Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2024 Aug;9(8):744-753. doi: 10.1016/j.bpsc.2024.04.018. Epub 2024 May 8.
Transcranial magnetic stimulation (TMS) is used to treat several neuropsychiatric disorders including depression, where it is effective in approximately one half of patients for whom pharmacological approaches have failed. Treatment response is related to stimulation parameters such as the stimulation frequency, pattern, intensity, location, total number of pulses and sessions applied, and target brain network engagement. One critical but underexplored component of the stimulation procedure is the orientation or yaw angle of the commonly used figure-of-eight TMS coil, which is known to impact neuronal response to TMS. However, coil orientation has remained largely unchanged since TMS was first used to treat depression and continues to be based on motor cortex anatomy, which may not be optimal for the dorsolateral prefrontal cortex treatment site. In this targeted narrative review, we evaluate experimental, clinical, and computational evidence indicating that optimizing coil orientation may improve TMS treatment outcomes. The properties of the electric field induced by TMS, the changes to this field caused by the differing conductivities of head tissues, and the interaction between coil orientation and the underlying cortical anatomy are summarized. We describe evidence that the magnitude and site of cortical activation, surrogate markers of TMS dosing and brain network targeting considered central in clinical response to TMS, are influenced by coil orientation. We suggest that coil orientation should be considered when applying therapeutic TMS and propose several approaches to optimizing this potentially important treatment parameter.
经颅磁刺激（TMS）用于治疗多种神经精神疾病，包括抑郁症，对于药物治疗失败的约一半患者，TMS 治疗有效。治疗反应与刺激参数有关，如刺激频率、模式、强度、位置、施加的总脉冲数和疗程，以及目标大脑网络的参与。刺激过程中一个关键但研究不足的部分是常用的 8 字形 TMS 线圈的方向或偏航角，众所周知，这会影响神经元对 TMS 的反应。然而，自 TMS 首次用于治疗抑郁症以来，线圈方向基本保持不变，并且仍然基于运动皮层解剖结构，这对于背外侧前额叶皮层的治疗部位可能不是最佳的。在本次有针对性的叙述性综述中，我们评估了实验、临床和计算证据，这些证据表明优化线圈方向可能会改善 TMS 治疗效果。总结了 TMS 诱导的电场特性、头部组织不同电导率引起的该电场变化以及线圈方向与下伏皮层解剖结构之间的相互作用。我们描述了证据表明，皮层激活的幅度和部位、TMS 剂量和大脑网络靶向的替代标志物，这些在 TMS 治疗反应中被认为是至关重要的，受到线圈方向的影响。我们建议在应用治疗性 TMS 时应考虑线圈方向，并提出了几种优化这一潜在重要治疗参数的方法。
