Depression core network-based individualized targeting for transcranial magnetic stimulation
Background: Transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for major depressive disorder (MDD). Recent attempts to improve TMS efficacy by individually targeting DLPFC subregions that are functionally connected to the subgenual anter...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-03-01
|
| Series: | Brain Stimulation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X23017059 |
| _version_ | 1797832789532344320 |
|---|---|
| author | Tuukka T. Raij Emma Komulainen Dogu Baran Aydogan Siina Pamilo Erkki Isometsä Tommi Raij |
| author_facet | Tuukka T. Raij Emma Komulainen Dogu Baran Aydogan Siina Pamilo Erkki Isometsä Tommi Raij |
| author_sort | Tuukka T. Raij |
| collection | DOAJ |
| description | Background: Transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for major depressive disorder (MDD). Recent attempts to improve TMS efficacy by individually targeting DLPFC subregions that are functionally connected to the subgenual anterior cingulate cortex (sgACC) appear promising. However, sgACC covers only a small subset of core MDD-related areas. Further, fMRI connectivity of sgACC is poorly repeatable within subjects. Methods: Based on an fMRI database analysis, we first constructed a novel core network model (CNM), capturing voxelwise emotion regulation- and MDD-related DLPFC connectivity. Then, in a sample of 15 healthy subjects and 29 MDD patients, we assessed (i) within-subject repeatability of the DLPFC connectivity patterns computed from time segments of varying lengths of individual-level fMRI data and (ii) association of MDD severity with the individual DLPFC connectivity strengths. We extracted group-level connectivity strengths in CNM from individual DLPFC coordinates stimulated with neuronavigated TMS in a separate sample of 25 MDD patients. These connectivity strengths were then correlated with individual TMS efficacy. Results: Compared with sgACC connectivity, CNM increased intraindividual repeatability 5-fold. DLPFC connectivity strength from CNM was associated with MDD severity and TMS efficacy. While the locations of CNM-based individual TMS targets remained constant within individuals, they varied considerably between individuals. Conclusions: CNM increased repeatability of functional targeting to a clinically feasible level. The observed association of MDD severity and TMS efficacy with DLPFC connectivity supports the validity of the CNM. The interindividual differences in target locations motivate future individualized clinical trials leveraging the CNM. |
| first_indexed | 2024-04-09T14:13:26Z |
| format | Article |
| id | doaj.art-ba74c122e1a047abb9ce3209b74bd390 |
| institution | Directory Open Access Journal |
| issn | 1935-861X |
| language | English |
| last_indexed | 2024-04-09T14:13:26Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj.art-ba74c122e1a047abb9ce3209b74bd3902023-05-06T04:37:22ZengElsevierBrain Stimulation1935-861X2023-03-01162619627Depression core network-based individualized targeting for transcranial magnetic stimulationTuukka T. Raij0Emma Komulainen1Dogu Baran Aydogan2Siina Pamilo3Erkki Isometsä4Tommi Raij5Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland; Corresponding author. Department of Psychiatry, Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Finland.Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, FinlandDepartment of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, Finland; A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, FinlandDepartment of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, P.O Box 13000, FI-00076, AALTO, Espoo, FinlandDepartment of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FI-00029, HUS, Helsinki, FinlandAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USABackground: Transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for major depressive disorder (MDD). Recent attempts to improve TMS efficacy by individually targeting DLPFC subregions that are functionally connected to the subgenual anterior cingulate cortex (sgACC) appear promising. However, sgACC covers only a small subset of core MDD-related areas. Further, fMRI connectivity of sgACC is poorly repeatable within subjects. Methods: Based on an fMRI database analysis, we first constructed a novel core network model (CNM), capturing voxelwise emotion regulation- and MDD-related DLPFC connectivity. Then, in a sample of 15 healthy subjects and 29 MDD patients, we assessed (i) within-subject repeatability of the DLPFC connectivity patterns computed from time segments of varying lengths of individual-level fMRI data and (ii) association of MDD severity with the individual DLPFC connectivity strengths. We extracted group-level connectivity strengths in CNM from individual DLPFC coordinates stimulated with neuronavigated TMS in a separate sample of 25 MDD patients. These connectivity strengths were then correlated with individual TMS efficacy. Results: Compared with sgACC connectivity, CNM increased intraindividual repeatability 5-fold. DLPFC connectivity strength from CNM was associated with MDD severity and TMS efficacy. While the locations of CNM-based individual TMS targets remained constant within individuals, they varied considerably between individuals. Conclusions: CNM increased repeatability of functional targeting to a clinically feasible level. The observed association of MDD severity and TMS efficacy with DLPFC connectivity supports the validity of the CNM. The interindividual differences in target locations motivate future individualized clinical trials leveraging the CNM.http://www.sciencedirect.com/science/article/pii/S1935861X23017059Transcranial magnetic stimulationTargetingFunctional magnetic resonance imagingMajor depressive disorderEmotion regulation |
| spellingShingle | Tuukka T. Raij Emma Komulainen Dogu Baran Aydogan Siina Pamilo Erkki Isometsä Tommi Raij Depression core network-based individualized targeting for transcranial magnetic stimulation Brain Stimulation Transcranial magnetic stimulation Targeting Functional magnetic resonance imaging Major depressive disorder Emotion regulation |
| title | Depression core network-based individualized targeting for transcranial magnetic stimulation |
| title_full | Depression core network-based individualized targeting for transcranial magnetic stimulation |
| title_fullStr | Depression core network-based individualized targeting for transcranial magnetic stimulation |
| title_full_unstemmed | Depression core network-based individualized targeting for transcranial magnetic stimulation |
| title_short | Depression core network-based individualized targeting for transcranial magnetic stimulation |
| title_sort | depression core network based individualized targeting for transcranial magnetic stimulation |
| topic | Transcranial magnetic stimulation Targeting Functional magnetic resonance imaging Major depressive disorder Emotion regulation |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X23017059 |
| work_keys_str_mv | AT tuukkatraij depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation AT emmakomulainen depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation AT dogubaranaydogan depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation AT siinapamilo depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation AT erkkiisometsa depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation AT tommiraij depressioncorenetworkbasedindividualizedtargetingfortranscranialmagneticstimulation |