Reliability of targeting methods in TMS for depression: Beam F3 vs. 5.5 cm

Trapp, Nicholas T.; Bruss, Joel; Johnson, Marcie King; Uitermarkt, Brandt D.; Garrett, Laren; Heinzerling, Amanda; Wu, Chaorong; Koscik, Timothy R.; Eyck, Patrick Ten; Boes, Aaron D.

doi:10.1016/j.brs.2020.01.010

Cited by 60 publications

(43 citation statements)

References 15 publications

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“…Software has since been developed to estimate the F3 electrode position based on only a few scalp measurements (Beam F3) (49,50). This approach has seen widespread clinical implementation, is located with high reliability (51), and is endorsed by the Clinical TMS Society (52). However, this targeting approach has not yet been validated in double-blinded randomized trials as the 5-to 6-cm method has.…”

Section: Targeting Tms Using Scalp Measurementsmentioning

confidence: 99%

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Cash

Weigand

Zalesky

et al. 2021

Biological Psychiatry

182

169

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Transcranial magnetic stimulation (TMS) is an effective treatment for depression but is limited in that the optimal therapeutic target remains unknown. Early TMS trials lacked a focal target and thus positioned the TMS coil over the prefrontal cortex using scalp measurements. Over time, it became clear that this method leads to variation in the stimulation site and that this could contribute to heterogeneity in antidepressant response. Newer methods allow for precise positioning of the TMS coil over a specific brain location, but leveraging these precise methods requires a more precise therapeutic target. We review how neuroimaging is being used to identify a more focal therapeutic target for depression. We highlight recent studies showing that more effective TMS targets in the frontal cortex are functionally connected to deep limbic regions such as the subgenual cingulate cortex. We review how connectivity might be used to identify an optimal TMS target for use in all patients and potentially even a personalized target for each individual patient. We address the clinical implications of this emerging field and highlight critical questions for future research.

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Section: Targeting Tms Using Scalp Measurementsmentioning

confidence: 99%

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Cash

Weigand

Zalesky

et al. 2021

Biological Psychiatry

182

169

View full text Add to dashboard Cite

show abstract

“…In six of 12 studies ( Table 2 ) of adolescent depression the targeting strategy was scalp-based, four used MRI-guidance, and two provide no data. Scalp-based targeting is unreliable and imprecise for localizing DLPFC ( 184 – 188 ). MRI-based neuronavigation used for rTMS shows larger effect sizes ( 127 , 130 , 131 ).…”

Section: Limitations Of the Existing Literature And Proposed Resolutionsmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment

et al. 2021

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Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.

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“…This approach is recommended by the National Network of Depression Centers [ 78 ] when frameless stereotaxy is unavailable or impractical. It offers significant advantages over the standard “5-cm rule” that often misses the DLPFC [ 79 ]. We recognize that this method has limitations in and of itself, particularly if our goal was discovery of novel approaches to precision targeting.…”

Section: Discussionmentioning

confidence: 99%

Identifying response and predictive biomarkers for Transcranial magnetic stimulation outcomes: protocol and rationale for a mechanistic study of functional neuroimaging and behavioral biomarkers in veterans with Pharmacoresistant depression

et al. 2021

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Background Although repetitive transcranial magnetic stimulation (‘TMS’) is becoming a gold standard treatment for pharmacoresistant depression, we lack neural target biomarkers for identifying who is most likely to respond to TMS and why. To address this gap in knowledge we evaluate neural targets defined by activation and functional connectivity of the dorsolateral prefrontal cortex-anchored cognitive control circuit, regions of the default mode network and attention circuit, and interactions with the subgenual anterior cingulate. We evaluate whether these targets and interactions between them change in a dose-dependent manner, whether changes in these neural targets correspond to changes in cognitive behavioral performance, and whether baseline and early change in neural target and cognitive behavioral performance predict subsequent symptom severity, suicidality, and quality of life outcomes. This study is designed as a pragmatic, mechanistic trial partnering with the National Clinical TMS Program of the Veteran’s Health Administration. Methods Target enrollment consists of 100 veterans with pharmacoresistant Major Depressive Disorder (MDD). All veterans will receive a clinical course of TMS and will be assessed at ‘baseline’ pre-TMS commencement, ‘first week’ after initiation of TMS (targeting five sessions) and ‘post-treatment’ at the completion of TMS (targeting 30 sessions). Veterans will be assessed using functional magnetic resonance imaging (fMRI), a cognitive behavioral performance battery, and established questionnaires. Multivariate linear mixed models will be used to assess whether neural targets change with TMS as a function of dose (Aim 1), whether extent and change of neural target relates to and predicts extent of behavioral performance (Aim 3), and whether extent of neural target change predicts improvement in symptom severity, suicidality, and quality of life (Aim 3). For all three aims, we will also assess the contribution of baseline moderators such as biological sex and age. Discussion To our knowledge, our study will be the first pragmatic, mechanistic observational trial to use fMRI imaging and cognitive-behavioral performance as biomarkers of TMS treatment response in pharmacoresistant MDD. The results of this trial will allow providers to select suitable candidates for TMS treatment and better predict treatment response by assessing circuit connectivity and cognitive-behavioral performance at baseline and during early treatment. Trial registration ClinicalTrials.gov NCT04663481, December 5th, 2020, retrospectively registered. The first veteran was enrolled October 30th, 2020.

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Reliability of targeting methods in TMS for depression: Beam F3 vs. 5.5 cm

Cited by 60 publications

References 15 publications

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment

Identifying response and predictive biomarkers for Transcranial magnetic stimulation outcomes: protocol and rationale for a mechanistic study of functional neuroimaging and behavioral biomarkers in veterans with Pharmacoresistant depression

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