Journal article
A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness
Brain stimulation, Vol.16(5), pp.1392-1400
09/13/2023
DOI: 10.1016/j.brs.2023.09.006
PMCID: PMC11095825
PMID: 37714408
Abstract
The Beam F3 and 5.5 cm methods are the two most common targeting strategies for localizing the left dorsolateral prefrontal cortex (DLPFC) treatment site in repetitive transcranial magnetic stimulation (rTMS) protocols. This prospective, randomized, double-blind comparative effectiveness trial assesses the clinical outcomes for these two methods in a naturalistic sample of patients with major depressive disorder (MDD) undergoing clinical rTMS treatment.
105 adult patients with MDD (mean age = 43.2; range = 18–73; 66% female) were randomized to receive rTMS to the Beam F3 (n = 58) or 5.5 cm (n = 47) target. Between group differences from pre-to post-treatment were evaluated with the Patient Health Questionnaire-9 (PHQ-9) [primary outcome measure], Generalized Anxiety Disorder-7 (GAD-7), and clinician-administered Montgomery-Åsberg Depression Scale (MADRS). Primary treatment endpoint was completion of daily treatment series.
Per-protocol analyses showed no statistically significant differences on any measure between the F3 and 5.5 cm groups (all p ≥ 0.50), including percent improvement (PHQ-9: 39% vs. 39%; GAD-7: 34% vs. 27%; MADRS: 40% vs. 38%), response rate (PHQ-9: 37% vs. 43%; GAD-7: 27% vs. 30%; MADRS: 43% vs. 43%), and remission rate (PHQ-9: 22% vs. 21%; MADRS: 20% vs. 19%). Post hoc analysis of anxiety symptom change while controlling for depression severity suggested more favorable anxiolytic effects with 5.5 cm targeting (p = 0.03).
Similar antidepressant effects were observed with DLFPC rTMS using either the Beam F3 or 5.5 cm targeting method, supporting clinical equipoise in MDD patients with head circumference ≤ 60 cm. Comparison to MRI-based targeting and differential effects on anxiety symptoms require further investigation.
ClinicalTrials.gov identifier: NCT03378570.
•Beam F3 and the 5.5 cm rule are common strategies to target rTMS for depression.•Beam F3 and 5.5 cm targets achieve similar outcomes for major depressive disorder.•Retention rate was similar between groups.•5.5 cm target may have greater anxiolytic effects but further investigation needed.
Details
- Title: Subtitle
- A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness
- Creators
- Nicholas T. Trapp - University of IowaBenjamin D. Pace - University of IowaBrandon Neisewander - University of IowaPatrick Ten Eyck - University of IowaAaron D. Boes - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Brain stimulation, Vol.16(5), pp.1392-1400
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.brs.2023.09.006
- PMID
- 37714408
- PMCID
- PMC11095825
- ISSN
- 1935-861X
- eISSN
- 1876-4754
- Language
- English
- Date published
- 09/13/2023
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Psychiatry; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Biostatistics; Neurology (Pediatrics); Design Biostat and Ethics
- Record Identifier
- 9984466845502771
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