Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
Mol Psychiatry. 2024 Sep;29(9):2678-2688. doi: 10.1038/s41380-024-02535-3. Epub 2024 Mar 26.
Transcranial magnetic stimulation (TMS) applied to a left dorsolateral prefrontal cortex (DLPFC) area with a specific connectivity profile to the subgenual anterior cingulate cortex (sgACC) has emerged as a highly effective non-invasive treatment option for depression. However, antidepressant outcomes demonstrate significant variability among therapy plans and individuals. One overlooked contributing factor is the individual brain state at the time of treatment. In this study we used interleaved TMS-fMRI to investigate the influence of brain state on acute TMS effects, both locally and remotely. TMS was performed during rest and during different phases of cognitive task processing. Twenty healthy participants were included in this study. In the first session, imaging data for TMS targeting were acquired, allowing for identification of individualized targets in the left DLPFC based on highest anti-correlation with the sgACC. The second session involved chronometric interleaved TMS-fMRI measurements, with 10 Hz triplets of TMS administered during rest and at distinct timings during an N-back task. Consistent with prior findings, interleaved TMS-fMRI revealed significant BOLD activation changes in the targeted network. The precise timing of TMS relative to the cognitive states during the task demonstrated distinct BOLD response in clinically relevant brain regions, including the sgACC. Employing a standardized timing approach for TMS using a task revealed more consistent modulation of the sgACC at the group level compared to stimulation during rest. In conclusion, our findings strongly suggest that acute local and remote effects of TMS are influenced by brain state during stimulation. This study establishes a basis for considering brain state as a significant factor in designing treatment protocols, possibly improving TMS treatment outcomes.
经颅磁刺激（TMS）应用于与前扣带回皮质下亚区（sgACC）具有特定连接模式的左背外侧前额叶皮层（DLPFC）区域，已成为治疗抑郁症的一种非常有效的非侵入性治疗选择。然而，抗抑郁治疗效果在治疗方案和个体之间存在显著差异。一个被忽视的影响因素是治疗时的个体大脑状态。在这项研究中，我们使用交错 TMS-fMRI 来研究大脑状态对急性 TMS 效应的影响，包括局部和远程的影响。TMS 在休息时和认知任务处理的不同阶段进行。本研究纳入了 20 名健康参与者。在第一阶段，采集了用于 TMS 靶向的成像数据，允许根据与 sgACC 的最高反相关性，在左 DLPFC 中识别个体化的目标。第二阶段涉及计时交错 TMS-fMRI 测量，在休息时和 N-back 任务的不同时间点给予 10Hz 三联 TMS。与先前的研究结果一致，交错 TMS-fMRI 显示靶向网络中的 BOLD 激活变化显著。TMS 相对于任务期间认知状态的精确时间显示出在包括 sgACC 在内的临床相关脑区有明显的 BOLD 反应。使用任务来为 TMS 采用标准化的定时方法，与在休息时刺激相比，在组水平上更一致地调节 sgACC。总之，我们的研究结果强烈表明，TMS 的急性局部和远程效应受刺激期间大脑状态的影响。这项研究为将大脑状态视为设计治疗方案的重要因素奠定了基础，可能会改善 TMS 治疗效果。
