Effects of transcranial direct current stimulation for treating depression: A modeling study
Effects of transcranial direct current stimulation for treating depression: A modeling study
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DOI：
10.1016/j.jad.2018.02.077
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发表时间：
2018-07-01
影响因子：
6.6
通讯作者：
Mittner, Matthias
中科院分区：
文献类型：
--
作者：
Csifcsak, Gabor;Boayue, Nya Mehnwolo;Mittner, Matthias
背景：经颅直流电刺激左侧背外侧前额叶皮质(LDLPFC)已广泛用于改善重度抑郁障碍(MDD)的症状。然而，在包括患者数据在内的大样本中，不同刺激方案对整个额叶的影响还没有得到研究。方法：我们使用了38个头部模型，这些模型来自19名健康成人和19名MDD患者的结构磁共振成像数据，并应用计算模型来模拟tDCS20个额区的诱发电场(EFS)的空间分布。我们评估了7个双极和2个多电极4×1 tdcs协议的效果。结果：对于双极蒙太奇，电刺激在lDLPFC和内侧前额叶皮质(MPFC)具有相同的强度。根据刺激参数的不同，EF皮质图有相当大的差异，但在对照组和患者中发现相似。4x1蒙太奇产生了更多的局部化效果，但效果较弱。限制：没有对白质各向异性进行建模。结论：除刺激LDLPFC外，MPFC的兴奋性变化也应被认为是双相蒙太奇临床疗效的潜在机制。MDD相关的解剖变异不太可能对电流产生实质性影响。对tdcs协议进行单独建模可以显著提高皮质靶向性。我们建议未来的研究明确测试lDLPFC和MPFC刺激对这种疾病的tDDC治疗结果的贡献。
Background: Transcranial direct current stimulation (tDCS) above the left dorsolateral prefrontal cortex (lDLPFC) has been widely used to improve symptoms of major depressive disorder (MDD). However, the effects of different stimulation protocols in the entire frontal lobe have not been investigated in a large sample including patient data.Methods: We used 38 head models created from structural magnetic resonance imaging data of 19 healthy adults and 19 MDD patients and applied computational modeling to simulate the spatial distribution of tDCS-induced electric fields (EFs) in 20 frontal regions. We evaluated effects of seven bipolar and two multi-electrode 4 x 1 tDCS protocols.Results: For bipolar montages, EFs were of comparable strength in the lDLPFC and in the medial prefrontal cortex (MPFC). Depending on stimulation parameters, EF cortical maps varied to a considerable degree, but were found to be similar in controls and patients. 4 x 1 montages produced more localized, albeit weaker effects.Limitations: White matter anisotropy was not modeled. The relationship between EF strength and clinical response to tDCS could not be evaluated.Conclusions: In addition to lDLPFC stimulation, excitability changes in the MPFC should also be considered as a potential mechanism underlying clinical efficacy of bipolar montages. MDD-associated anatomical variations are not likely to substantially influence current flow. Individual modeling of tDCS protocols can substantially improve cortical targeting. We make recommendations for future research to explicitly test the contribution of lDLPFC vs. MPFC stimulation to therapeutic outcomes of tDCS in this disorder.