Objective:

The study objective was to investigate the predictive value of functional connectivity changes induced by acute repetitive transcranial magnetic stimulation (rTMS) for clinical response in treatment-resistant depression.

Methods:

Cross-sectional changes in functional connectivity induced by a single concurrent rTMS-fMRI session were assessed in 38 outpatients with treatment-resistant depression (26 of them female; mean age, 41.87 years) who subsequently underwent a 4-week course of rTMS. rTMS was delivered at 1 Hz over the right dorsolateral prefrontal cortex. Acute rTMS-induced functional connectivity changes were computed and subjected to connectome-based predictive modeling to test their association with changes in score on the Montgomery-Åsberg Depression Rating Scale (MADRS) after rTMS treatment.

Results:

TMS-fMRI induced widespread, acute, and transient alterations in functional connectivity. The rTMS-induced connectivity changes predicted about 30% of the variance of improvement in the MADRS score. The most robust predictive associations involved connections between prefrontal regions and motor, parietal, and insular cortices and between bilateral regions of the thalamus.

Conclusions:

Acute rTMS-induced connectivity changes in patients with treatment-resistant depression may index macro-level neuroplasticity, relevant to interindividual variability in rTMS treatment response. Large-scale network phenomena occurring during rTMS might be used to inform prospective clinical trials.

中文翻译：

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对 rTMS 的急性神经可塑性反应在抑郁症治疗结果中的预测价值：同时进行的 TMS-fMRI 试验

客观的：

研究目的是研究急性重复经颅磁刺激 (rTMS) 诱导的功能连接变化对难治性抑郁症临床反应的预测价值。

方法：

对 38 名患有难治性抑郁症的门诊患者（其中 26 名女性；平均年龄 41.87 岁）随后接受了为期 4 周的 rTMS 疗程，评估了由单次并发 rTMS-fMRI 会话引起的功能连接的横截面变化。rTMS 以 1 Hz 的频率在右背外侧前额叶皮层传送。计算急性 rTMS 引起的功能连接变化，并进行基于连接组的预测模型，以测试它们与 rTMS 治疗后蒙哥马利-埃斯伯格抑郁评定量表 (MADRS) 评分变化的关联。

结果：

TMS-fMRI 在功能连接中引起广泛、急性和短暂的改变。rTMS 引起的连通性变化预测了 MADRS 评分改善方差的约 30%。最强大的预测关联涉及前额区域与运动、顶叶和岛叶皮质之间以及丘脑双侧区域之间的联系。

结论：

难治性抑郁症患者的急性 rTMS 诱导的连通性变化可能表明宏观水平的神经可塑性，这与 rTMS 治疗反应的个体间变异性有关。rTMS 期间发生的大规模网络现象可用于为前瞻性临床试验提供信息。