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Introduction: Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for late-life depression (LLD) but may have lower rates of response and remission owing to age-related brain changes. In particular, rTMS induced electric field strength may be attenuated by cortical atrophy in the prefrontal cortex. To identify clinical characteristics and treatment parameters associated with response, we undertook a pilot study of accelerated fMRI-guided intermittent theta burst stimulation (iTBS) to the right dorsolateral prefrontal cortex in 25 adults aged 50 or greater diagnosed with LLD and qualifying to receive clinical rTMS. Methods: Participants underwent baseline behavioral assessment, cognitive testing, and structural and functional MRI to generate individualized targets and perform electric field modeling. Forty-five sessions of iTBS were delivered over 9 days (1800 pulses per session, 50-min inter-session interval). Assessments and testing were repeated after 15 sessions (Visit 2) and 45 sessions (Visit 3). Primary outcome measure was the change in depressive symptoms on the Inventory of Depressive Symptomatology-30-Clinician (IDS-C-30) from Visit 1 to Visit 3. Results: Overall there was a significant improvement in IDS score with the treatment (Visit 1: 38.6; Visit 2: 31.0; Visit 3: 21.3; mean improvement 45.5%) with 13/25 (52%) achieving response and 5/25 (20%) achieving remission (IDS-C-30 < 12). Electric field strength and antidepressant effect were positively correlated in a subregion of the ventrolateral prefrontal cortex (VLPFC) (Brodmann area 47) and negatively correlated in the posterior dorsolateral prefrontal cortex (DLPFC). Conclusion: Response and remission rates were lower than in recently published trials of accelerated fMRI-guided iTBS to the left DLPFC. These results suggest that sufficient electric field strength in VLPFC may be a contributor to effective rTMS, and that modeling to optimize electric field strength in this area may improve response and remission rates. Further studies are needed to clarify the relationship of induced electric field strength with antidepressant effects of rTMS for LLD.
RESUMO
BACKGROUND: Despite increased reporting of resting-state magnetoencephalography (MEG), reliability of those measures remains scarce and predominately reported in healthy controls (HC). As such, there is limited knowledge on MEG resting-state reliability in schizophrenia (SZ). METHODS: To address test-retest reliability in psychosis, a reproducibility study of 26 participants (13-SZ, 13-HC) was performed. We collected eyes open and eyes closed resting-state data during 4 separate instances (2 Visits, 2 runs per visit) to estimate spectral power reliability (power, normalized power, alpha reactivity) across one hour and one week. Intraclass correlation coefficients (ICCs) were calculated. For source modeling, we applied an anatomically constrained linear estimation inverse model known as dynamic statistical parametric mapping (MNE dSPM) and source-based connectivity using the weighted phase lag index. RESULTS: Across one week there was excellent test-retest reliability in global spectral measures in theta-gamma bands (HC ICCAvgâ¯=â¯0.87, SZ ICCAvgâ¯=â¯0.87), regional spectral measures in all bands (HC ICCAvgâ¯=â¯0.86, SZ ICCAvgâ¯=â¯0.80), and parietal alpha measures (HC ICCAvgâ¯=â¯0.90, SZ ICCAvgâ¯=â¯0.84). Conversely, functional connectivity had poor reliability, as did source spectral power across one hour for SZ. Relative to HC, SZ also had reduced parietal alpha normalized power during eyes closed only, reduced alpha reactivity, and an association between higher PANSS positive scores and lower parietal alpha power. CONCLUSIONS: There was excellent to good test-retest reliability in most MEG spectral measures with a few exceptions in the schizophrenia patient group. Overall, these findings encourage the use of resting-state MEG while emphasizing the importance of determining reliability in clinical populations.