Individual interregional perfusion between the left dorsolateral prefrontal cortex stimulation targets and the subgenual anterior cortex predicts response and remission to aiTBS treatment in medication-resistant depression: The influence of behavioral inhibition

Guo-Rong Wu,Chris Baeken

doi:10.1016/j.brs.2021.12.003

Abstract

BackgroundAccelerated intermittent Theta Burst Stimulation (aiTBS) has been put forward as an effective treatment to alleviate depressive symptoms. Baseline functional connectivity (FC) patterns between the left dorsolateral prefrontal cortex (DLPFC) and the subgenual anterior cortex (sgACC) have gained a lot of attention as a potential biomarker for response. However, arterial spin labeling (ASL) - measuring regional cerebral blood flow - may allow a more straightforward physiological interpretation of such interregional functional connections. ObjectivesWe investigated whether baseline covariance perfusion connectivity between the individually stimulated left DLPFC targets and sgACC could predict meaningful clinical outcome. Considering that individual characteristics may influence efficacy prediction, all patients were also assessed with the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scale. MethodsAfter baseline ASL scanning, forty-one medication-resistant depressed patients received twenty sessions of neuronavigated left DLPFC aiTBS in an accelerated sham-controlled crossover fashion, where all stimulation sessions were spread over four days (Trial registration: http://clinicaltrials.gov/show/NCT01832805). ResultsStronger individual baseline interregional covariance perfusion connectivity patterns predicted response and/or remission. Furthermore, responders and remitters with higher BIS scores displayed stronger baseline interregional perfusion connections. ConclusionsTargeting the left DLPFC with aiTBS based on personal structural imaging data only may not be the most optimal method to enhance meaningful antidepressant responses. Individual baseline interregional perfusion connectivity could be an important added brain imaging method for individual optimization of more valid stimulation targets within the left DLPFC. Additional therapies dealing with behavioral inhibition may be warranted.

Highlights

This study suggests that clinical response patterns to rTMS treatment could be associated with certain depression subtypes, which differ in behavioral inhibition and/or behavioralactivation patterns
We hypothesized that clinical response and/or remission can be predicted by baseline covariance perfusion connectivity between the individually stimulated left dorsolateral prefrontal cortex (DLPFC) targets and the sgACC. Given that both Behavioral Inhibition System (BIS)/BASscales have been linked to clinical outcomes, we explored whether the predictive value of this interregional covariance connectivity was influenced by individual scores on this self-report measure
By using baseline perfusion, we retrospectively examined whether the functional connections between the individually targeted left DLPFC coordinates and the sgACC could predict clinical efficacy in a well-defined AD

Summary

Introduction

Classical daily rTMS and arTMS protocols show similar clinical efficacy [3], indicating that the major advantage of accelerated stimulation is the shorter treatment duration and a likely faster onset of clinical response. It is assumed that accelerated TBS treatment protocols may show similar clinical efficacy when compared to accelerated rTMS in treatment-resistant depression [2]. Objectives: We investigated whether baseline covariance perfusion connectivity between the individually stimulated left DLPFC targets and sgACC could predict meaningful clinical outcome. Methods: After baseline ASL scanning, forty-one medication-resistant depressed patients received twenty sessions of neuronavigated left DLPFC aiTBS in an accelerated sham-controlled crossover fashion, where all stimulation sessions were spread over four days (Trial registration: http://clinicaltrials.gov/ show/NCT01832805). Individual baseline interregional perfusion connectivity could be an important added brain imaging method for individual optimization of more valid stimulation targets within the left DLPFC.

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