使用经颅磁刺激-脑电图技术识别治疗抵抗性抑郁症的间歇性 theta 爆发刺激的神经生理学标志物。

Identifying Neurophysiological Markers of Intermittent Theta Burst Stimulation in Treatment-Resistant Depression Using Transcranial Magnetic Stimulation-Electroencephalography.

机构信息

Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

出版信息

Biol Psychiatry. 2023 Sep 15;94(6):454-465. doi: 10.1016/j.biopsych.2023.04.011. Epub 2023 Apr 20.

DOI:10.1016/j.biopsych.2023.04.011

PMID:37084864

Abstract

BACKGROUND

Intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex is effective for treatment-resistant depression, but the effects of iTBS on neurophysiological markers remain unclear. Here, we indexed transcranial magnetic stimulation-electroencephalography (TMS-EEG) markers, specifically, the N45 and N100 amplitudes, at baseline and post-iTBS, comparing separated and contiguous iTBS schedules. TMS-EEG markers were also compared between iTBS responders and nonresponders.

METHODS

TMS-EEG was analyzed from a triple-blind 1:1 randomized trial for treatment-resistant depression, comparing a separated (54-minute interval) and contiguous (0-minute interval) schedule of 2 × 600-pulse iTBS for 30 treatments. Participants underwent TMS-EEG over the left dorsolateral prefrontal cortex at baseline and posttreatment. One hundred fourteen participants had usable TMS-EEG at baseline, and 98 at posttreatment. TMS-evoked potential components (N45, N100) were examined via global mean field analysis.

RESULTS

The N100 amplitude decreased from baseline to posttreatment, regardless of the treatment group (F = 5.20, p = .02). There were no changes in N45 amplitude in either treatment group. In responders, the N100 amplitude decreased after iTBS (F = 11.30, p = .001, p = .0004). Responders showed higher posttreatment N45 amplitude than nonresponders (F = 4.11, p = .045, p = .016). Higher baseline N100 amplitude predicted lower post-iTBS depression scores (F = 6.28, p = .00014).

CONCLUSIONS

These results provide further evidence for an association between the neurophysiological effects of iTBS and treatment efficacy in treatment-resistant depression. Future studies are needed to test the predictive potential for clinical applications of TMS-EEG markers.

摘要

背景

针对左侧背外侧前额叶皮层的间歇性 theta 爆发刺激（iTBS）对治疗抵抗性抑郁症有效，但 iTBS 对神经生理标志物的影响仍不清楚。在这里，我们在基线和 iTBS 后标记了经颅磁刺激-脑电图（TMS-EEG）标志物，特别是 N45 和 N100 幅度，比较了分离和连续 iTBS 方案。还比较了 iTBS 反应者和非反应者之间的 TMS-EEG 标志物。

方法

对一项治疗抵抗性抑郁症的双盲 1:1 随机试验进行了 TMS-EEG 分析，比较了两种 2×600 脉冲 iTBS 的分离（54 分钟间隔）和连续（0 分钟间隔）方案，共 30 次治疗。参与者在基线和治疗后接受左侧背外侧前额叶皮层的 TMS-EEG。114 名参与者在基线时有可用的 TMS-EEG，98 名在治疗后有可用的 TMS-EEG。通过全局平均场分析检查 TMS 诱发的电位成分（N45、N100）。

结果

无论治疗组如何，N100 幅度都从基线下降到治疗后（F=5.20，p=0.02）。两组的 N45 幅度都没有变化。在反应者中，iTBS 后 N100 幅度下降（F=11.30，p=0.001，p=0.0004）。反应者的治疗后 N45 幅度高于非反应者（F=4.11，p=0.045，p=0.016）。较高的基线 N100 幅度预测了 iTBS 后较低的抑郁评分（F=6.28，p=0.00014）。