Personalized Repetitive Transcranial Magnetic Stimulation for Depression

Gogulski, Juha; Ross, Jessica M.; Talbot, Austin; Cline, Christopher C.; Donati, Francesco; Saachi, Munot,; Kim, Naryeong; Gibbs, Ciara; Bastin, Nikita; Yang, Jessica; Minasi, Christopher; Sarkar, Manjima; Truong, Jade; Keller, Corey J.

doi:10.1016/j.bpsc.2022.10.006

Cited by 10 publications

(12 citation statements)

References 131 publications

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“…However, more research is needed to elucidate its specificity, clinical significance, and relationship to the course of illness. As TMS is gaining momentum in psychiatric research and treatment, future studies should explore a role for TMS-EEG measures, including the natural frequency, in informing the diagnosis, prognosis, and personalization of treatment in schizophrenia and other psychiatric conditions [ 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

et al. 2023

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Despite the heavy burden of schizophrenia, research on biomarkers associated with its early course is still ongoing. Single-pulse Transcranial Magnetic Stimulation coupled with electroencephalography (TMS-EEG) has revealed that the main oscillatory frequency (or “natural frequency”) is reduced in several frontal brain areas, including the premotor cortex, of chronic patients with schizophrenia. However, no study has explored the natural frequency at the beginning of illness. Here, we used TMS-EEG to probe the intrinsic oscillatory properties of the left premotor cortex in early-course schizophrenia patients (<2 years from onset) and age/gender-matched healthy comparison subjects (HCs). State-of-the-art real-time monitoring of EEG responses to TMS and noise-masking procedures were employed to ensure data quality. We found that the natural frequency of the premotor cortex was significantly reduced in early-course schizophrenia compared to HCs. No correlation was found between the natural frequency and age, clinical symptom severity, or dose of antipsychotic medications at the time of TMS-EEG. This finding extends to early-course schizophrenia previous evidence in chronic patients and supports the hypothesis of a deficit in frontal cortical synchronization as a core mechanism underlying this disorder. Future work should further explore the putative role of frontal natural frequencies as early pathophysiological biomarkers for schizophrenia.

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Section: Discussionmentioning

confidence: 99%

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

et al. 2023

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“…39,46,47,50 The heterogeneity of stimulation parameters, coil localization, illness/ participant variables and other methodological factors and the array of permutations formed by the combination of these elements is an inherit and recognized challenge in this field of research. 81,87,88,121,122 At the same time, it also encourages diverse lines of scientific inquiry, such as those pertaining to safety and the durability of treatment response. 68 Concerns about safety and tolerability are to be expected as accelerated protocols deliver more pulses per session and more sessions per day (particularly with short ISIs) at higher stimulation intensities relative to RMT.…”

Section: The Futurementioning

confidence: 97%

“…The scope for future research is diverse and extends beyond the crucial need for larger clinical trials featuring prospective, randomized, comparison or sham-controlled designs 39,46,47,50 . The heterogeneity of stimulation parameters, coil localization, illness/participant variables and other methodological factors and the array of permutations formed by the combination of these elements is an inherit and recognized challenge in this field of research 81,87,88,121,122 . At the same time, it also encourages diverse lines of scientific inquiry, such as those pertaining to safety and the durability of treatment response 68 .…”

Section: The Futurementioning

confidence: 99%

“…Modak and Fitzgerald’s 150 review of 30 studies that incorporated personalization of rTMS/TBS protocols using neuroimaging found a trend toward improved clinical outcomes with personalized stimulation parameters. Validation of these approaches in future clinical trials would be worthwhile, although the statistical power required and the permutations of examinable personalization methods and parameters are foreseeable challenges 122,146 . It is also unclear at present how personalized parameters influence each other and whether attempts to personalize multiple parameters might infer additional benefits over personalizing single parameters.…”

Section: The Futurementioning

confidence: 99%

“…The variability of inter-and intra-individual responses to rTMS [140][141][142][143] and TBS 144,145 are well documented, opening the possibility of personalizing protocols to improve stimulation-induced neuromodulatory and therapeutic effects. In present day clinical practice, stimulation intensity is typically the only personalized parameter in rTMS/TBS therapy, 122 derived from the individual's RMT, while other stimulation parameters are predetermined and usually derived from clinical trial evidence. Personalizing rTMS parameters via modifications to coil placement, orientation, and stimulation intensity based on neuroimaging findings have been suggested, for example.…”

Section: How Might Neuroimaging Facilitate Individualization Of Accel...mentioning

confidence: 99%

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Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Chen

Klooster

Tik

et al. 2023

Harv Rev Psychiatry

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Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based therapy for treatment-resistant major depressive disorder. A conventional course of rTMS applies 20-30 daily sessions over 4-6 weeks. The schedule of rTMS delivery can be accelerated by applying multiple stimulation sessions per day, which reduces the duration of a treatment course with a predefined number of sessions. Accelerated rTMS reduces time demands, improves clinical efficiency, and potentially induces faster onset of antidepressant effects. However, considerable heterogeneity exists across study designs. Stimulation protocols vary in parameters such as the stimulation target, frequency, intensity, number of pulses applied per session or over a course of treatment, and duration of intersession intervals. In this article, clinician-researchers and neuroscientists who have extensive research experience in accelerated rTMS synthesize a consensus based on two decades of investigation and development, from early studies ("Past") to contemporaneous theta burst stimulation, a time-efficient form of rTMS gaining acceptance in clinical settings ("Present"). We propose descriptive nomenclature for accelerated rTMS, recommend avenues to optimize therapeutic and efficiency potential, and suggest using neuroimaging and electrophysiological biomarkers to individualize treatment protocols ("Future"). Overall, empirical studies show that accelerated rTMS protocols are well tolerated and not associated with serious adverse effects. Importantly, the antidepressant efficacy of accelerated rTMS appears comparable to conventional, once daily rTMS protocols. Whether accelerated rTMS induces antidepressant effects more quickly remains uncertain. On present evidence, treatment protocols incorporating high pulse dose and multiple treatments per day show promise and improved efficacy.

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Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee

Vucic¹,

Chen²,

Kiernan³

et al. 2023

Clinical Neurophysiology

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Personalized Repetitive Transcranial Magnetic Stimulation for Depression

Cited by 10 publications

References 131 publications

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

Natural Oscillatory Frequency Slowing in the Premotor Cortex of Early-Course Schizophrenia Patients: A TMS-EEG Study

Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future

Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee

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