Caeyenberghs Karen, Duprat Romain, Leemans Alexander, Hosseini Hadi, Wilson Peter H, Klooster Debby, Baeken Chris
School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Netw Neurosci. 2018 Nov 1;3(1):157-172. doi: 10.1162/netn_a_00060. eCollection 2019.
Accelerated intermittent theta burst stimulation (aiTBS) is a noninvasive neurostimulation technique that shows promise for improving clinical outcome in patients suffering from treatment-resistant depression (TRD). Although it has been suggested that aiTBS may evoke beneficial neuroplasticity effects in neuronal circuits, the effects of aiTBS on brain networks have not been investigated until now. Fifty TRD patients were enrolled in a randomized double-blind sham-controlled crossover trial involving aiTBS, applied to the left dorsolateral prefrontal cortex. Diffusion-weighted MRI data were acquired at each of three time points (T at baseline; T after the first week of real/sham aiTBS stimulation; and T after the second week of treatment). Graph analysis was performed on the structural connectivity to examine treatment-related changes in the organization of brain networks. Changes in depression severity were assessed using the Hamilton Depression Rating Scale (HDRS). Baseline data were compared with 60 healthy controls. We observed a significant reduction in depression symptoms over time ( < 0.001). At T, both TRD patients and controls exhibited a small-world topology in their white matter networks. More importantly, the TRD patients demonstrated a significantly shorter normalized path length ( = 0.01), and decreased assortativity ( = 0.035) of the structural networks, compared with the healthy control group. Within the TRD group, graph analysis revealed a less modular network configuration between T and T in the TRD group who received real aiTBS stimulation in the first week ( < 0.013). Finally, there were no significant correlations between changes on HDRS scores and reduced modularity. Application of aiTBS in TRD is characterized by reduced modularity, already evident 4 days after treatment. These findings support the potential clinical application of such noninvasive brain stimulation in TRD.
加速间歇性θ波爆发刺激（aiTBS）是一种非侵入性神经刺激技术，在改善难治性抑郁症（TRD）患者的临床结局方面显示出前景。尽管有人提出aiTBS可能在神经元回路中引发有益的神经可塑性效应，但迄今为止，aiTBS对脑网络的影响尚未得到研究。五十名TRD患者参加了一项随机双盲假对照交叉试验，该试验涉及将aiTBS应用于左侧背外侧前额叶皮层。在三个时间点（基线时的T；真实/假aiTBS刺激第一周后的T；治疗第二周后的T）分别采集扩散加权MRI数据。对结构连通性进行图分析，以检查脑网络组织中与治疗相关的变化。使用汉密尔顿抑郁量表（HDRS）评估抑郁严重程度的变化。将基线数据与60名健康对照者进行比较。我们观察到随着时间的推移，抑郁症状显著减轻（<0.001）。在T时，TRD患者和对照者在其白质网络中均表现出小世界拓扑结构。更重要的是，与健康对照组相比，TRD患者的结构网络标准化路径长度显著缩短（=0.01），且聚类系数降低（=0.035）。在TRD组中，图分析显示，在第一周接受真实aiTBS刺激的TRD组中，T和T之间的网络模块化配置较少（<0.013）。最后，HDRS评分的变化与模块化降低之间没有显著相关性。aiTBS在TRD中的应用特点是模块化降低，在治疗4天后就已明显。这些发现支持了这种非侵入性脑刺激在TRD中的潜在临床应用。
