重复经颅磁刺激对重性抑郁障碍静息态功能连接个体变异性的影响。
Effects of repetitive transcranial magnetic stimulation on individual variability of resting-state functional connectivity in major depressive disorder.
机构信息
From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger).
From the Campbell Family Research Centre, Centre for Addiction and Mental Health, Toronto, Ont. (Tan, Blumberger, Hawco); the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Downar, Nestor); the Harquail Centre for Neuromodulation, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Nestor, Blumberger, Hawco); the Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC (Vila-Rodriguez); the Department of Psychiatry, University of California, San Diego (Daskalakis); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ont. (Blumberger)
出版信息
J Psychiatry Neurosci. 2024 May 10;49(3):E172-E181. doi: 10.1503/jpn.230135. Print 2024 May-Jun.
BACKGROUND
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD), but substantial heterogeneity in outcomes remains. We examined a potential mechanism of action of rTMS to normalize individual variability in resting-state functional connectivity (rs-fc) before and after a course of treatment.
METHODS
Variability in rs-fc was examined in healthy controls (baseline) and individuals with MDD (baseline and after 4-6 weeks of rTMS). Seed-based connectivity was calculated to 4 regions associated with MDD: left dorsolateral prefrontal cortex (DLPFC), right subgenual anterior cingulate cortex (sgACC), bilateral insula, and bilateral precuneus. Individual variability was quantified for each region by calculating the mean correlational distance of connectivity maps relative to the healthy controls; a higher variability score indicated a more atypical/idiosyncratic connectivity pattern.
RESULTS
We included data from 66 healthy controls and 252 individuals with MDD in our analyses. Patients with MDD did not show significant differences in baseline variability of rs-fc compared with controls. Treatment with rTMS increased rs-fc variability from the right sgACC and precuneus, but the increased variability was not associated with clinical outcomes. Interestingly, higher baseline variability of the right sgACC was significantly associated with less clinical improvement ( = 0.037, uncorrected; did not survive false discovery rate correction). The linear model was constructed separately for each region of interest.
CONCLUSION
This was, to our knowledge, the first study to examine individual variability of rs-fc related to rTMS in individuals with MDD. In contrast to our hypotheses, we found that rTMS increased the individual variability of rs-fc. Our results suggest that individual variability of the right sgACC and bilateral precuneus connectivity may be a potential mechanism of rTMS.
背景
重复经颅磁刺激(rTMS)是治疗重度抑郁症(MDD)的有效方法，但治疗效果存在显著的个体差异。我们研究了 rTMS 作用的一种潜在机制，即在治疗前后，通过静息态功能连接(rs-fc)来正常化个体的变异性。
方法
在健康对照者(基线)和 MDD 个体(基线和 rTMS 治疗 4-6 周后)中，我们检查了 rs-fc 的变异性。采用种子点连接方法计算与 MDD 相关的 4 个区域的连接：左侧背外侧前额叶皮质(DLPFC)、右侧前扣带回(subgenual anterior cingulate cortex，sgACC)、双侧岛叶和双侧楔前叶。通过计算相对于健康对照组的连接图的平均相关距离，为每个区域量化个体变异性；变异性得分越高，表明连接模式越不典型/独特。
结果
我们的分析纳入了 66 名健康对照者和 252 名 MDD 患者的数据。与对照组相比，MDD 患者的 rs-fc 变异性在基线时没有显著差异。rTMS 治疗后，右侧 sgACC 和楔前叶的 rs-fc 变异性增加，但增加的变异性与临床结果无关。有趣的是，右侧 sgACC 的基线变异性越高，临床改善越差( = 0.037，未校正；未通过假发现率校正)。线性模型是为每个感兴趣的区域分别构建的。
结论
据我们所知，这是第一项研究 rTMS 与 MDD 患者 rs-fc 个体变异性的研究。与我们的假设相反，我们发现 rTMS 增加了 rs-fc 的个体变异性。我们的研究结果表明，右侧 sgACC 和双侧楔前叶连接的个体变异性可能是 rTMS 的一个潜在机制。
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