TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90024, USA.
Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, CO, USA; NOAA National Centers for Environmental Information (NCEI), Boulder, CO, USA.
Brain Stimul. 2023 Nov-Dec;16(6):1566-1571. doi: 10.1016/j.brs.2023.10.006. Epub 2023 Oct 18.
Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD). Two common rTMS protocols, 10 Hz and intermittent theta burst stimulation (iTBS), have comparable rates of efficacy in groups of patients. Recent evidence suggests that some individuals may be more likely to benefit from one form of stimulation than the other. The pretreatment pupillary light reflex (PLR) is significantly associated with response to a full course of rTMS using heterogeneous stimulation protocols.
To test whether the relationship between pretreatment PLR and early symptom improvement differed between subjects treated with iTBS or 10 Hz stimulation.
PLR was measured in 52 subjects who received solely 10 Hz (n = 35) or iTBS (n = 17) to left dorsolateral prefrontal cortex (DLPFC) for the first ten sessions of their treatment course. Primary outcome measure was the percent change of Inventory of Depressive Symptomatology - Self Report (IDS-SR) from session 1 to session 10.
There was a positive association between normalized maximum constriction velocity (nMCV) and early improvement in subjects receiving 10 Hz stimulation (R = 0.48, p = 0.004) and a negative association in subjects receiving iTBS (R = -0.52, p = 0.03). ANOVA revealed a significant interaction between nMCV and the type of initial stimulation (p = 0.001). Among subjects with low nMCV, those initially treated with iTBS showed 2.6 times greater improvement after 10 sessions (p = 0.01) than subjects initially receiving 10 Hz stimulation.
nMCV may detect physiologic differences between those likely to benefit from 10 Hz or iTBS treatment. Future studies should examine whether PLR could guide prospective treatment selection.
重复经颅磁刺激（rTMS）是治疗重度抑郁症（MDD）的有效方法。两种常见的 rTMS 方案，10Hz 和间歇性 theta 爆发刺激（iTBS），在患者群体中的疗效相当。最近的证据表明，有些人可能更倾向于从一种刺激形式中受益，而不是另一种。预处理瞳孔光反射（PLR）与使用异质刺激方案的全疗程 rTMS 反应显著相关。
测试预处理 PLR 与 iTBS 或 10Hz 刺激治疗的早期症状改善之间的关系是否不同。
52 名受试者仅接受左侧背外侧前额叶皮层（DLPFC）的 10Hz（n=35）或 iTBS（n=17）刺激，共进行前十次治疗。主要观察指标是从第 1 次治疗到第 10 次治疗期间，抑郁症状自评量表 - 自我报告（IDS-SR）的百分比变化。
接受 10Hz 刺激的受试者中，正常化最大收缩速度（nMCV）与早期改善呈正相关（R=0.48，p=0.004），而接受 iTBS 刺激的受试者中，nMCV 与早期改善呈负相关（R=-0.52，p=0.03）。方差分析显示 nMCV 与初始刺激类型之间存在显著的交互作用（p=0.001）。在 nMCV 较低的受试者中，那些最初接受 iTBS 治疗的受试者在 10 次治疗后改善程度高出 2.6 倍（p=0.01），而那些最初接受 10Hz 刺激的受试者。
nMCV 可能检测出那些可能从 10Hz 或 iTBS 治疗中受益的人之间的生理差异。未来的研究应该检查 PLR 是否可以指导前瞻性的治疗选择。
