Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial.
Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial.
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DOI：
10.1016/j.brs.2012.02.003
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发表时间：
2013-03
影响因子：
7.7
通讯作者：
Nahas, Ziad
中科院分区：
文献类型：
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作者：
Johnson, Kevin A.;Baig, Mirza;Ramsey, Dave;Lisanby, Sarah H.;Avery, David;McDonald, William M.;Li, Xingbao;Bernhardt, Elisabeth R.;Haynor, David R.;Holtzheimer, Paul E., III;Sackeim, Harold A.;George, Mark S.;Nahas, Ziad
关键词：
运动皮层定位和运动阈值确定通常指导经颅磁刺激（TMS）放置和非运动脑刺激的强度设置。然而，解剖变异性导致放置和有效强度的变异性。OPT-TMS研究的研究后分析审查了刺激的最终定位和有效强度（考虑相对前额头皮-皮层距离）。我们在一项左前额叶经颅磁刺激治疗抑郁症的多中心试验中获得了185例患者的MRI扫描。扫描有标记的运动部位（经颅磁刺激定位）和标记的前额叶部位（根据“5 cm规则”，运动皮层前5 cm）。根据首次治疗前进行的目视测定，TMS治疗发生在5 cm位置或向前调整1 cm。刺激强度为静息运动阈值的120%。“5 cm规则”会将刺激置于9%的患者的运动前皮层，经过调整后减少到4%。我们没有发现体位对缓解的统计学显著影响，但没有运动前刺激患者获得缓解（0/7）。有效刺激范围为运动阈值的93-156%，在此范围内未诱导癫痫发作。患者在有效刺激强度为运动阈值的93-146%范围内缓解，我们没有发现有效强度对缓解的显著影响。我们的数据表明，个性化的定位方法是有用的，以减少在放置的变化。以120%运动阈值进行刺激，未调整头皮-皮层距离，似乎对广泛的患者是安全的。
Motor cortex localization and motor threshold determination often guide Transcranial Magnetic Stimulation (TMS) placement and intensity settings for non-motor brain stimulation. However, anatomic variability results in variability of placement and effective intensity. Post-study analysis of the OPT-TMS Study reviewed both the final positioning and the effective intensity of stimulation (accounting for relative prefrontal scalp-cortex distances). We acquired MRI scans of 185 patients in a multi-site trial of left prefrontal TMS for depression. Scans had marked motor sites (localized with TMS) and marked prefrontal sites (5 cm anterior of motor cortex by the “5 cm rule”). Based on a visual determination made before the first treatment, TMS therapy occurred either at the 5 cm location or was adjusted 1 cm forward. Stimulation intensity was 120% of resting motor threshold. The “5 cm rule” would have placed stimulation in premotor cortex for 9% of patients, which was reduced to 4% with adjustments. We did not find a statistically significant effect of positioning on remission, but no patients with premotor stimulation achieved remission (0/7). Effective stimulation ranged from 93–156% of motor threshold, and no seizures were induced across this range. Patients experienced remission with effective stimulation intensity ranging from 93–146% of motor threshold, and we did not find a significant effect of effective intensity on remission. Our data indicates that individualized positioning methods are useful to reduce variability in placement. Stimulation at 120% of motor threshold, unadjusted for scalp-cortex distances, appears safe for a broad range of patients.
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影响因子：
7.7
作者：
Anderson, Berry S.;Kavanagh, Katie;Borckardt, Jeffrey J.;Nahas, Ziad H.;Kose, Samet;Lisanby, Sarah H.;McDonald, William M.;Avery, David;Sackeim, Harold A.;George, Mark S.
通讯作者：
George, Mark S.
影响因子：
1.3
作者：
COLLINS, DL;NEELIN, P;EVANS, AC
通讯作者：
EVANS, AC
影响因子：
3.4
作者：
Kähkönen, S;Komssi, S;Ilmoniemi, RJ
通讯作者：
Ilmoniemi, RJ
影响因子：
10.6
作者：
Bohning, DE;Shastri, A;George, MS
通讯作者：
George, MS
影响因子：
--
作者：
George, Mark S.;Lisanby, Sarah H.;Sackeim, Harold A.
通讯作者：
Sackeim, Harold A.