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Precision targeting in prediction for rTMS clinical outcome in depression: what about sgACC lateralization, metabolic connectivity, and the potential role of the cerebellum?

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Abstract

Predicting clinical response to repetitive transcranial magnetic stimulation (rTMS) in medication-resistant depression (MRD) has gained great importance in recent years. Mainly, the right subgenual anterior cingulate cortex (sgACC) functional connectivity has been put forward as biomarker in relation to rTMS clinical outcome. Even though the left and right sgACC may have different neurobiological functions, little is known about the possible lateralized predictive role of the sgACC in rTMS clinical outcome. In 43 right-handed antidepressant-free MRD patients, we applied a searchlight-based interregional covariance connectivity approach using the baseline 18FDG-PET scan—collected from two previous high-frequency (HF)-rTMS treatment studies delivering stimulation to the left dorsolateral prefrontal cortex (DLPFC)—and investigated whether unilateral or bilateral sgACC glucose metabolism at baseline would result in different predictive metabolic connectivity patterns. Regardless of sgACC lateralization, the weaker the sgACC seed-based baseline metabolic functional connections with the (left anterior) cerebellar areas, the significantly better the clinical outcome. However, the seed diameter seems to be crucial. Similar significant findings on sgACC metabolic connectivity with the left anterior cerebellum, also unrelated to sgACC lateralization, in relation to clinical outcome were observed when using the HCPex atlas. Although we could not substantiate that specifically right sgACC metabolic connectivity would predict HF-rTMS clinical outcome, our findings suggest considering the entire sgACC in functional connectivity predictions. Given that the interregional covariance connectivity results were significant only when using the Beck Depression Inventory (BDI-II) and not with the Hamilton Depression Rating Scale (HDRS), our sgACC metabolic connectivity observations also suggest the possible involvement of the (left) anterior cerebellum involved in higher-order cognitive processing as part of this predictive value.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant No. 62271415, 61876156). This work was also supported by the Queen Elisabeth Medical Foundation for Neurosciences, by the Ghent University Multidisciplinary Research Partnership “The integrative neuroscience of behavioral control”, a Grant BOF16/GOA/017 for a Concerted Research Action of Ghent University, and by an Applied Biomedical (TBM) grant of the Agency for Innovation through Science and Technology (IWT), part of the Research Foundation—Flanders (FWO) PrevenD Project 2.0 (T000720N) and FWO project G011018N.

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Authors and Affiliations

  1. Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China

    Guo-Rong Wu

  2. School of Psychology, Jiangxi Normal University, Nanchang, China

    Guo-Rong Wu

  3. Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium

    Guo-Rong Wu & Chris Baeken

  4. Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Chris Baeken

  5. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

    Chris Baeken

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Wu, GR., Baeken, C. Precision targeting in prediction for rTMS clinical outcome in depression: what about sgACC lateralization, metabolic connectivity, and the potential role of the cerebellum?. Eur Arch Psychiatry Clin Neurosci 273, 1443–1450 (2023). https://doi.org/10.1007/s00406-023-01637-3

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  • DOI: https://doi.org/10.1007/s00406-023-01637-3

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