Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA; Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA.
Brain Stimul. 2022 Jan-Feb;15(1):63-72. doi: 10.1016/j.brs.2021.11.008. Epub 2021 Nov 10.
The efficacy of repetitive transcranial magnetic stimulation (rTMS) for depression may vary depending on the subregion stimulated within the dorsolateral prefrontal cortex (DLPFC). Clinical TMS typically uses scalp-based landmarks for DLPFC targeting, rather than individualized MRI guidance.
In rTMS patients, determine the brain systems targeted by multiple DLPFC stimulation rules by computing several surrogate measures: underlying brain targets labeled with connectivity-based atlases, subgenual cingulate anticorrelation strength, and functionally connected networks.
Forty-nine patients in a randomized controlled trial of rTMS therapy for treatment resistant major depression underwent structural and functional MRI. DLPFC rules were applied virtually using MR-image guidance. Underlying cortical regions were labeled, and connectivity with the subgenual cingulate and whole-brain computed.
Scalp-targeting rules applied post hoc to these MRIs that adjusted for head size, including Beam F3, were comparably precise, successful in directly targeting classical DLPFC and frontal networks, and anticorrelated with the subgenual cingulate. In contrast, all rules involving fixed distances introduced variability in regions and networks targeted. The 5 cm rule targeted a transitional DLPFC region with a different connectivity profile from the adjusted rules. Seed-based connectivity analyses identified multiple regions, such as posterior cingulate and inferior parietal lobe, that warrant further study in order to understand their potential contribution to clinical response.
EEG-based rules consistently targeted DLPFC brain regions with resting-state fMRI features known to be associated with depression response. These results provide a bridge from lab to clinic by enabling clinicians to relate scalp-targeting rules to functionally connected brain systems.
重复经颅磁刺激（rTMS）治疗抑郁症的疗效可能因刺激背外侧前额叶皮层（DLPFC）的亚区而异。临床 TMS 通常使用头皮上的地标来定位 DLPFC，而不是个体化的 MRI 指导。
在 rTMS 患者中，通过计算几个替代指标来确定多种 DLPFC 刺激规则所针对的脑系统：使用基于连通性图谱标记的下皮质目标、扣带回下前部的反相关强度以及功能连接网络。
49 名接受 rTMS 治疗难治性重度抑郁症的随机对照试验患者接受了结构和功能 MRI 检查。使用 MRI 图像引导虚拟应用 DLPFC 规则。对皮质下区域进行标记，并计算与扣带回下前部和全脑的连通性。
后处理应用于这些 MRI 的头皮靶向规则，这些规则根据头的大小进行了调整，包括 Beam F3，结果同样精确，成功地直接靶向经典的 DLPFC 和额网络，并与扣带回下前部呈反相关。相比之下，所有涉及固定距离的规则都会导致靶向区域和网络的变异性。5cm 规则靶向的是一个过渡性的 DLPFC 区域，与调整后的规则具有不同的连通性特征。基于种子的连通性分析确定了多个区域，如后扣带回和下顶叶，需要进一步研究以了解它们对临床反应的潜在贡献。
基于 EEG 的规则一致地靶向 DLPFC 脑区，这些脑区具有静息态 fMRI 特征，已知与抑郁反应相关。这些结果为实验室到临床提供了一个桥梁，使临床医生能够将头皮靶向规则与功能连接的脑系统联系起来。
