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Randomized Controlled Trial
. 2019:22:101719.
doi: 10.1016/j.nicl.2019.101719. Epub 2019 Feb 13.

Segregation of salience network predicts treatment response of depression to repetitive transcranial magnetic stimulation

Jie Fan  1 , Ivy F Tso  2 , Daniel F Maixner  3 , Tessa Abagis  4 , Luis Hernandez-Garcia  5 , Stephan F Taylor  6
Affiliations
Randomized Controlled Trial

Segregation of salience network predicts treatment response of depression to repetitive transcranial magnetic stimulation

Jie Fan et al. Neuroimage Clin. 2019.

Abstract

Background: The present study tested the hypothesis that network segregation, a graph theoretic measure of functional organization of the brain, is correlated with treatment response in patients with major depressive disorder (MDD) undergoing repetitive transcranial magnetic stimulation (rTMS).

Methods: Network segregation, calculated from resting state functional magnetic resonance imaging scans, was measured in 32 patients with MDD who entered a sham-controlled, double-blinded, randomized trial of rTMS to the left dorsolateral prefrontal cortex, and a cohort of 20 healthy controls (HCs). Half of the MDD patients received sham treatment in the blinded phase, followed by active rTMS in the open-label phase. The analyses focused on segregation of the following networks: default mode (DMN), salience (SN), fronto-parietal (FPN), cingulo-opercular (CON), and memory retrieval (MRN).

Results: There was no differential change in network segregation comparing sham to active treatment. However, in the combined group of patients who completed active rTMS treatment (in the blinded plus open-label phases), higher baseline segregation of SN significantly predicted more symptom improvement after rTMS. Compared to HCs at baseline, MDD patients showed decreased segregation in DMN, and trend-level decreases in SN and MRN.

Conclusion: The results highlight the importance of network segregation in MDD, particularly in the SN, where more normal baseline segregation of SN may predict better treatment response to rTMS in depression.

Keywords: Default mode network; Depression; Repetitive transcranial magnetic stimulation; Salience network; Segregation.

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Figures

Fig. 1
Fig. 1
The 5 networks-of-interest defined by Power et al. (2011).
Fig. 2
Fig. 2
Segregation of salience network (SN) predicted the treatment response of rTMS to depression (β = 2. 44, s.e. = 0.79, t = 3,07, p = .006).
Fig. 3
Fig. 3
Segregation differences between MDD patients at baseline and HCs. MDD patients had significant decreases in segregation of DMN (F[1,43] = 8.74, p = .005, Eta2 = 0.169), and trend decrease in segregation of SN (F[1,43] = 4.42, p = .041, Eta2 = 0.093) and MRN (F[1,43] = 4.79, p = .034, Eta2 = 0.100) as compared to HCs. There were no significant differences between MDD and HCs in segregation of FPN (F[1,43] = 4.42, p = .889) and CON (F[1,43] = 0.06, p = .807). SN, salience network; DMN, default mode network; MRN, memory retrieval network; FPN, fronto-parietal control network, CO, cingulo-opercular control network; MDD, major depressive disorder; HCs, healthy controls. auncorrected p < .05, *uncorrected p < .01 (p < .05 when corrected for 5 multiple comparisons).
See this image and copyright information in PMC

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