Background
Transcranial magnetic stimulation (TMS) to the left dorsolateral prefrontal cortex
(DLPFC) is used clinically for the treatment of depression. However, the antidepressant
mechanism remains unknown and its therapeutic efficacy remains limited. Recent data
suggest that some left DLPFC targets are more effective than others; however, the
reasons for this heterogeneity and how to capitalize on this information remain unclear.
Methods
Intrinsic (resting state) functional magnetic resonance imaging data from 98 normal
subjects were used to compute functional connectivity with various left DLPFC TMS
targets employed in the literature. Differences in functional connectivity related
to differences in previously reported clinical efficacy were identified. This information
was translated into a connectivity-based targeting strategy to identify optimized
left DLPFC TMS coordinates. Results in normal subjects were tested for reproducibility
in an independent cohort of 13 patients with depression.
Results
Differences in functional connectivity were related to previously reported differences
in clinical efficacy across a distributed set of cortical and limbic regions. Dorsolateral
prefrontal cortex TMS sites with better clinical efficacy were more negatively correlated
(anticorrelated) with the subgenual cingulate. Optimum connectivity-based stimulation
coordinates were identified in Brodmann area 46. Results were reproducible in patients
with depression.
Conclusions
Reported antidepressant efficacy of different left DLPFC TMS sites is related to the
anticorrelation of each site with the subgenual cingulate, potentially lending insight
into the antidepressant mechanism of TMS and suggesting a role for intrinsically anticorrelated
networks in depression. These results can be translated into a connectivity-based
targeting strategy for focal brain stimulation that might be used to optimize clinical
response.
Key Words
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Article info
Publication history
Published online: June 04, 2012
Accepted:
April 30,
2012
Received in revised form:
April 20,
2012
Received:
November 14,
2011
Identification
Copyright
© 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
