Personalized connectivity-guided DLPFC-TMS for depression: Advancing computational feasibility, precision and reproducibility.
Personalized connectivity-guided DLPFC-TMS for depression: Advancing computational feasibility, precision and reproducibility.
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个性化连接引导的DLPFC-TMS治疗抑郁症：提高计算的可行性，精度和可重复性。
DOI：
10.1002/hbm.25330
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发表时间：
2021-09
影响因子：
4.8
通讯作者：
Zalesky A
中科院分区：
文献类型：
--
作者：
Cash RFH;Cocchi L;Lv J;Wu Y;Fitzgerald PB;Zalesky A
重复经颅前额叶皮质磁刺激(RTMS)是治疗难治性抑郁症的有效方法，但治疗效果各不相同。越来越多的证据表明，临床反应与精确刺激DLPFC部位的亚膝扣带回(SGC)的功能连接有关。关键的是，SGC相关的网络结构在DLPFC的空间范围内显示出相当大的个体间差异，这表明基于连接性的靶点个体化可能是改善治疗结果的潜在必要。然而，到目前为止，准确的个性化似乎还不可行，最近的工作表明，最佳目标的个体内重复性限制在3.5厘米。在这里，我们开发了可靠和准确的方法来计算个性化的连接引导刺激目标。在对1,000名健康成年人进行的静息状态功能磁共振扫描中，我们证明，使用这种方法，可以可靠而稳健地定位个性化目标，在不同日期重复扫描之间的中位数精度为~2 mm。这些目标保持高度稳定，即使在1 年后，个体间坐标之间的中位数距离仅为2.7Min mm。个性化目标的个体间空间变异比个体内变异高出6.85倍，这表明个性化目标并不是简单地收敛到一个群体平均站点。此外，个性化的目标是可遗传的，这表明连接引导的rTMS个性化随着时间的推移是稳定的，并受基因控制。这种计算框架为个性化的连接性引导的TMS目标提供了高精度的稳健计算能力，并具有灵活地推进其他基础研究和临床应用的研究。经颅磁刺激(TMS)为难治性抑郁症提供了一种重要的治疗选择。先前的研究表明，针对特定大脑连接的个性化治疗可能会改善TMS的临床结果。在这里，我们设计了创新的方法，使这些联系能够使用TMS在特定人的水平上以前所未有的精度识别和定位。
Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) is an established treatment for refractory depression, however, therapeutic outcomes vary. Mounting evidence suggests that clinical response relates to functional connectivity with the subgenual cingulate cortex (SGC) at the precise DLPFC stimulation site. Critically, SGC‐related network architecture shows considerable interindividual variation across the spatial extent of the DLPFC, indicating that connectivity‐based target personalization could potentially be necessary to improve treatment outcomes. However, to date accurate personalization has not appeared feasible, with recent work indicating that the intraindividual reproducibility of optimal targets is limited to 3.5 cm. Here we developed reliable and accurate methodologies to compute individualized connectivity‐guided stimulation targets. In resting‐state functional MRI scans acquired across 1,000 healthy adults, we demonstrate that, using this approach, personalized targets can be reliably and robustly pinpointed, with a median accuracy of ~2 mm between scans repeated across separate days. These targets remained highly stable, even after 1 year, with a median intraindividual distance between coordinates of only 2.7 mm. Interindividual spatial variation in personalized targets exceeded intraindividual variation by a factor of up to 6.85, suggesting that personalized targets did not trivially converge to a group‐average site. Moreover, personalized targets were heritable, suggesting that connectivity‐guided rTMS personalization is stable over time and under genetic control. This computational framework provides capacity for personalized connectivity‐guided TMS targets to be robustly computed with high precision and has the flexibly to advance research in other basic research and clinical applications. Transcranial magnetic stimulation (TMS) provides an important therapeutic option for treatment resistant depression. Prior research demonstrates that clinical outcomes to TMS could likely be enhanced by personalized treatment that is targeted to specific brain connections. Here we designed innovative methodology which enables these connections to be identified and targeted using TMS at a person‐specific level with unprecedented precision.
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影响因子：
5.7
作者：
Fox MD;Liu H;Pascual-Leone A
通讯作者：
Pascual-Leone A
影响因子：
5.3
作者：
Bystritsky, Alexander;Kaplan, Jonas T.;Iacoboni, Marco
通讯作者：
Iacoboni, Marco
DOI：
10.1073/pnas.1801582115
发表时间：
2018-07-03
影响因子：
11.1
作者：
Coalson, Timothy S.;Van Essen, David C.;Glasser, Matthew F.
通讯作者：
Glasser, Matthew F.
DOI：
10.1073/pnas.1405003111
发表时间：
2014-10-14
影响因子：
11.1
作者：
Fox, Michael D.;Buckner, Randy L.;Pascual-Leone, Alvaro
通讯作者：
Pascual-Leone, Alvaro
影响因子：
19.9
作者：
Dubois J;Adolphs R
通讯作者：
Adolphs R