Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial

Ge, Ruiyang; Humaira, A.; Gregory, Elizabeth; Alamian, Golnoush; MacMillan, Erin L.; Barlow, Laura; Todd, Rebecca M.; Nestor, Sean M.; Frangou, Sophia; Vila‐Rodriguez, Fidel

doi:10.1176/appi.ajp.21050541

Cited by 40 publications

(21 citation statements)

References 46 publications

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“…87,88 Furthermore, such outcomes can also be used to personalise and improve rTMS treatment, as it has been shown in patients with depression. 89,90 Given the heterogeneity of the disorder and associated mech- neuropathic orofacial pain, 29 and that inhibitory rTMS stimulation over S1 can successfully alter proprioceptive facial perceptions. 91,92 In addition, female gender, shorter duration of pain and lower anxiety have shown a certain favourable profile on analgesic facial pain rTMS response.…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion of cortical excitability measures and imaging methods such as functional magnetic resonance imaging (fMRI) before and after treatment to assess more objective outcomes, could have given more insight into rTMS analgesic pathways and would be extremely valuable in future trials 87,88 . Furthermore, such outcomes can also be used to personalise and improve rTMS treatment, as it has been shown in patients with depression 89,90 …”

Section: Discussionmentioning

confidence: 99%

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One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders

Herrero Babiloni,

Provost,

Charlebois‐Plante

et al. 2024

J of Oral Rehabilitation

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ObjectiveTemporomandibular disorders (TMD) are characterised by chronic pain and dysfunction in the jaw joint and masticatory muscles. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non‐invasive treatment for chronic pain; however, its effectiveness in individuals with TMD has not been thoroughly investigated. This study aimed to evaluate the immediate and sustained (over seven consecutive days) effects of a single session of active rTMS compared to sham stimulation on pain intensity and pain unpleasantness in individuals with TMD.MethodsA randomised, double‐blind, sham‐controlled trial enrolled 41 female participants with chronic TMD. Pain intensity and pain unpleasantness were assessed immediately pre‐ and post‐intervention, as well as twice daily for 21 days using electronic diaries. Secondary outcomes included pain interference, sleep quality, positive and negative affect and pain catastrophizing. Adverse effects were monitored. Repeated measures ANOVA and multilevel modelling regression analyses were employed for data analysis.ResultActive rTMS demonstrated a significant immediate mild reduction in pain intensity and pain unpleasantness compared to sham stimulation. However, these effects were not sustained over the 7‐day post‐intervention period. No significant differences were observed between interventions for pain interference, sleep quality and negative affect. A minority of participants reported minor and transient side effects, including headaches and fatigue.ConclusionA single session of active rTMS was safe and led to immediate mild analgesic effects in individuals with TMD compared to sham stimulation. However, no significant differences were observed between interventions over the 7‐day post‐intervention period. Based on this study, rTMS stimulation appears to be a promising safe approach to be tested in TMD patients with longer stimulation protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders

Herrero Babiloni,

Provost,

Charlebois‐Plante

et al. 2024

J of Oral Rehabilitation

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“…Although case-control comparisons must be interpreted with caution when GSR has been implemented, our results support the clinical relevance of such analyses with regard to rTMS treatment outcomes. Substantial evidence has shown that sgACC FC profiles in MDD patients are related to rTMS treatment response (30, 81). Our results add to this conceptualization by showing that the degree of group differences in the sgACC FC profiles were positively related to the clinical improvements after receiving rTMS to the left DLPFC.…”

Section: Discussionmentioning

confidence: 99%

Subgenual Anterior Cingulate Cortex Functional Connectivity Abnormalities in Depression: Insights from Brain Imaging Big Data and Precision-Guided Personalized Intervention via Transcranial Magnetic Stimulation

Chen

Lü

Wang

et al. 2023

Preprint

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The subgenual anterior cingulate cortex (sgACC) appears to play a central role in the pathophysiology of major depressive disorder (MDD). To wit, its functional interactive profile with the left dorsal lateral prefrontal cortex (DLPFC) has been shown to be related to treatment outcomes with transcranial magnetic stimulation (TMS) treatment outcomes. Nevertheless, previous research on sgACC functional connectivity (FC) in MDD has yielded inconsistent results, partly due to small sample sizes and limited statistical power of prior work. Here, leveraging a large multi-site sample (1660 MDD patients vs. 1341 healthy controls) from Phase II of the Depression Imaging REsearch ConsorTium (DIRECT), we systematically delineated case-control difference maps of sgACC FC and examined their clinical relevance to previously identified TMS targets. We also investigated case-control FC difference maps of left DLPFC sub-fields. In MDD patients we found significantly increased FC between sgACC and thalamus and reduced FC to a broad array of brain regions, including somatosensory area, occipital lobe, medial and lateral temporal lobe, and insular cortex, when global signal regression (GSR) was not implemented. Intriguingly, we found enhanced left DLPFC-sgACC FC in MDD patients when GSR was performed. We leveraged an prior independent sample to explore the possible relationship between the case-control differences regarding sgACC's FC profiles and the treatment out comes of TMS. In sites in which open TMS treatment was administered, case-control differences in sgACC FC, with GSR, were related to clinical improvement. Next we tested whether the position of peak of the FC maps (previously identified TMS target) could be altered in MDD patients as compred with healthy controls (HC)s. We found the optimized TMS target differed in MDD patients. Several DLPFC sub-fields yielded case-control differences in whole-brain FC maps. In summary, we reliably delineated MDD-related abnormalities of sgACC FC profiles in a large sample. GSR was essential in applying case-control difference maps to identify optimized TMS targets. Our results highlight the functional heterogeneity of the left DLPFC and of precise TMS targets therein.

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“…The dlPFC is currently one of the most widely used targeting sites for rTMS in depression patients, and there is good evidence to suggest that left dlPFC stimulation potentially improves depression symptoms by normalizing connectivity between the dlPFC and the subgenual anterior cingulate cortex 20,39,45 . However, the mechanisms that mediate anxiety reduction following right dlPFC stimulation.…”

Section: Discussionmentioning

confidence: 99%

Interleaved TMS/fMRI shows that threat decreases dlPFC-mediated top-down regulation of emotion processing

Patel,

Teferi,

Casalvera

et al. 2023

Preprint

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BackgroundThe right dorsolateral prefrontal cortex (dlPFC) has been indicated to be a key region in the cognitive regulation of emotion by many previous neuromodulation and neuroimaging studies. However, there is little direct causal evidence supporting this top-down regulation hypothesis. Furthermore, it is unclear whether contextual threat impacts this top-down regulation. By combining TMS/fMRI, this study aimed to uncover the impact of unpredictable threat on TMS-evoked BOLD response in dlPFC-regulated emotional networks. Based on the previous findings linking the dlPFC to the downregulation of emotional network activity, we hypothesized TMS pulses would deactivate activity in anxiety expression regions, and that threat would reduce this top-down regulation.Methods44 healthy controls (no current or history of psychiatric disorders) were recruited to take part in a broader study. Subjects completed the neutral, predictable, and unpredictable (NPU) threat task while receiving TMS pulses to either the right dlPFC or a control region. dlPFC targeting was based on data from a separate targeting session, where subjects completed the Sternberg working memory (WM) task inside the MRI scanner.ResultsWhen compared to safe conditions, subjects reported significantly higher levels of anxiety under threat conditions. Additionally, TMS-evoked responses in the left insula (LI), right sensory/motor cortex (RSM), and a region encompassing the bilateral SMA regions (BSMA) differed significantly between safe and threat conditions. There was a significant TMS-evoked deactivation in safe periods that was significantly attenuated in threat periods across all 3 regions.ConclusionsThese findings suggest that threat decreases dlPFC-regulated emotional processing by attenuating the top-down control of emotion, like the left insula. Critically, these findings provide support for the use of right dlPFC stimulation as a potential intervention in anxiety disorders.

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Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial

Cited by 40 publications

References 46 publications

One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders

One session of repetitive transcranial magnetic stimulation induces mild and transient analgesic effects among female individuals with painful temporomandibular disorders

Subgenual Anterior Cingulate Cortex Functional Connectivity Abnormalities in Depression: Insights from Brain Imaging Big Data and Precision-Guided Personalized Intervention via Transcranial Magnetic Stimulation

Interleaved TMS/fMRI shows that threat decreases dlPFC-mediated top-down regulation of emotion processing

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