TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
Brain Stimul. 2021 Jul-Aug;14(4):1015-1021. doi: 10.1016/j.brs.2021.06.008. Epub 2021 Jun 23.
Intermittent theta-burst stimulation priming (iTBS-P) can improve clinical outcome of patients with Major Depressive Disorder (MDD) who do not show early benefit from 10 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC), also known as high-frequency left-sided (HFL) stimulation. The intensity and pulse number for iTBS-P needed to induce clinical benefit have not been systematically examined.
To study the effect of intensity and pulse number on the clinical efficacy of iTBS-P.
We conducted a retrospective review of 71 participants who received at least five sessions of HFL with limited clinical benefit and received iTBS-P augmentation for between 5 and 25 sessions. Intensity of iTBS-P priming stimuli ranged from 75 to 120% of motor threshold (MT) and pulse number ranged from 600 to 1800. Associations among intensity, pulse number, and clinical outcome were analyzed using a mixed methods linear model with change in IDS-SR as the primary outcome variable, priming stimulation intensity (subthreshold or suprathreshold), pulse number (<1200 or >1200 pulses), and gender as fixed factors, and number of iTBS-P treatments and age as continuous covariates.
Subjects who received subthreshold intensity iTBS-P experienced greater reduction in depressive symptoms than those who received suprathreshold iTBS-P (p = 0.011) with no effect of pulse number after controlling for stimulus intensity.
Subthreshold intensity iTBS-P was associated with greater clinical improvement than suprathreshold stimulation. This finding is consistent with iTBS-P acting through homeostatic plasticity mechanisms.
间歇性 theta 爆发刺激启动（iTBS-P）可以改善那些未从左背外侧前额叶皮层（DLPFC）10Hz 刺激（也称为高频左侧刺激，HFL）中早期获益的重度抑郁症（MDD）患者的临床结果。iTBS-P 诱导临床获益所需的强度和脉冲数尚未系统研究。
研究强度和脉冲数对 iTBS-P 临床疗效的影响。
我们对 71 名至少接受 5 次 HFL 治疗但疗效有限且接受 5 至 25 次 iTBS-P 增强治疗的参与者进行了回顾性分析。iTBS-P 启动刺激的强度范围为 75%至 120%的运动阈值（MT），脉冲数范围为 600 至 1800。使用混合方法线性模型，以 IDS-SR 变化为主要结果变量，分析强度、脉冲数与临床结果之间的关系，iTBS-P 启动刺激强度（亚阈值或超阈值）、脉冲数（<1200 或>1200 脉冲）和性别为固定因素，iTBS-P 治疗次数和年龄为连续协变量。
与接受超阈值 iTBS-P 的患者相比，接受亚阈值 iTBS-P 的患者的抑郁症状减轻更多（p=0.011），在控制刺激强度后，脉冲数没有影响。
亚阈值强度 iTBS-P 与更大的临床改善相关，优于超阈值刺激。这一发现与 iTBS-P 通过稳态可塑性机制起作用一致。
