间接额眶部结构连接可预测加速 rTMS 治疗重度抑郁症的临床反应。
Indirect frontocingulate structural connectivity predicts clinical response to accelerated rTMS in major depressive disorder.
机构信息
From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken).
出版信息
J Psychiatry Neurosci. 2020 Jul 1;45(4):243-252. doi: 10.1503/jpn.190088.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD), but its clinical efficacy remains rather modest. One reason for this could be that the propagation of rTMS effects via structural connections from the stimulated area to deeper brain structures (such as the cingulate cortices) is suboptimal.
METHODS
We investigated whether structural connectivity — derived from diffusion MRI data — could serve as a biomarker to predict treatment response. We hypothesized that stronger structural connections between the patient-specific stimulation position in the left dorsolateral prefrontal cortex (dlPFC) and the cingulate cortices would predict better clinical outcomes. We applied accelerated intermittent theta burst stimulation (aiTBS) to the left dlPFC in 40 patients with MDD. We correlated baseline structural connectivity, quantified using various metrics (fractional anisotropy, mean diffusivity, tract density, tract volume and number of tracts), with changes in depression severity scores after aiTBS.
RESULTS
Exploratory results (p < 0.05) showed that structural connectivity between the patient-specific stimulation site and the caudal and posterior parts of the cingulate cortex had predictive potential for clinical response to aiTBS.
LIMITATIONS
We used the diffusion tensor to perform tractography. A main limitation was that multiple fibre directions within voxels could not be resolved, which might have led to missing connections in some patients.
CONCLUSION
Stronger structural frontocingular connections may be of essence to optimally benefit from left dlPFC rTMS treatment in MDD. Even though the results are promising, further investigation with larger numbers of patients, more advanced tractography algorithms and classic daily rTMS treatment paradigms is warranted.
CLINICAL TRIAL REGISTRATION
背景
重复经颅磁刺激（rTMS）是一种治疗重度抑郁症（MDD）的成熟方法，但临床疗效仍相当有限。原因之一可能是 rTMS 效应通过从刺激区域到大脑深部结构（如扣带回皮质）的结构连接的传播不理想。
方法
我们研究了结构连接（源自弥散 MRI 数据）是否可以作为预测治疗反应的生物标志物。我们假设左背外侧前额叶皮质（dlPFC）中患者特定刺激位置与扣带回皮质之间的结构连接越强，临床结局越好。我们在 40 例 MDD 患者中应用了加速间歇性经颅磁刺激（aiTBS）。我们用各种指标（各向异性分数、平均扩散率、束密度、束体积和束数）来量化基线结构连接，并将其与 aiTBS 后抑郁严重程度评分的变化进行相关分析。
结果
探索性结果（p < 0.05）表明，患者特定刺激部位与扣带回皮质尾部和后部之间的结构连接对 aiTBS 治疗的临床反应有预测潜力。
局限性
我们使用扩散张量进行束追踪。一个主要的局限性是不能分辨体素内的多个纤维方向，这可能导致一些患者的连接丢失。
结论
更强的额扣带结构连接可能是从左 dlPFC rTMS 治疗中获得最佳疗效的关键。尽管结果很有希望，但仍需要更多的患者、更先进的束追踪算法和经典的日常 rTMS 治疗方案进行进一步研究。
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