TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
Cereb Cortex. 2019 Dec 17;29(12):4958-4967. doi: 10.1093/cercor/bhz035.
Repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD) is associated with changes in brain functional connectivity (FC). These changes may be related to the mechanism of action of rTMS and explain the variability in clinical outcome. We examined changes in electroencephalographic FC during the first rTMS treatment in 109 subjects treated with 10 Hz stimulation to left dorsolateral prefrontal cortex. All subjects subsequently received 30 treatments and clinical response was defined as ≥40% improvement in the inventory of depressive symptomatology-30 SR score at treatment 30. Connectivity change was assessed with coherence, envelope correlation, and a novel measure, alpha spectral correlation (αSC). Machine learning was used to develop predictive models of outcome for each connectivity measure, which were compared with prediction based upon early clinical improvement. Significant connectivity changes were associated with clinical outcome (P < 0.001). Machine learning models based on αSC yielded the most accurate prediction (area under the curve, AUC = 0.83), and performance improved when combined with early clinical improvement measures (AUC = 0.91). The initial rTMS treatment session produced robust changes in FC, which were significant predictors of clinical outcome of a full course of treatment for MDD.
重复经颅磁刺激（rTMS）治疗重性抑郁障碍（MDD）与大脑功能连接（FC）的变化有关。这些变化可能与 rTMS 的作用机制有关，并解释了临床结果的可变性。我们检查了 109 名受试者在接受左背外侧前额叶 10 Hz 刺激的第一次 rTMS 治疗期间脑电图 FC 的变化。所有受试者随后接受了 30 次治疗，临床反应定义为在治疗 30 时抑郁症状清单-30 SR 评分≥40%的改善。采用相干性、包络相关和一种新的测量方法（α 谱相关（αSC））评估连接性变化。使用机器学习为每个连接性测量值开发了预测模型，并将其与基于早期临床改善的预测进行了比较。显著的连接性变化与临床结果相关（P < 0.001）。基于 αSC 的机器学习模型产生了最准确的预测（曲线下面积，AUC = 0.83），当与早期临床改善措施相结合时，性能得到了提高（AUC = 0.91）。初始 rTMS 治疗产生了强大的 FC 变化，这是 MDD 全疗程临床结果的显著预测因子。
