Functional connectivity of the anterior cingulate cortex predicts treatment outcome for rTMS in treatment-resistant depression at 3-month follow-up
Functional connectivity of the anterior cingulate cortex predicts treatment outcome for rTMS in treatment-resistant depression at 3-month follow-up
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DOI：
10.1016/j.brs.2019.10.012
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发表时间：
2020-01-01
影响因子：
7.7
通讯作者：
Vila-Rodriguez, Fidel
中科院分区：
文献类型：
--
作者：
Ge, Ruiyang;Downar, Jonathan;Vila-Rodriguez, Fidel
背景和目的：重复经颅磁刺激（rTMS）是治疗难治性抑郁症（TRD）的一线治疗方法。 rTMS 的作用机制尚不完全清楚，并且没有生物标志物可以帮助临床实践预测 rTMS 的反应。本研究旨在证明 rTMS 后临床改善与膝下扣带皮层 (sgACC) 和吻侧前扣带皮层 (rACC) 的功能连接 (FC) 变化相关，并且 sgACC 和 rACC 的 FC 可能作为治疗反应的潜在预测因子。 方法：在 rTMS 前 1 周内收集静息态功能磁共振成像 (rs-fMRI) 数据 在 50 名 TRD 患者中启动，以预测左侧背外侧前额叶皮层 (DLPFC) 对 rTMS 的后续反应。 rTMS 完成后 12 周获得随访 rs-fMRI，并将 sgACC 和 rACC 相关 FC 模式中 rTMS 的神经相关性与之前的 rTMS 数据以及健康参与者的 rs-fMRI 进行比较。 结果：治疗反应与基线时测量的 sgACC 相对于右侧 DLPFC 的较低 FC 和较高的 rACC 到左侧顶叶皮层 (IPL) 的 FC 相关。使用 sgACC-DLPFC 和 rACC-IPL 连接作为特征，应答者-无应答者分类准确率分别为 84% 和 76%（治疗结束）、88% 和 81%（3 个月随访）。纵向rs-fMRI数据分析显示，sgACC和视皮层之间的超连接性已标准化至与健康参与者相当的水平。结论：抑郁症患者的大脑活动模式可预测rTMS的治疗反应，rTMS后相关脑回路中大脑活动的纵向变化与抑郁症的治疗反应相关。目标参与范式可能会通过最佳选择治疗患者来提高 rTMS 在 TRD 中的疗效。 (c) 2019 Elsevier Inc。这是一篇基于 CC BY-NC-ND 许可证 (http://creativecommons.org/licenses/by-nc-nd/4.0/) 的开放获取文章。
Background and objective: Repetitive transcranial magnetic stimulation (rTMS) is a first-line treatment for treatment-resistant depression (TRD). The mechanisms of action of rTMS are not fully understood, and no biomarkers are available to assist in clinical practice to predict response to rTMS. This study aimed to demonstrate that after-rTMS clinical improvement is associated with functional connectivity (FC) changes of the subgenual cingulate cortex (sgACC) and rostral anterior cingulate (rACC), and FC of sgACC and rACC might serve as potential predictors for treatment response.Methods: Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected within 1 week before rTMS initiation in 50 TRD patients to predict subsequent response to rTMS on the left dorsolateral prefrontal cortex (DLPFC). Follow-up rs-fMRI was obtained 12 weeks after completion of rTMS and neural correlates of rTMS in sgACC- and rACC-related FC patterns were compared to before rTMS data and with rs-fMRI from healthy participants.Results: Treatment response was associated with lower FC of sgACC to right DLPFC and higher FC of rACC to left lateral parietal cortex (IPL) measured at baseline. Using sgACC-DLPFC and rACC-IPL connectivity as features, responder-nonresponder classification accuracies of 84% and 76% (end-of-treatment), 88% and 81% (3-month follow-up), respectively were achieved. Longitudinal rs-fMRI data analyses revealed that the hyperconnectivity between sgACC and visual cortex was normalized to a level which was comparable to that of healthy participants.Conclusions: Brain activity patterns in depression are predictive of treatment response to rTMS, and longitudinal change of brain activity in relevant brain circuits after rTMS is associated with treatment response in depression. Target engagement paradigms may offer opportunities to increase the efficacy of rTMS in TRD by optimal selection of patients for treatment. (c) 2019 Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).