Elsevier

Brain Stimulation

Volume 8, Issue 2, March–April 2015, Page 396
Brain Stimulation

Resting-state functional connectivity to subgenual cingulate cortex differentially predicts treatment response for 10 Hz versus intermittent theta-burst rTMS in major depression

https://doi.org/10.1016/j.brs.2015.01.265Get rights and content

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Background

In a concurrently submitted abstract, we recently found similar rates of response (∼40%) and remission (∼20%) for 3 min intermittent theta-burst (iTBS) vs. 37.5 min conventional 10 Hz rTMS of the left dorsolateral prefrontal cortex (DLPFC) in major depressive disorder (MDD). Recent studies have identified neural predictors of rTMS treatment outcome based on resting-state functional connectivity (rsFC) on pre-treatment fMRI. However, it is unclear whether these predictors apply similarly or

Objective

To compare rsFC predictors of outcome for iTBS versus conventional 10 Hz DLPFC-rTMS in MDD.

Methods

In a preliminary sample of 93 MDD patients randomized to undergo 20-30 sessions of iTBS or 10 Hz DLPFC-rTMS under MRI guidance (X-38 Y+44 Z+26), we performed T1 anatomical and 10 min resting-state fMRI series 1 week prior to treatment. We then used the target as a seed to construct whole-brain DLPFC-rsFC maps. A second-level analysis then compared patterns of DLPFC-rsFC in responders to iTBS versus responders to 10 Hz rTMS.

Results

There were no brain areas whose DLPFC-rsFC significantly predicted response across both the 10 Hz and the iTBS groups. Across the whole brain, only a single cortical area showed differential patterns of DLPFC-rsFC in iTBS versus 10 Hz responders: the subgenual cingulate cortex, bilaterally.

Conclusions

Although both iTBS and 10 Hz rTMS yield statistically similar proportions of responders in MDD, at the neural level these responder fractions appear to have distinct characteristics. Specifically, pre-treatment DLPFC-subgenual cingulate rsFC appears different in iTBS responders versus 10 Hz responders. No patterns of DLPFC-rsFC significantly predicted treatment response across both groups. These findings suggest that iTBS and 10 Hz rTMS may actually treat distinct subpopulations of MDD

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