Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland.
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland.
Brain Stimul. 2023 Mar-Apr;16(2):619-627. doi: 10.1016/j.brs.2023.03.005. Epub 2023 Mar 15.
BACKGROUND: Transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for major depressive disorder (MDD). Recent attempts to improve TMS efficacy by individually targeting DLPFC subregions that are functionally connected to the subgenual anterior cingulate cortex (sgACC) appear promising. However, sgACC covers only a small subset of core MDD-related areas. Further, fMRI connectivity of sgACC is poorly repeatable within subjects. METHODS: Based on an fMRI database analysis, we first constructed a novel core network model (CNM), capturing voxelwise emotion regulation- and MDD-related DLPFC connectivity. Then, in a sample of 15 healthy subjects and 29 MDD patients, we assessed (i) within-subject repeatability of the DLPFC connectivity patterns computed from time segments of varying lengths of individual-level fMRI data and (ii) association of MDD severity with the individual DLPFC connectivity strengths. We extracted group-level connectivity strengths in CNM from individual DLPFC coordinates stimulated with neuronavigated TMS in a separate sample of 25 MDD patients. These connectivity strengths were then correlated with individual TMS efficacy. RESULTS: Compared with sgACC connectivity, CNM increased intraindividual repeatability 5-fold. DLPFC connectivity strength from CNM was associated with MDD severity and TMS efficacy. While the locations of CNM-based individual TMS targets remained constant within individuals, they varied considerably between individuals. CONCLUSIONS: CNM increased repeatability of functional targeting to a clinically feasible level. The observed association of MDD severity and TMS efficacy with DLPFC connectivity supports the validity of the CNM. The interindividual differences in target locations motivate future individualized clinical trials leveraging the CNM.
背景:经颅磁刺激(TMS)对背外侧前额叶皮层(DLPFC)的刺激是治疗重度抑郁症(MDD)的一种已确立的方法。最近,人们试图通过单独针对与亚属前扣带回皮层(sgACC)功能连接的 DLPFC 亚区来提高 TMS 的疗效,这种尝试似乎很有前景。然而,sgACC 仅覆盖了一小部分与核心 MDD 相关的区域。此外,sgACC 的 fMRI 连接在个体内部的可重复性较差。
方法:基于 fMRI 数据库分析,我们首先构建了一个新的核心网络模型(CNM),捕获了基于体素的情绪调节和 MDD 相关的 DLPFC 连接。然后,在 15 名健康受试者和 29 名 MDD 患者的样本中,我们评估了(i)从个体 fMRI 数据的不同时间片段计算的 DLPFC 连接模式的个体内可重复性,以及(ii)与 MDD 严重程度与个体 DLPFC 连接强度的关联。我们从使用神经导航 TMS 刺激的个体 DLPFC 坐标中提取了 25 名 MDD 患者的个体样本的 CNM 的组水平连接强度。然后,这些连接强度与个体 TMS 疗效相关联。
结果:与 sgACC 连接相比,CNM 将个体内的可重复性提高了 5 倍。来自 CNM 的 DLPFC 连接强度与 MDD 严重程度和 TMS 疗效相关。虽然基于 CNM 的个体 TMS 目标的位置在个体内部保持不变,但它们在个体之间差异很大。
结论:CNM 提高了功能靶向的可重复性,达到了临床可行的水平。观察到的 MDD 严重程度和 TMS 疗效与 DLPFC 连接的相关性支持了 CNM 的有效性。目标位置的个体间差异激发了未来利用 CNM 的个体化临床试验。
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