INRIA, Unit/Projet team VisAGeS, France.
Psychiatry Res. 2011 Apr 30;186(2-3):232-8. doi: 10.1016/j.psychres.2010.06.012. Epub 2010 Aug 7.
Transcranial magnetic stimulation (TMS) is a non-invasive technique used in the treatment of major depression. Meta-analyses have shown that it is more efficient than a placebo and that its efficacy is enhanced by the optimum tuning of stimulation parameters. However, the stimulation target, the dorsolateral prefrontal cortex (DLPFC), is still located using an inaccurate method. In this study, a neuronavigation system was used to perform a comprehensive quantification of target localization errors. We identified and quantified 3 sources of error in the standard method: cap repositioning, interexpert variability in coil positioning and distance between the stimulated point and the expected target. For cap repositioning, the standard deviation was lower than 5mm in the 3 axes. For interexpert variability in coil positioning, the spatial dispersion of the points was higher than 10mm in 2 of the 3 axes. For interindividual anatomical variability, the distance between the actual "reference" DLPFC and its standard determination was greater than 20mm for 54% of the subjects, while one subject out of eleven was correctly targeted which means 10mm or less from the reference. Results showed that interindividual anatomical variability and interexpert variability were the two main sources of error using the standard method. Results demonstrate that a neuronavigation system is mandatory to conduct reproducible and reliable studies.
经颅磁刺激（TMS）是一种用于治疗重度抑郁症的非侵入性技术。荟萃分析表明，它比安慰剂更有效，并且通过最佳调整刺激参数可以增强其疗效。但是，刺激靶点，即背外侧前额叶皮层（DLPFC），仍然使用不准确的方法进行定位。在这项研究中，使用神经导航系统对目标定位误差进行了全面的量化。我们确定并量化了标准方法中的 3 种误差源：帽重新定位，线圈定位和刺激点与预期目标之间的距离的专家间变异性。对于帽重新定位，在 3 个轴上的标准偏差均低于 5mm。对于线圈定位的专家间变异性，在 3 个轴中的 2 个轴上，点的空间散布高于 10mm。对于个体解剖学变异性，在 54％的受试者中，实际的“参考”DLPFC与其标准确定之间的距离大于 20mm，而在 11 个受试者中，有 1 个受试者的目标定位正确，这意味着距离参考点在 10mm 以内。结果表明，个体解剖学变异性和专家间变异性是使用标准方法的两个主要误差源。结果表明，神经导航系统是进行可重复且可靠的研究的必要条件。
