Journal article
Repetitive Transcranial Magnetic Stimulation with Resting-State Network Targeting for Treatment-Resistant Depression in Traumatic Brain Injury: A Randomized, Controlled, Double-Blinded Pilot Study
Journal of neurotrauma, Vol.36(8), pp.1361-1374
04/15/2019
DOI: 10.1089/neu.2018.5889
PMCID: PMC6909726
PMID: 30381997
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has demonstrated antidepressant efficacy but has limited evidence in depression associated with traumatic brain injury (TBI). Here, we investigate the use of rTMS targeted with individualized resting-state network mapping (RSNM) of dorsal attention network (DAN) and default mode network (DMN) in subjects with treatment-resistant depression associated with concussive or moderate TBI. The planned sample size was 50 with first interim analysis planned at 20, but only 15 were enrolled before the study was terminated for logistical reasons. Subjects were randomized to 20 sessions of bilateral rTMS (4000 left-sided excitatory pulses, 1000 right-sided inhibitory pulses) or sham. Treatment was targeted to the dorsolateral prefrontal cluster with maximal difference between DAN and DMN correlations based on resting-state functional magnetic resonance imaging with individualized RSNM. Mean improvement in the primary outcome, Montgomery-Asberg Depression Rating Scale (MADRS), was 56% ± 14% (
n
= 9) with active treatment and 27% ± 25% (
n
= 5) with sham (Cohen's
d
= 1.43). One subject randomized to sham withdrew before starting treatment. There were no seizures or other significant adverse events. MADRS improvement was inversely correlated with functional connectivity between the right-sided stimulation site and the subgenual anterior cingulate cortex (sgACC;
r
= -0.68, 95% confidence interval 0.03-0.925). Active treatment led to increased sgACC-DMN connectivity (
d
= 1.55) and increased sgACC anti-correlation with the left- and right-sided stimulation sites (
d
= -1.26 and -0.69, respectively). This pilot study provides evidence that RSNM-targeted rTMS is feasible in TBI patients with depression. Given the dearth of existing evidence-based treatments for depression in this patient population, these preliminarily encouraging results indicate that larger controlled trials are warranted.
Details
- Title: Subtitle
- Repetitive Transcranial Magnetic Stimulation with Resting-State Network Targeting for Treatment-Resistant Depression in Traumatic Brain Injury: A Randomized, Controlled, Double-Blinded Pilot Study
- Creators
- Shan H Siddiqi - 3Department of Psychiatry, Washington University School of Medicine, St. Louis, MissouriNicholas T Trapp - 6Department of Psychiatry, University of Iowa Carver College of Medicine, University of Iowa, Iowa City, IowaCarl D Hacker - 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, MissouriTimothy O Laumann - 3Department of Psychiatry, Washington University School of Medicine, St. Louis, MissouriSridhar Kandala - 3Department of Psychiatry, Washington University School of Medicine, St. Louis, MissouriXin Hong - 5Department of Neurology, Washington University School of Medicine, St. Louis, MissouriLudwig Trillo - 3Department of Psychiatry, Washington University School of Medicine, St. Louis, MissouriPashtun Shahim - 2Center for Neuroscience and Regenerative Medicine, National Institutes of Health/Uniformed Services University of Health Sciences Traumatic Brain Injury Research Group, Bethesda, MarylandEric C Leuthardt - 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, MissouriAlexandre R Carter - 5Department of Neurology, Washington University School of Medicine, St. Louis, MissouriDavid L Brody - 5Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
- Resource Type
- Journal article
- Publication Details
- Journal of neurotrauma, Vol.36(8), pp.1361-1374
- DOI
- 10.1089/neu.2018.5889
- PMID
- 30381997
- PMCID
- PMC6909726
- NLM abbreviation
- J Neurotrauma
- ISSN
- 0897-7151
- eISSN
- 1557-9042
- Publisher
- Mary Ann Liebert, Inc., publishers
- Language
- English
- Date published
- 04/15/2019
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984003948102771
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