Functional Connectivity Mapping for rTMS Target Selection in Depression.
Functional Connectivity Mapping for rTMS Target Selection in Depression.
复制标题
抑郁症 rTMS 目标选择的功能连接映射。
DOI：
10.1176/appi.ajp.20220306
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Liston,Conor
中科院分区：
文献类型：
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作者：
Elbau,ImmanuelG;Lynch,CharlesJ;Downar,Jonathan;Vila-Rodriguez,Fidel;Power,JonathanD;Solomonov,Nili;Daskalakis,ZafirisJ;Blumberger,DanielM;Liston,Conor
目的越来越多的经颅磁刺激（rTMS）方案使用亚属前扣带皮层（sgACC）功能连通性来个性化治疗目标。然而，这种方法的有效性尚不清楚，研究结果相互矛盾，不同研究的效果大小也不同。在这里，作者研究了刺激部位与sgACC的功能连接（sgACC- stimfc）对295名重度抑郁症患者rTMS治疗结果的影响。方法通过接受大量功能性MRI测试的个体数据验证了估计sgACC功能连通性的可靠性和准确性。电场模型用于分析sgarc - stimfc与临床改善之间的关联，并通过标准化评估评估异质性的来源。结果基于假设的方法提供了可靠、准确的sgACC功能连通性估计。治疗反应与sgACC-StimFC呈弱但强相关（r= - 0.16），但仅当使用电场模型识别受刺激皮层时才如此。令人惊讶的是，这种关联是由由特定周期性呼吸模式引起的强烈全球信号波动患者驱动的（r= - 0.49）。sgACC和受刺激皮层之间的功能连接与治疗结果的个体差异相关，但这种关联比之前研究中观察到的要弱，并且在扫描中具有明显呼吸相关信号模式的患者亚组中得到强调。这些发现表明，在大量重度抑郁症患者的代表性样本中，sgACC-StimFC的个体差异仅解释了结果差异的约3%，这可能限制了现有的基于sgacc的靶向治疗方案的效用。然而，这些数据也提供了强有力的证据，证明了一个真实的（尽管影响很小）效应，并强调了将额外的功能连接措施纳入rTMS响应模型的机会，该模型具有增强的预测能力。
ObjectiveRepetitive transcranial magnetic stimulation (rTMS) protocols increasingly use subgenual anterior cingulate cortex (sgACC) functional connectivity to individualize treatment targets. However, the efficacy of this approach is unclear, with conflicting findings and varying effect sizes across studies. Here, the authors investigated the effect of the stimulation site’s functional connectivity with the sgACC (sgACC-StimFC) on treatment outcome to rTMS in 295 patients with major depression.MethodsThe reliability and accuracy of estimating sgACC functional connectivity were validated with data from individuals who underwent extensive functional MRI testing. Electric field modeling was used to analyze associations between sgACC-StimFC and clinical improvement using standardized assessments and to evaluate sources of heterogeneity.ResultsAn imputation-based method provided reliable and accurate sgACC functional connectivity estimates. Treatment responses weakly but robustly correlated with sgACC-StimFC (r=−0.16), but only when the stimulated cortex was identified using electric field modeling. Surprisingly, this association was driven by patients with strong global signal fluctuations stemming from a specific periodic respiratory pattern (r=−0.49).ConclusionsFunctional connectivity between the sgACC and the stimulated cortex was correlated with individual differences in treatment outcomes, but the association was weaker than those observed in previous studies and was accentuated in a subgroup of patients with distinct, respiration-related signal patterns in their scans. These findings indicate that in a large representative sample of patients with major depressive disorder, individual differences in sgACC-StimFC explained only ∼3% of the variance in outcomes, which may limit the utility of existing sgACC-based targeting protocols. However, these data also provide strong evidence for a true—albeit small—effect and highlight opportunities for incorporating additional functional connectivity measures to generate models of rTMS response with enhanced predictive power.