Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm for imaging-guided intervention
Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm for imaging-guided intervention
复制标题
DOI：
10.1016/j.neuroimage.2016.12.083
复制
发表时间：
2017-03-01
期刊：
影响因子：
5.7
通讯作者：
Strauman, Timothy J.
中科院分区：
文献类型：
--
作者：
Luber, Bruce M.;Davis, Simon;Strauman, Timothy J.
使用重复经颅磁刺激（rTMS）治疗重度抑郁症（MDD）的标准临床技术迄今为止疗效有限。这种有限的疗效可能是由于依赖于基于头皮的靶向，而不是基于神经回路功能障碍的特定模型结合fMRI引导的神经导航的科学方法。在这篇综述中，我们研究了这样一个特定的模型来自调节焦点理论，假设两个大脑/行为系统，促进和预防系统，潜在的目标追求。这些系统中的个体差异已被证明可以预测MDD的易感性以及共病广泛性焦虑症（GAD）。通过启动激活个人的促进或预防目标，导致由个人对实现目标的进展的评价调制的动机和情感反应。此外，启动促进与预防目标诱导可辨别的大脑激活模式，这些模式对抑郁和焦虑的影响敏感：MDD与促进系统失败、快感缺乏/烦躁症状和左前额叶皮层特定区域的低激活相关，而GAD与预防系统失败、过度警惕/激动症状和右前额叶皮层（PFC）的过度激活相关。这些左侧和右侧PFC位置可以以个性化的方式直接针对TMS。此外，这种单独靶向的rTMS可以与旨在激活与促进与预防相关的神经回路的认知干预相结合，从而允许由rTMS诱导的神经可塑性使可能参与治疗抑郁症的系统受益。有针对性地参与情绪调节的皮质系统使用个性化的fMRI指导可能有助于提高抑郁症的rTMS的疗效。
The standard clinical technique for using repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) is associated with limited efficacy to date. Such limited efficacy may be due to reliance on scalp-based targeting rather than state-of-the-science methods which incorporate fMRI-guided neuronavigation based on a specific model of neurocircuit dysfunction. In this review, we examine such a specific model drawn from regulatory focus theory, which postulates two brain/behavior systems, the promotion and prevention systems, underlying goal pursuit. Individual differences in these systems have been shown to predict vulnerability to MDD as well as to comorbid generalized anxiety disorder (GAD). Activation of an individual's promotion or prevention goals via priming leads to motivational and affective responses modulated by the individual's appraisal of their progress in attaining the goal. In addition, priming promotion vs. prevention goals induces discriminable patterns of brain activation that are sensitive to the effects of depression and anxiety: MDD is associated with promotion system failure, anhedonic/dysphoric symptoms, and hypoactivation in specific regions in left prefrontal cortex, whereas GAD is associated with prevention system failure, hypervigilant/agitated symptoms, and hyperactivation in right prefrontal cortex (PFC). These left and right PFC locations can be directly targeted in an individualized manner for TMS. Additionally, this individually targeted rTMS can be integrated with cognitive interventions designed to activate the neural circuitry associated with promotion vs. prevention, thus allowing the neuroplasticity induced by the rTMS to benefit the systems likely to be involved in remediating depression. Targeted engagement of cortical systems involved in emotion regulation using individualized fMRI guidance may help increase the efficacy of rTMS in depression.