Advertisement

More Lateral and Anterior Prefrontal Coil Location Is Associated with Better Repetitive Transcranial Magnetic Stimulation Antidepressant Response

      Background

      The left dorsolateral prefrontal cortex (DLPFC) is the most commonly used target for transcranial magnetic stimulation (TMS) in the treatment of depression. The “5-cm rule” is an empiric method used for probabilistic targeting of the DLPFC in most clinical trials. This rule may be suboptimal, as it does not account for differences in skull size or variations in prefrontal anatomy relative to motor cortex location. This study is a post hoc analysis of data from a large repetitive TMS (rTMS) trial in which we examined the variability of coil placement and how it affects antidepressant efficacy.

      Methods

      Fifty-four depressed subjects enrolled in a randomized, single-site trial received either active rTMS or sham for 3 weeks. Prior to treatment initiation, investigators placed vitamin E capsules at the point of stimulation and used a high-resolution magnetic resonance imaging (MRI) scan to image these fiducials relative to anatomy. We employed a semiautomated imaging-processing algorithm to localize the cortical region stimulated.

      Results

      Active TMS significantly reduced Hamilton Depression Rating Scale (HDRS) scores. A linear model for this improvement involving the coordinates of the stimulated cortex location, age, and treatment condition was highly significant. Specifically, individuals with more anterior and lateral stimulation sites were more likely to respond.

      Conclusions

      These results suggest that within the general anatomical area targeted by the 5-cm rule, placing the TMS coil more laterally and anteriorly is associated with improved response rates in TMS depression studies. Controlled studies testing this anatomical hypothesis are needed.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Daskalakis Z.J.
        • Christensen B.K.
        • Fitzgerald P.B.
        • Chen R.
        Transcranial magnetic stimulation: A new investigational and treatment tool in psychiatry.
        J Neuropsychiatry Clin Neurosci. 2002; 14: 406-415
        • Fitzgerald P.B.
        • Brown T.L.
        • Daskalakis Z.J.
        The application of transcranial magnetic stimulation in psychiatry and neurosciences research.
        Acta Psychiatr Scand. 2002; 105: 324-340
        • O'Reardon J.P.
        • Solvason H.B.
        • Janicak P.G.
        • Sampson S.
        • Isenberg K.E.
        • Nahas Z.
        • et al.
        Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial.
        Biol Psychiatry. 2007; 62: 1208-1216
        • Burt T.
        • Lisanby S.H.
        • Sackeim H.A.
        Neuropsychiatric applications of transcranial magnetic stimulation.
        Int J Neuropsychopharmacol. 2002; 5: 73-103
        • Kozel F.A.
        • George M.S.
        Meta-analysis of left prefrontal repetitive transcranial magnetic stimulation (rTMS) to treat depression.
        J Psychiatr Pract. 2002; 8: 270-275
        • Teneback C.C.
        • Nahas Z.
        • Speer A.M.
        • Molloy M.
        • Stallings L.E.
        • Spicer K.M.
        • et al.
        Changes in prefrontal cortex and paralimbic activity in depression following two weeks of daily left prefrontal TMS.
        J Neuropsychiatry Clin Neurosci. 1999; 11: 426-435
        • George M.S.
        • Wassermann E.M.
        • Williams W.A.
        • Callahan A.
        • Ketter T.A.
        • Basser P.
        • et al.
        Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.
        Neuroreport. 1995; 6: 1853-1856
        • Pascual-Leone A.
        • Rubio B.
        • Pallardo F.
        • Catala M.D.
        Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression.
        Lancet. 1996; 348: 233-237
        • George M.S.
        • Wassermann E.M.
        • Williams W.A.
        • Steppel J.
        • Pascual-Leone A.
        • Basser P.
        • et al.
        Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex.
        J Neuropsychiatry Clin Neurosci. 1996; 8: 172-180
        • Herwig U.
        • Padberg F.
        • Unger J.
        • Spitzer M.
        • Schonfeldt-Lecuona C.
        Transcranial magnetic stimulation in therapy studies: Examination of the reliability of “standard” coil positioning by neuronavigation.
        Biol Psychiatry. 2001; 50: 58-61
        • Kozel F.A.
        • Nahas Z.
        • deBrux C.
        • Molloy M.
        • Lorberbaum J.P.
        • Bohning D.
        • et al.
        How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation.
        J Neuropsychiatry Clin Neurosci. 2000; 12: 376-384
        • George M.S.
        • Nahas Z.
        • Molloy M.
        • Speer A.M.
        • Oliver N.C.
        • Li X.B.
        • et al.
        A controlled trial of daily left prefrontal cortex TMS for treating depression.
        Biol Psychiatry. 2000; 48: 962-970
        • Padberg F.
        • Zwanzger P.
        • Thoma H.
        • Kathmann N.
        • Haag C.
        • Greenberg B.D.
        • et al.
        Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: Comparative study of fast, slow and sham rTMS.
        Psychiatry Res. 1999; 88: 163-171
        • Avery D.H.
        • Holtzheimer 3rd, P.E.
        • Fawaz W.
        • Russo J.
        • Neumaier J.
        • Dunner D.L.
        • et al.
        A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression.
        Biol Psychiatry. 2006; 59: 187-194
        • Fregni F.
        • Marcolin M.A.
        • Myczkowski M.
        • Amiaz R.
        • Hasey G.
        • Rumi D.O.
        • et al.
        Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation.
        Int J Neuropsychopharmacol. 2006; 9: 641-654
        • Fitzgerald P.B.
        • Hoy K.
        • McQueen S.
        • Maller J.J.
        • Herring S.
        • Segrave R.
        • et al.
        A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression.
        Neuropsychopharmacology. 2009; 34: 1255-1262
        • Bohning D.E.
        • Denslow S.
        • Bohning P.A.
        • Walker J.A.
        • George M.S.
        A TMS coil positioning/holding system for MR image-guided TMS interleaved with fMRI.
        Clin Neurophysiol. 2003; 114: 2210-2219
        • Gugino L.D.
        • Romero J.R.
        • Aglio L.
        • Titone D.
        • Ramirez M.
        • Pascual-Leone A.
        • et al.
        Transcranial magnetic stimulation coregistered with MRI: A comparison of a guided versus blind stimulation technique and its effect on evoked compound muscle action potentials.
        Clin Neurophysiol. 2001; 112: 1781-1792
        • Herwig U.
        • Satrapi P.
        • Schonfeldt-Lecuona C.
        Using the international 10-20 EEG system for positioning of transcranial magnetic stimulation.
        Brain Topogr. 2003; 16: 95-99
        • Schonfeldt-Lecuona C.
        • Thielscher A.
        • Freudenmann R.W.
        • Kron M.
        • Spitzer M.
        • Herwig U.
        Accuracy of stereotaxic positioning of transcranial magnetic stimulation.
        Brain Topogr. 2005; 17: 253-259
        • Lancaster J.L.
        • Narayana S.
        • Wenzel D.
        • Luckemeyer J.
        • Roby J.
        • Fox P.
        Evaluation of an image-guided, robotically positioned transcranial magnetic stimulation system.
        Hum Brain Mapp. 2004; 22: 329-340
        • Paus T.
        Imaging the brain before, during, and after transcranial magnetic stimulation.
        Neuropsychologia. 1999; 37: 219-224
        • First M.
        • Gibbon M.
        • Spitzer R.
        • Williams J.
        Structured Clinical Interiew for DSM-IV Disorders-Research Version (SCID-I, Version 2.0).
        Biometrics Research Department, New York State Psychiatric Institute, New York1996
        • Nahas Z.
        • Li X.
        • Kozel F.A.
        • Mirzki D.
        • Memon M.
        • Miller K.
        • et al.
        Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55-75 years of age: A pilot study.
        Depress Anxiety. 2004; 19: 249-256
        • Smith S.M.
        • Jenkinson M.
        • Woolrich M.W.
        • Beckmann C.F.
        • Behrens T.E.
        • Johansen-Berg H.
        • et al.
        Advances in functional and structural MR image analysis and implementation as FSL.
        Neuroimage. 2004; 23: S208-S219
        • Nahas Z.
        • Teneback C.C.
        • Kozel A.
        • Speer A.M.
        • DeBrux C.
        • Molloy M.
        • et al.
        Brain effects of TMS delivered over prefrontal cortex in depressed adults: Role of stimulation frequency and coil-cortex distance.
        J Neuropsychiatry Clin Neurosci. 2001; 13: 459-470
        • George M.S.
        • Wassermann E.M.
        Rapid-rate transcranial magnetic stimulation and ECT.
        Convuls Ther. 1994; 10 (discussion 255–258): 251-254
        • Li X.
        • Nahas Z.
        • Kozel F.A.
        • Anderson B.
        • Bohning D.E.
        • George M.S.
        Acute left prefrontal transcranial magnetic stimulation in depressed patients is associated with immediately increased activity in prefrontal cortical as well as subcortical regions.
        Biol Psychiatry. 2004; 55: 882-890
        • Tekin S.
        • Cummings J.L.
        Frontal-subcortical neuronal circuits and clinical neuropsychiatry: An update.
        J Psychosom Res. 2002; 53: 647-654
        • Kimbrell T.A.
        • Dunn R.T.
        • George M.S.
        • Danielson A.L.
        • Willis M.W.
        • Repella J.D.
        • et al.
        Left prefrontal-repetitive transcranial magnetic stimulation (rTMS) and regional cerebral glucose metabolism in normal volunteers.
        Psychiatry Res. 2002; 115: 101-113
        • Alexander G.E.
        • DeLong M.R.
        • Strick P.L.
        Parallel organization of functionally segregated circuits linking basal ganglia and cortex.
        Annu Rev Neurosci. 1986; 9: 357-381
        • George M.S.
        • Belmaker R.H.
        Transcranial Stimulation in Neuropsychiatry.
        1st ed. American Psychiatric Press, Washington, DC2000
        • Lisanby S.H.
        • Husain M.M.
        • Rosenquist P.B.
        • Maixner D.
        • Gutierrez R.
        • Krystal A.
        • et al.
        Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: Clinical predictors of outcome in a multisite, randomized controlled clinical trial.
        Neuropsychopharmacology. 2009; 34: 522-534
        • Jorge R.E.
        • Moser D.J.
        • Acion L.
        • Robinson R.G.
        Treatment of vascular depression using repetitive transcranial magnetic stimulation.
        Arch Gen Psychiatry. 2008; 65: 268-276
        • Figiel G.S.
        • Epstein C.
        • McDonald W.M.
        • Amazon-Leece J.
        • Figiel L.
        • Saldivia A.
        • et al.
        The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients.
        J Neuropsychiatry Clin Neurosci. 1998; 10: 20-25