More Lateral and Anterior Prefrontal Coil Location Is Associated with Better Repetitive Transcranial Magnetic Stimulation Antidepressant Response

Herbsman, Tal; Avery, David; Ramsey, Dave; Holtzheimer, Paul E.; Wadjik, Chandra; Hardaway, Frances; Haynor, David R.; George, Mark S.; Nahas, Ziad

doi:10.1016/j.biopsych.2009.04.034

Cited by 188 publications

(168 citation statements)

References 31 publications

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“…We also note in particular that the MPFC, which is one key part of the DMN, has been postulated to be critical for the antidepressant effects of medications and rTMS (43,44). The clinical efficacy of rTMS, however, remains fairly limited, owing to a poor mechanistic understanding of the effects of rTMS and suboptimal targeting of stimulation, which currently makes minimal explicit reference to patients' structural or functional neuroanatomy (44,45). It is therefore intriguing that the MPFC-regulating CEN node (pMFG) was located 5-6 cm anterior of primary motor cortex, consistent with current methods for localizing the clinical rTMS stimulation site (25,26).…”

Section: Discussionmentioning

confidence: 99%

Causal interactions between fronto-parietal central executive and default-mode networks in humans

Chen

Oathes

Chang

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

510

358

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Information processing during human cognitive and emotional operations is thought to involve the dynamic interplay of several large-scale neural networks, including the fronto-parietal central executive network (CEN), cingulo-opercular salience network (SN), and the medial prefrontal-medial parietal default mode networks (DMN). It has been theorized that there is a causal neural mechanism by which the CEN/SN negatively regulate the DMN. Support for this idea has come from correlational neuroimaging studies; however, direct evidence for this neural mechanism is lacking. Here we undertook a direct test of this mechanism by combining transcranial magnetic stimulation (TMS) with functional MRI to causally excite or inhibit TMS-accessible prefrontal nodes within the CEN or SN and determine consequent effects on the DMN. Single-pulse excitatory stimulations delivered to only the CEN node induced negative DMN connectivity with the CEN and SN, consistent with the CEN/SN's hypothesized negative regulation of the DMN. Conversely, low-frequency inhibitory repetitive TMS to the CEN node resulted in a shift of DMN signal from its normally low-frequency range to a higher frequency, suggesting disinhibition of DMN activity. Moreover, the CEN node exhibited this causal regulatory relationship primarily with the medial prefrontal portion of the DMN. These findings significantly advance our understanding of the causal mechanisms by which major brain networks normally coordinate information processing. Given that poorly regulated information processing is a hallmark of most neuropsychiatric disorders, these findings provide a foundation for ways to study network dysregulation and develop brain stimulation treatments for these disorders. task positive network | task negative network | fMRI | neuromodulation E xtensive neuroimaging work has described a set of largescale, intrinsically organized networks in the human brain, as well as those of other mammals, which are thought to underlie a broad range of functions, from basic sensory and motor capacities to cognition and higher-level functions (1-4). Three networks in particular have been the focus of work related to these higher-level functions (5): the fronto-parietal central executive network (CEN), the cingulo-opercular salience network (SN), and the medial prefrontal-medial parietal default mode network (DMN). These networks are thought to interact and together control attention, working memory, decision making, and other higher-level cognitive operations (6-8).Findings to date, however, emphasize the need for a direct test of the proposed causal relationship between these networks. On the basis of observations in resting-state functional MRI (rsfMRI) scans in humans of time-locked negative CEN/DMN and SN/DMN connectivity (9-11), as well as mathematical modeling of temporal relationships between these networks (12), it has been argued that the CEN and/or SN negatively regulate activity in the DMN. However, because a similar pattern of connectivity can be spuriously introduced du...

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Section: Discussionmentioning

confidence: 99%

Causal interactions between fronto-parietal central executive and default-mode networks in humans

Chen

Oathes

Chang

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

510

358

View full text Add to dashboard Cite

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“…Furthermore, we have recently conducted a meta-analysis on the integrity of blinding in high-frequency rTMS trials in MD and have showed that after an average of 13 rTMS sessions, 52 and 59% of subjects receiving active and sham rTMS (n ¼ 396), respectively, were able to correctly guess their treatment allocation (p ¼ 0.58) (Berlim et al, submitted-b). Third, the most commonly used strategy for locating the DLPFC (ie, the '5-cm method') has been recently criticized for its inaccuracy (Bradfield et al, 2012;Fitzgerald et al, 2009a;Fitzgerald et al, 2009b;Herbsman et al, 2009;Rusjan et al, 2010), and future studies might benefit from neuronavigation approaches (Ruohonen and Karhu, 2010; Schonfeldt-Lecuona et al, 2010). Fourth, we have only examined the efficacy of LF-rTMS at study end, and thus could not estimate the stability of its medium-to long-term antidepressant effects and/or its cost-effectiveness.…”

Section: Limitationsmentioning

confidence: 99%

Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials

Berlim

Eynde

Daskalakis

2012

Neuropsychopharmacol

252

141

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Clinical trials on low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the right dorsolateral prefrontal cortex have yielded conflicting evidence concerning its overall efficacy for treating major depression (MD). As this may have been the result of limited statistical power of individual trials, we have carried the present systematic review and meta-analysis to examine this issue. We searched the literature for English language randomized, double-blind and sham-controlled trials (RCTs) on LF-rTMS for treating MD from 1995 through July 2012 using EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, and ProQuest Dissertations & Theses, and from October 2008 until July 2012 using MEDLINE. The main outcome measures were response and remission rates as well as overall dropout rates at study end. We used a random-effects model, odds ratios (ORs) and number needed to treat (NNT). Data were obtained from eight RCTs, totaling 263 subjects with MD. After an average of 12.6±3.9 rTMS sessions, 38.2% (50/131) and 15.1% (20/132) of subjects receiving active LF-rTMS and sham rTMS were classified as responders (OR ¼ 3.35; 95% CI ¼ 1.4-8.02; p ¼ 0.007). Also, 34.6% (35/101) and 9.7% (10/103) of subjects receiving active LF-rTMS and sham rTMS were classified as remitters (OR ¼ 4.76; 95% CI ¼ 2.13-10.64; po0.0001). The associated NNT for both response and remission rates was 5. Sensitivity analyses have shown that protocols delivering 41200 magnetic pulses in total as well as those offering rTMS as a monotherapy for MD were associated with higher rates of response to treatment. No differences on mean baseline depression scores and dropout rates for active and sham rTMS groups were found. Finally, the risk of publication bias was low. In conclusion, LF-rTMS is a promising treatment for MD, as it provides clinically meaningful benefits that are comparable to those of standard antidepressants and high-frequency rTMS. Furthermore, LF-rTMS seems to be an acceptable intervention for depressed subjects.

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“…First, findings could be used to improve treatments. For example, TMS treatment of depression is limited by the inability to identify the optimal stimulation site in the left DLPFC (15,18,(37)(38)(39). Using resting-state functional-connectivity MRI (rs-fcMRI), a technique used to visualize brain networks based on correlated fluctuations in blood oxygenation (40)(41)(42), the efficacy of different DLPFC TMS sites has been related to their correlation with the subgenual cingulate, a DBS target for depression (43).…”

Section: Significancementioning

confidence: 99%

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Fox

Buckner

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

526

435

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Significance Brain stimulation is a powerful treatment for an increasing number of psychiatric and neurological diseases, but it is unclear why certain stimulation sites work or where in the brain is the best place to stimulate to treat a given patient or disease. We found that although different types of brain stimulation are applied in different locations, targets used to treat the same disease most often are nodes in the same brain network. These results suggest that brain networks might be used to understand why brain stimulation works and to improve therapy by identifying the best places to stimulate the brain.

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More Lateral and Anterior Prefrontal Coil Location Is Associated with Better Repetitive Transcranial Magnetic Stimulation Antidepressant Response

Cited by 188 publications

References 31 publications

Causal interactions between fronto-parietal central executive and default-mode networks in humans

Causal interactions between fronto-parietal central executive and default-mode networks in humans

Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

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