TY - JOUR
T1 - Personalized Repetitive Transcranial Magnetic Stimulation for Depression
AU - Gogulski, Juha
AU - Ross, Jessica M.
AU - Talbot, Austin
AU - Cline, Christopher
AU - Donati, Francesco
AU - Munot, Saachi
AU - Kim, Naryeong
AU - Gibbs, Ciara
AU - Bastin, Nikita
AU - Yang, Jessica
AU - Minasi, Christopher
AU - Sarkar, Manjima
AU - Truong, Jade
AU - Keller, Corey J.
PY - 2023/4
Y1 - 2023/4
N2 - Personalized treatments are gaining momentum across all fields of medicine. Precision medicine can be applied to neuromodulatory techniques, in which focused brain stimulation treatments such as repetitive transcranial magnetic stimulation (rTMS) modulate brain circuits and alleviate clinical symptoms. rTMS is well tolerated and clinically effective for treatment-resistant depression and other neuropsychiatric disorders. Despite its wide stimulation parameter space (location, angle, pattern, frequency, and intensity can be adjusted), rTMS is currently applied in a one-size-fits-all manner, potentially contributing to its suboptimal clinical response (w50%). In this review, we examine components of rTMS that can be optimized to account for interindividual variability in neural function and anatomy. We discuss current treatment options for treatment-resistant depression, the neural mechanisms thought to underlie treatment, targeting strategies, stimulation parameter selection, and adaptive closed-loop treatment. We conclude that a better understanding of the wide and modifiable parameter space of rTMS will greatly improve the clinical outcome.
AB - Personalized treatments are gaining momentum across all fields of medicine. Precision medicine can be applied to neuromodulatory techniques, in which focused brain stimulation treatments such as repetitive transcranial magnetic stimulation (rTMS) modulate brain circuits and alleviate clinical symptoms. rTMS is well tolerated and clinically effective for treatment-resistant depression and other neuropsychiatric disorders. Despite its wide stimulation parameter space (location, angle, pattern, frequency, and intensity can be adjusted), rTMS is currently applied in a one-size-fits-all manner, potentially contributing to its suboptimal clinical response (w50%). In this review, we examine components of rTMS that can be optimized to account for interindividual variability in neural function and anatomy. We discuss current treatment options for treatment-resistant depression, the neural mechanisms thought to underlie treatment, targeting strategies, stimulation parameter selection, and adaptive closed-loop treatment. We conclude that a better understanding of the wide and modifiable parameter space of rTMS will greatly improve the clinical outcome.
KW - 3124 Neurology and psychiatry
KW - Dorsolateral prefrontal cortex
KW - Obsessive-compulsive disorder
KW - Theta burst stimulation
KW - Deep brain-stimulation
KW - Sham-controlled trial
KW - Major depression
KW - Double-blind
KW - Motor threshold
KW - Functional connectivity
KW - Antidepressant response
U2 - 10.1016/j.bpsc.2022.10.006
DO - 10.1016/j.bpsc.2022.10.006
M3 - Review Article
SN - 2451-9022
VL - 8
SP - 351
EP - 360
JO - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
JF - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
IS - 4
ER -