Yachou Yassine, Bouaziz Noomane, Makdah Gabriel, Senova Yann-Sühan, Januel Dominique, Pelissolo Antoine, Mallet Luc, Leboyer Marion, Houenou Josselin, Opitz Alexander, Wischnewski Miles, Laidi Charles
Mondor University Hospitals, INSERM U955, Institut Mondor de La Recherche Biomédicale (IMRB), University of Paris Est Créteil, Équipe Neuropsychiatrie Translationnelle, Créteil, France; NeuroSpin, Neuroimaging Platform, CEA, UNIACT Lab, PsyBrain Team, Saclay, France.
Mondor University Hospitals, INSERM U955, Institut Mondor de La Recherche Biomédicale (IMRB), University of Paris Est Créteil, Équipe Neuropsychiatrie Translationnelle, Créteil, France; Clinical research center, Ville-Evrard Hospital, Neuilly-sur-Marne, France.
J Affect Disord. 2025 Apr 1;374:540-552. doi: 10.1016/j.jad.2025.01.001. Epub 2025 Jan 6.
Transcranial Direct Current Stimulation (tDCS) has shown potential in modulating cortical activity and treating depression. Despite its promise, variability in electrode montage configurations and electric field strength across studies has resulted in inconsistent outcomes. Traditional meta-analytic methods assessing the effect of tDCS in depression typically do not compare tDCS montage and the anatomical distribution of electric field, which is a major source of inter-experimental variability. We hypothesize that considering these parameters and anatomical variability in a meta-analysis might unravel brain regions associated with tDCS response in patients with depression. We correlate the clinical outcome (Effect size) with electric field intensities across 8 diverse head models, analyzing data from 29 studies involving 1766 patients between 2000 and 2023. Our analysis found a significant effect of tDCS on depression, with a Hedge's g = 0.66 (95 % CI: 0.565 to 0.767). Although studies aimed to target the L-DLPFC, particularly Brodmann area (BA) 46, based on the Frontal Brain Asymmetry theory, our findings show that all the montages do not selectively target the L-DLPFC as intended. Instead, our findings indicated that the electric field impact was dispersing broadly across the frontal lobes and exhibiting significant heterogeneity. We found a correlation between electric field strength and clinical outcomes in BA 10, BA 11, and the anterior part of BA 46 despite tDCS montages heterogeneity and individual variability, suggesting that targeting frontopolar prefrontal and orbitofrontal cortices could be ideal for tDCS in treating depression. Our work underscores brain regions associated with tDCS response and highlights the need for simulation-guided, personalized trials that consider individual anatomical differences.
经颅直流电刺激（tDCS）已显示出在调节皮层活动和治疗抑郁症方面的潜力。尽管前景广阔，但不同研究中电极蒙太奇配置和电场强度的差异导致了结果不一致。传统的评估tDCS对抑郁症疗效的荟萃分析方法通常不比较tDCS蒙太奇和电场的解剖分布，而这是实验间变异性的主要来源。我们假设在荟萃分析中考虑这些参数和解剖变异性可能会揭示抑郁症患者中与tDCS反应相关的脑区。我们将临床结果（效应大小）与8种不同头部模型的电场强度进行关联，分析了2000年至2023年间涉及1766名患者的29项研究的数据。我们的分析发现tDCS对抑郁症有显著影响，Hedge's g = 0.66（95% CI：0.565至0.767）。尽管基于额叶脑不对称理论，研究旨在靶向左侧背外侧前额叶皮质，特别是布罗德曼区（BA）46，但我们的研究结果表明，所有蒙太奇并未按预期选择性地靶向左侧背外侧前额叶皮质。相反，我们的研究结果表明电场影响广泛分布在额叶，并表现出显著的异质性。尽管tDCS蒙太奇存在异质性和个体变异性，但我们发现在BA 10、BA 11和BA 46前部，电场强度与临床结果之间存在相关性，这表明靶向额极前额叶皮质和眶额皮质可能是tDCS治疗抑郁症的理想选择。我们的工作强调了与tDCS反应相关的脑区，并强调了需要进行考虑个体解剖差异的模拟指导的个性化试验。
