MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Journal of Visualized Experiments : JoVE
Katharine DunlopJonathan Downar

Abstract

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-...Continue Reading

Associated Clinical Trials

Citations

Oct 13, 2018·Psychotherapy Research : Journal of the Society for Psychotherapy Research·Jan Philipp KleinUlrich Schweiger
Sep 25, 2017·Frontiers in Human Neuroscience·Wei LiuBing Jin Li
Jul 30, 2020·Brain Sciences·Derrick Matthew BuchananAmedeo D'Angiulli
Jul 9, 2021·Frontiers in Human Neuroscience·Pedro Caldana GordonChristoph Zrenner

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