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Clinical Trial
. 2021 Mar 1;78(3):337-339.
doi: 10.1001/jamapsychiatry.2020.3794.

Functional Magnetic Resonance Imaging-Guided Personalization of Transcranial Magnetic Stimulation Treatment for Depression

Robin F H Cash  1   2 , Luca Cocchi  1 , Jinglei Lv  2   3   4 , Paul B Fitzgerald  5 , Andrew Zalesky  2   3
Affiliations
Clinical Trial

Functional Magnetic Resonance Imaging-Guided Personalization of Transcranial Magnetic Stimulation Treatment for Depression

Robin F H Cash et al. JAMA Psychiatry. .

Abstract

This study assesses whether treatment response for depression could be improved via a single one-site-fits-all dorsolateral prefrontal cortex target, representing the group average optimal site of subgenual cingulate cortex functional connectivity, or whether target site personalization is necessary.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fitzgerald reports a patent for a type of transcranial direct current stimulation device (10,112,056 B2) issued; has received equipment for research from MagVenture A/S, Nextsim, Neuronetics, Brainsway, Cervel Neurotech, and Medtronic; funding for research from Neuronetics; and is a founder of TMS Clinics Australia. Dr Zalesky reports grants from National Health and Medical Research Council during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Closer Proximity to Personalized Stimulation Targets Associated With Improved Response to Repetitive Transcranial Magnetic Stimulation Treatment for Depression
A, Personalized stimulation targets were computed retrospectively for 26 individuals who previously received left-sided repetitive transcranial magnetic stimulation treatment for 3 weeks based on the F3 beam targeting method. Functional connectivity (FC) was computed between the subgenual cingulate cortex and each vertex comprising the dorsolateral prefrontal cortex using each individual’s own resting-state functional magnetic resonance imaging scan. Vertices most anticorrelated with the subgenual cingulate cortex were spatially clustered, and the center of the largest cluster was defined as the personalized target coordinate. Change in depression symptoms at 3 weeks was assessed compared with baseline using the Montgomery-Asberg Depression Rating Scale (MADRS). B, We anticipated that closer proximity between clinically applied and functional magnetic resonance imaging–personalized targets would lead to improved treatment response. This is a cartoon example only. C, Personalized stimulation targets (gray spheres) varied considerably across the spatial extent of the dorsolateral prefrontal cortex. D, Closer proximity between clinically applied and personalized targets associated with better clinical response.
See this image and copyright information in PMC

References

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    1. Cash RFH, Zalesky A, Thomson RH, Tian Y, Cocchi L, Fitzgerald PB. Subgenual functional connectivity predicts antidepressant treatment response to transcranial magnetic stimulation: independent validation and evaluation of personalization. Biol Psychiatry. 2019;86(2):e5-e7. doi:10.1016/j.biopsych.2018.12.002 - DOI - PubMed
    1. Cash RFH, Weigand A, Zalesky A, et al. . Using brain imaging to improve spatial targeting of transcranial magnetic stimulation for depression. Biol Psychiatry. 2020;S0006-3223(20)31668-1. doi:10.1016/j.biopsych.2020.05.033 - DOI - PubMed
    1. Cash R, Cocchi L, Lv J, Fitzgerald P, Zalesky A. Toward state-of-the-art connectivity-guided TMS: personalization, precision & clinical response. Paper presented at: 26th Annual Meeting of the Organization For Human Brain Mapping; June 23-July 3, 2020; virtual meeting. Accessed October 22, 2020. https://www.humanbrainmapping.org/files/2020/OHBM_2020_Virtual_Abstracts...