Baldi Samantha, Chiulli Nicole, Palm Stephan, Frandsen Summer, Pell Gaby S, Zibman Samuel, Rodriguez-Ponde Josias, Brown Joshua C, Siddiqi Shan H
Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Neuropsychopharmacology. 2025 Jun 30. doi: 10.1038/s41386-025-02157-5.
The efficacy of transcranial magnetic stimulation (TMS) for depression may depend on targeting specific brain circuits. However, this has not been tested for TMS with the H1 coil, a widely used device believed to target more broadly and deeply than TMS with figure-of-8 coils. This study examined whether targeting a specific brain circuit with H1 coil TMS treatment may impact depressive symptom improvement. We retrospectively analyzed data from 97 patients at McLean Hospital, who received at least 19 TMS sessions and had incidentally completed an anatomical brain MRI. We modeled each patient's electric (E-)field using SimNIBS and estimated the connectivity of the E-field using a normative connectome (n = 1000), which was correlated with depression improvement as measured by the Quick Inventory of Depressive Symptomatology. H1 E-fields improving depression were preferentially connected to a distinct brain circuit, validated with leave-one-out cross-validation (p = 0.0005). This circuit was significantly similar to a predefined causal depression circuit (spatial r = 0.59, p = 0.04) derived from TMS, deep brain stimulation, and lesion studies. E-fields with greater connectivity similarity to this circuit led to greater symptom improvement (r = 0.41, p < 0.001). Post-hoc analyses revealed that more posterior coil positioning increases H1 E-field overlap with the depression circuit, with high overlap at scalp locations 3-6 cm anterior to the motor hotspot. Thus, H1 coil stimulation sites that improve depression converge on a common causal depression circuit. Prospective studies are needed to validate these findings.
经颅磁刺激（TMS）治疗抑郁症的疗效可能取决于针对特定的脑回路。然而，对于H1线圈TMS，尚未进行过此类测试，H1线圈是一种广泛使用的设备，人们认为它比8字形线圈TMS的靶向范围更广、更深。本研究考察了用H1线圈TMS治疗靶向特定脑回路是否会影响抑郁症状的改善。我们回顾性分析了麦克莱恩医院97例患者的数据，这些患者接受了至少19次TMS治疗，并偶然完成了脑部解剖MRI。我们使用SimNIBS对每位患者的电场（E场）进行建模，并使用标准连接组（n = 1000）估计E场的连通性，该连接组与通过抑郁症状快速检查表测量的抑郁改善情况相关。改善抑郁的H1 E场优先连接到一个独特的脑回路，通过留一法交叉验证得到验证（p = 0.0005）。该回路与从TMS、深部脑刺激和病变研究得出的预定义因果抑郁回路显著相似（空间r = 0.59，p = 0.04）。与该回路具有更高连通性相似性的E场导致更大的症状改善（r = 0.41，p < 0.001）。事后分析表明，线圈位置越靠后，H1 E场与抑郁回路的重叠越大，在运动热点前方3 - 6厘米的头皮位置重叠度较高。因此，改善抑郁的H1线圈刺激部位汇聚在一个共同的因果抑郁回路上。需要进行前瞻性研究来验证这些发现。
