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BRIGhTMIND试验中重复经颅磁刺激治疗难治性重度抑郁症的改善轨迹

Trajectories of improvement with repetitive transcranial magnetic stimulation for treatment-resistant major depression in the BRIGhTMIND trial.

作者信息

Briley P M, Webster L, Lankappa S, Pszczolkowski S, McAllister-Williams R H, Liddle P F, Auer D P, Morriss R

机构信息

Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.

Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, UK.

出版信息

Npj Ment Health Res. 2024 Jun 27;3(1):32. doi: 10.1038/s44184-024-00077-8.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is an established non-invasive brain stimulation treatment for major depressive disorder, but there is marked inter-individual variability in response. Using latent class growth analysis with session-by-session patient global impression ratings from the recently completed BRIGhTMIND trial, we identified five distinct classes of improvement trajectory during a 20-session treatment course. This included a substantial class of patients noticing delayed onset of improvement. Contrary to prior expectations, members of a class characterised by early and continued improvement showed greatest inter-session variability in stimulated location. By relating target locations and inter-session variability to a well-studied atlas, we estimated an average of 3.0 brain networks were stimulated across the treatment course in this group, compared to 1.1 in a group that reported symptom worsening (p < 0.001, d = 0.893). If confirmed, this would suggest that deliberate targeting of multiple brain networks could be beneficial to rTMS outcomes.

摘要

重复经颅磁刺激(rTMS)是一种已被认可的用于治疗重度抑郁症的非侵入性脑刺激疗法,但个体间的反应存在显著差异。通过对最近完成的BRIGhTMIND试验中逐次患者整体印象评分进行潜在类别增长分析,我们在一个20次治疗疗程中确定了五种不同的改善轨迹类别。这包括相当一部分患者注意到改善出现延迟。与先前的预期相反,以早期和持续改善为特征的类别成员在受刺激位置上显示出最大的疗程间变异性。通过将目标位置和疗程间变异性与一个经过充分研究的图谱相关联,我们估计该组在整个治疗过程中平均刺激了3.0个脑网络,而报告症状恶化的组为1.1个(p < 0.001,d = 0.893)。如果得到证实,这将表明有意针对多个脑网络可能有利于rTMS治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d898/11211415/5f57c6444aa1/44184_2024_77_Fig1_HTML.jpg

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