期刊
BRAIN STIMULATION
卷 10, 期 4, 页码 787-794出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.brs.2017.03.013
关键词
MDD; rTMS; Dorsolateral prefrontal cortex; Motor cortex; Excitability; Antidepressant response prediction
资金
- Berenson-Allen Foundation
- Sidney R. Baer Jr. Foundation
- National Institutes of Health [R01HD069776, R21 NS082870, R01NS073601, R21 MH099196, R21 NS085491, R21 HD07616]
- Harvard Catalyst \ The Harvard Clinical and Translational Science Center (NCRR)
- Harvard Catalyst \ The Harvard Clinical and Translational Science Center (NCATS NIH) [UL1 RR025758]
- Fundacao para a Ciencia e Tecnologia (Portugal) from the Harvard Medical School Portugal Program [HMSP-ICJ/0020/2011]
- Fundação para a Ciência e a Tecnologia [HMSP-ICJ/0020/2011] Funding Source: FCT
Background: Repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is a treatment option for patients with medication-resistant major depressive disorder (MDD). However, antidepressant response is variable and there are currently no response predictors with sufficient accuracy for clinical use. Objective: We report on results of an observational open-label study to determine whether the modulatory effect of 10 Hz motor cortex (MC) rTMS is predictive of the antidepressant effect of 10 Hz DLPFC rTMS. Methods: Fifty-one medication-resistant MDD patients were enrolled for a 10-day treatment course of DLPFC rTMS and antidepressant response was assessed according to post-treatment reduction of the 17 item Hamilton Rating Scale for Depression score. Prior to treatment, we assessed the modulation of motor evoked potential (MEP) amplitude by MC rTMS. MEP's were induced with single TMS pulses and measured using surface electromyography. MEP modulation was calculated as the change of mean MEP amplitude after MC rTMS. Results: MEP modulation proved to be a robust predictor of reduction of clinician-rated depression severity following the course of DLPFC rTMS: larger MC rTMS-induced increase of corticospinal excitability anticipated a better antidepressant response. This was found both in univariate analyses (Spearman regression: rho = 0.43, p < 0.005) and a multivariable linear regression model (0 = 0.25, p < 0.0001) controlling for baseline depression severity, age and resting motor threshold. Conclusions: These findings suggest that MC rTMS-induced modulation of corticospinal excitability warrants further evaluation as a potential predictive biomarker of antidepressant response to left DLPFC 10 Hz rTMS. (C) 2017 Elsevier Inc. All rights reserved.
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