Csukly Gábor, Orbán-Szigeti Boglárka, Réthelyi János M
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
Curr Opin Psychiatry. 2025 Sep 1;38(5):334-340. doi: 10.1097/YCO.0000000000001026. Epub 2025 Jul 22.
While rTMS is a safe therapeutic option, its efficacy remains to be improved. Patients with treatment-resistant depression show 50-60% response rates and 30-40% remission rates to standard 10 Hz rTMS protocols. Response prediction is a promising option to improve rTMS efficacy.
Most studies test response prediction in patients with depression, schizophrenia, and OCD. Clinical data and structural MRI are primarily used for patient stratification, fMRI is employed to determine the optimal localization, and EEG is utilized for fine-tuning rTMS parameters to achieve the best efficacy. Employing magnetic resonance spectroscopy, PET, and measuring cortical excitability may also be helpful. However, only a few studies tested these methods. Furthermore, a crucial new task is to connect theta-burst accelerated protocols with response prediction, an approach applied in some recent studies.
We propose planning and carrying out multicentre studies to confirm existing results and provide a definitive conclusion for clinicians. Primarily, individual alpha peak (IAPF)-based response prediction results should be replicated in large-sample, multicentre trials, as this approach is the most robust and has the best chance of being implemented in clinical practice. Structural MRI-based patient stratification and fMRI-guided stimulation are possible add-ons.
重复经颅磁刺激（rTMS）是一种安全的治疗选择，但其疗效仍有待提高。难治性抑郁症患者对标准的10赫兹rTMS方案的有效率为50%-60%，缓解率为30%-40%。反应预测是提高rTMS疗效的一个有前景的选择。
大多数研究在抑郁症、精神分裂症和强迫症患者中测试反应预测。临床数据和结构磁共振成像主要用于患者分层，功能磁共振成像用于确定最佳定位，脑电图用于微调rTMS参数以达到最佳疗效。采用磁共振波谱、正电子发射断层扫描和测量皮质兴奋性可能也有帮助。然而，只有少数研究测试了这些方法。此外，一项关键的新任务是将theta爆发加速方案与反应预测联系起来，这是一些近期研究所采用的方法。
我们建议规划并开展多中心研究，以证实现有结果并为临床医生提供明确结论。首先，基于个体阿尔法峰值（IAPF）的反应预测结果应在大样本、多中心试验中得到重复，因为这种方法最为可靠，且最有可能在临床实践中得以应用。基于结构磁共振成像的患者分层和功能磁共振成像引导的刺激可能是补充手段。
