Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression
IntroductionPrevious studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term...
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Neural Circuits |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fncir.2023.1161826/full |
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| author | Camila Cosmo Camila Cosmo Amin Zandvakili Amin Zandvakili Nicholas J. Petrosino Nicholas J. Petrosino Thaise Graziele L. de O. Toutain José Garcia Vivas Miranda Noah S. Philip Noah S. Philip |
| author_facet | Camila Cosmo Camila Cosmo Amin Zandvakili Amin Zandvakili Nicholas J. Petrosino Nicholas J. Petrosino Thaise Graziele L. de O. Toutain José Garcia Vivas Miranda Noah S. Philip Noah S. Philip |
| author_sort | Camila Cosmo |
| collection | DOAJ |
| description | IntroductionPrevious studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course.MethodsA total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-item Inventory of Depressive Symptoms-Self Report (IDS-SR).ResultsWe found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course.DiscussionOur findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response. |
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| institution | Directory Open Access Journal |
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| last_indexed | 2024-04-09T14:42:57Z |
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| spelling | doaj.art-f5888dc019e1407488bff4cebdc31af92023-05-03T04:54:59ZengFrontiers Media S.A.Frontiers in Neural Circuits1662-51102023-05-011710.3389/fncir.2023.11618261161826Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depressionCamila Cosmo0Camila Cosmo1Amin Zandvakili2Amin Zandvakili3Nicholas J. Petrosino4Nicholas J. Petrosino5Thaise Graziele L. de O. Toutain6José Garcia Vivas Miranda7Noah S. Philip8Noah S. Philip9Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United StatesVA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United StatesDepartment of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United StatesVA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United StatesDepartment of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United StatesVA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United StatesInstitute of Health Sciences, Federal University of Bahia, Salvador, BrazilInstitute of Physics, Federal University of Bahia, Salvador, BrazilDepartment of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, United StatesVA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, United StatesIntroductionPrevious studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course.MethodsA total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-item Inventory of Depressive Symptoms-Self Report (IDS-SR).ResultsWe found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course.DiscussionOur findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response.https://www.frontiersin.org/articles/10.3389/fncir.2023.1161826/fullfunctional cortical networksrepetitive transcranial magnetic stimulation (rTMS)non-invasive brain stimulation (NIBS)pharmacoresistant depressiontreatment-resistant depression (TRD)qEEG |
| spellingShingle | Camila Cosmo Camila Cosmo Amin Zandvakili Amin Zandvakili Nicholas J. Petrosino Nicholas J. Petrosino Thaise Graziele L. de O. Toutain José Garcia Vivas Miranda Noah S. Philip Noah S. Philip Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression Frontiers in Neural Circuits functional cortical networks repetitive transcranial magnetic stimulation (rTMS) non-invasive brain stimulation (NIBS) pharmacoresistant depression treatment-resistant depression (TRD) qEEG |
| title | Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| title_full | Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| title_fullStr | Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| title_full_unstemmed | Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| title_short | Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| title_sort | examining the neural mechanisms of rtms a naturalistic pilot study of acute and serial effects in pharmacoresistant depression |
| topic | functional cortical networks repetitive transcranial magnetic stimulation (rTMS) non-invasive brain stimulation (NIBS) pharmacoresistant depression treatment-resistant depression (TRD) qEEG |
| url | https://www.frontiersin.org/articles/10.3389/fncir.2023.1161826/full |
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