Indicators for Remission of Suicidal Ideation Following Magnetic Seizure Therapy in Patients With Treatment-Resistant Depression

Abstract

IMPORTANCE Magnetic seizure therapy (MST) is a novel therapeutic option for treatment-resistant depression (TRD). Suicidal ideation is often associated with TRD and contributes to the increased mortality and morbidity of the disorder. OBJECTIVE To identify a biomarker that may serve as an indicator of remission of suicidal ideation following a course of MST by using cortical inhibition measures from interleaved transcranial magnetic stimulation and electroencephalography (TMS-EEG). DESIGN, SETTING, AND PARTICIPANTS Thirty-three patients with TRD were part of an open-label clinical trial of MST treatment. Data from 27 patients (82%) were available for analysis in this study. Baseline TMS-EEG measures were assessed within 1 week before the initiation of MST treatment using the TMS-EEG measures of cortical inhibition (ie, N100 and long-interval cortical inhibition [LICI]) from the left dorsolateral prefrontal cortex and the left motor cortex, with the latter acting as a control site. INTERVENTIONS The MST treatments were administered under general anesthesia, and a stimulator coil consisting of 2 individual cone-shaped coils was used. MAIN OUTCOMES AND MEASURES Suicidal ideation was evaluated before initiation and after completion of MST using the Scale for Suicide Ideation (SSI). Measures of cortical inhibition (ie, N100 and LICI) from the left dorsolateral prefrontal cortex were selected. N100 was quantified as the amplitude of the negative peak around 100 milliseconds in the TMS-evoked potential (TEP) after a single TMS pulse. LICI was quantified as the amount of suppression in the double-pulse TEP relative to the single-pulse TEP. RESULTS Of the 27 patients included in the analyses, 15 (56%) were women; mean (SD) age of the sample was 46.0 (15.3) years. At baseline, patients had a mean SSI score of 9.0 (6.8), with 8 of 27 patients (30%) having a score of 0. After completion of MST, patients had a mean SSI score of 4.2 (6.3) (pre-post treatment mean difference, 4.8 [6.7]; paired t 26 = 3.72; P = .001), and 18 of 27 individuals (67%) had a score of 0 for a remission rate of 53%. The N100 and LICI in the frontal cortex-but not in the motor cortex-were indicators of remission of suicidal ideation with 89% accuracy, 90% sensitivity, and 89% specificity (area under the curve, 0.90; P = .003). CONCLUSIONS AND RELEVANCE These results suggest that cortical inhibition may be used to identify patients with TRD who are most likely to experience remission of suicidal ideation following a course of MST. Stronger inhibitory neurotransmission at baseline may reflect the integrity of transsynaptic networks that are targeted by MST for optimal therapeutic response.

A pilot study of the comparative efficacy of 100 Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression

“…Focal stimulation of other regions, such as the dorsal frontal cortex, as recently reported in an open label sample (Sun et al, 2016), may produce better responses. However, systematic research is required to identify the optimal MST treatment target prior to the conduct of further comparative studies of the sort reported in this paper.…”

Characterization of Glutamatergic and GABAA-Mediated Neurotransmission in Motor and Dorsolateral Prefrontal Cortex Using Paired-Pulse TMS–EEG

“…Such studies have demonstrated EEG neurophysiological correlates of cortical inhibitory circuits such as GABA B -mediated longinterval intracortical inhibition (LICI) in motor and dorsolateral prefrontal cortex (DLPFC) Fitzgerald et al, 2008). Changes in this paradigm have been associated with schizophrenia Radhu et al, 2015) and predict treatment response to magnetic seizure therapy in depression (Sun et al, 2016). Changes are typically characterized by modulation in the amplitude of components of the TMS-evoked potential (TEP) and modulation of oscillatory power at different frequencies.…”

Transcranial magnetic stimulation with electroencephalography: methodology, applications for research and cilinics

“…Маркеры ТМС-ЭЭГ обладают диагностическим и прогностическим по-тенциалом в отношении многих неврологических и психических болезней. В первую очередь это каса-ется шизофрении [46], депрессии [58], эпилепсии [59], болезни Альцгеймера [60], хронического боле-вого синдрома [61], нарушения сознания [62], череп-но-мозговой травмы [63] и др. Проводятся ТМС-ЭЭГ-исследования, направленные на изучение сохранности структурно-функциональной организа-ции мозга при неврологических и психических болез-нях.…”