Background: rTMS to left DLPFC is an effective treatment for depression, but optimal targeting approaches remain undetermined.We used surface-based brain reconstruction based upon the Human Connectome Project Multimodal Parcellation atlas (HCP-MMP1.0)to determine individualized treatment targets for open-label rTMS.Methods: Data was obtained from 15 individuals with moderate to severe depression resistant to at least two adequate antidepressant trials, of whom 11 received rTMS targeting the group-mean peak anticorrelated region to sgACC refined as the junction of parcels 46, 9-46d and 9-46v, with 4 receiving treatment targeting the middle of parcel 46.Pre-treatment MADRS scores (mean SEM) were 30.9 1.7 and 33.32.5, respectively.All individuals received standard 10-Hz rTMS for 6-weeks.Resting-state fMRI was obtained prior to and following treatment.Results: Among patients receiving junction-targeted rTMS, there was a 57.89.6% reduction in MADRS total score.Response and remission rates were 72.7% and 54.5%, respectively.Pre-treatment anti-correlation between parcel 46 and sgACC significantly predicted treatment response with area under the ROC curve of.875.110and sensitivity/specificity of.75 and 1.0 at maximal discrimination.For remission, the AUC was 1.0.Targeting the midpoint of parcel 46 produced a mean reduction if 38.219.3%, with a response rate of 25%.Discussion: These findings demonstrate feasibility of individual, parcel-guided rTMS and suggest response/remission rates similar to that observed using individualized localization of the peak anticorrelated region.Parcel-based RSFC calculations between DLPFC (parcel 46) and sgACC strongly predicted treatment response, suggesting that baseline patient characteristics may be as critical as targeting approaches for predicting treatment response.
Berman et al. (Mon,) studied this question.