Does 18 Hz deep TMS benefit a different subgroup of depressed patients relative to 10 Hz rTMS? The role of the individual alpha frequency

IF 6.1 2区医学 Q1 CLINICAL NEUROLOGY

European Neuropsychopharmacology Pub Date : 2024-10-12 DOI:10.1016/j.euroneuro.2024.09.007

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引用次数: 0

Abstract

Both 10 Hz repetitive transcranial magnetic stimulation (rTMS) as well as 18 Hz deep TMS (dTMS) constitute effective, FDA-approved TMS treatment protocols for depression. However, not all patients experience sufficient symptom relief after either of these protocols. Biomarker-guided treatment stratification could aid in personalizing treatment and thereby enhancing improvement. An individual alpha frequency (iAF)-based EEG-biomarker, Brainmarker-I, can differentially stratify patients to depression treatments. For instance, an iAF close to 10 Hz was associated with better improvement to 10 Hz rTMS, possibly reflecting entrainment of endogenous oscillations to the stimulation frequency.

Accordingly, we examined whether 18 Hz dTMS would result in better improvement in individuals whose iAF lies around 9 Hz, a harmonic frequency of 18 Hz.

Curve fitting and regression analyses were conducted to assess the relation between iAF and improvement. For treatment stratification purposes, correlations with iAF-distance to 10 Hz compared 18 Hz dTMS (N = 114) to 10 Hz rTMS (N = 72).

We found a robust quadratic effect, indicating that patients with an iAF around 9 Hz exhibited least symptom improvement (r²=0.126, p<.001). Improvement correlated positively with iAF-distance to 10 Hz (p=.003). A secondary analysis in 20 Hz figure-of-eight data confirmed this direction. A significant interaction of iAF-distance and stimulation frequency between 10 and 18 Hz datasets emerged (p=.026).

These results question entrainment of endogenous oscillations by their harmonic frequency for 18 Hz, and suggest that 10 Hz and 18 Hz TMS target different subgroups of depression patients. This study adds to iAF stratification, augmenting Brainmarker-I with alternative TMS protocols (18 Hz/20 Hz) for patients with a slower iAF, thereby broadening clinical applicability and relevance of the biomarker.

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与 10 赫兹经颅磁刺激相比，18 赫兹深部经颅磁刺激是否能使不同亚组的抑郁症患者受益？个体阿尔法频率的作用

10 赫兹重复经颅磁刺激（rTMS）和 18 赫兹深部经颅磁刺激（dTMS）都是经美国食品及药物管理局批准的有效抑郁症经颅磁刺激治疗方案。然而，并非所有患者在接受这两种治疗方案后症状都能得到充分缓解。以生物标志物为指导的治疗分层有助于个性化治疗，从而改善病情。基于个体α频率（iAF）的脑电图生物标志物--Brainmarker-I，可以对抑郁症患者进行分层治疗。例如，iAF接近10赫兹与10赫兹经颅磁刺激的改善效果更佳相关，这可能反映了内源性振荡对刺激频率的诱导作用。因此，我们研究了iAF位于9赫兹（18赫兹的谐波频率）附近的个体，18赫兹经颅磁刺激是否会带来更好的改善效果。出于治疗分层的目的，将 18 赫兹经颅磁刺激（N = 114）与 10 赫兹经颅磁刺激（N = 72）进行了比较。我们发现了一个强有力的二次效应，表明 iAF 在 9 赫兹左右的患者症状改善最少（r2=0.126，p<.001）。改善程度与 iAF 与 10 赫兹的距离呈正相关（p=.003）。对 20 赫兹八位数数据的二次分析证实了这一方向。在10赫兹和18赫兹数据集之间，iAF-距离与刺激频率之间出现了明显的交互作用（p=.026）。这些结果质疑了18赫兹谐波频率对内源性振荡的诱导作用，并表明10赫兹和18赫兹TMS针对的是不同的抑郁症患者亚群。这项研究为iAF分层增添了新的内容，为iAF较慢的患者提供了可供选择的TMS方案（18赫兹/20赫兹）来增强Brainmarker-I，从而扩大了生物标记的临床适用性和相关性。

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来源期刊

European Neuropsychopharmacology 医学-精神病学

CiteScore

10.30

自引率

5.40%

发文量

730

审稿时长

41 days

期刊介绍： European Neuropsychopharmacology is the official publication of the European College of Neuropsychopharmacology (ECNP). In accordance with the mission of the College, the journal focuses on clinical and basic science contributions that advance our understanding of brain function and human behaviour and enable translation into improved treatments and enhanced public health impact in psychiatry. Recent years have been characterized by exciting advances in basic knowledge and available experimental techniques in neuroscience and genomics. However, clinical translation of these findings has not been as rapid. The journal aims to narrow this gap by promoting findings that are expected to have a major impact on both our understanding of the biological bases of mental disorders and the development and improvement of treatments, ideally paving the way for prevention and recovery.