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A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness
Journal article   Open access   Peer reviewed

A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness

Nicholas T. Trapp, Benjamin D. Pace, Brandon Neisewander, Patrick Ten Eyck and Aaron D. Boes
Brain stimulation, Vol.16(5), pp.1392-1400
09/13/2023
DOI: 10.1016/j.brs.2023.09.006
PMCID: PMC11095825
PMID: 37714408
url
https://doi.org/10.1016/j.brs.2023.09.006View
Published (Version of record) Open Access

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.
 5.5 cm rule Anxiety Clinical trial Comparative effectiveness Depression Targeting TMS

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