for nonresponders (n = 12).
In each patient, the location of the stimulation site was recorded with frameless stereotaxy.
Connectivity between each patient's stimulation site and the subgenual cingulate was assessed using resting-state functional connectivity magnetic resonance imaging from a cohort of healthy subjects (n = 1000) and confirmed using connectivity from patients with depression (n = 38).
?
Results:
In the primary cohort, antidepressant efficacy was predicted by stimulation sites that were both more anterolateral (r = .51, p < .01) and more negatively correlated with the subgenual cingulate (r = -.55, p < .005).
领英推荐
However, subgenual connectivity was the only independent predictor of response and the only factor to predict response to active (r = -.52, p < .05) but not sham rTMS in the secondary cohort.
?
Conclusions:
This study provides prospective validation that functional connectivity between an individual's rTMS cortical target and the subgenual cingulate predicts antidepressant response.
Implications for improving the cortical rTMS target for depression are discussed.
?
Read the full publication here.
?
Weigand A., Horn A., Caballero R., et al. Prospective Validation That Subgenual Connectivity Predicts Antidepressant Efficacy of Transcranial Magnetic Stimulation Sites. Biol Psychiatry. 2018;84(1):28-37. doi:10.1016/j.biopsych.2017.10.028
?
--
Follow the International Clinical TMS Certification Course on LinkedIn to benefit from free and full open access to relevant scientific publications from the international brain stimulation literature and to stay informed about new developments on clinical efficacy, safety, and application expansion of TMS and TES.
?
Psychiatrist and Rewire TMS Clinics founder
11 个月How does FMRI guided navigation practically work? Get a FcMRI. Some software (like magus med) and then?
I can only make you think why you should never give up.
1 年If the brain dysfunction is in left DLPFC the stimulation diminishes or removes it ?? Remember Daniel G. Amen, M.D., M.D. is able to see if a certain therapy works or not using SPECT scans . Diminished or no brain "holes" (dysfunctions) after therapy, then the therapy works, so easy ?? https://link.medium.com/EetbiIJN26???
Lecturer at The University of Sheffield
1 年It definitely worth trouble. Excellent time and spatial resolution.
MD, PhD, FRCPsych, CCT (UK) Consultant Psychiatrist & Clinical Assistant Professor
1 年Very useful