Results Of Transcranial Magnetic Stimulation Research Articles

Leveraging DNA Methylation to Predict Transcranial Magnetic Stimulation Outcomes Among Patients With Treatment-Resistant Depression

Leveraging DNA Methylation to Predict Transcranial Magnetic Stimulation Outcomes Among Patients With Treatment-Resistant Depression

The test-retest reliability of non-navigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability early after stroke

Purpose Motor evoked potential (MEP) characteristics are potential biomarkers of whether rehabilitation interventions drive motor recovery after stroke. The test-retest reliability of Transcranial Magnetic Stimulation (TMS) measurements in sub-acute stroke remains unclear. This study aims to determine the test-retest reliability of upper limb MEP measures elicited by non-neuronavigated transcranial magnetic stimulation in sub-acute-stroke. Methods In two identical data collection sessions, 1–3 days apart, TMS measures assessed: motor threshold (MT), amplitude, latency (MEP-L), silent period (SP), recruitment curve slope in the biceps brachii (BB), extensor carpi radialis (ECR), and abductor pollicis brevis (APB) muscles of paretic and non-paretic upper limbs. Test-retest reliability was calculated using the intra-class correlation coefficient (ICC) and 95% confidence intervals (CI). Acceptable reliability was set at a lower 95% CI of 0.70 or above. The limits of agreement (LOA) and smallest detectable change (SDC) were calculated. Results 30 participants with sub-acute stroke were included (av 36 days post stroke) reliability was variable between poor to good for the different MEP characteristics. The SDC values differed across muscles and MEP characteristics in both paretic and less paretic limbs. Conclusions The present findings indicate there is limited evidence for acceptable test-retest reliability of non-navigated TMS outcomes when using the appropriate 95% CI for ICC, SDC and LOA values. Clinical Trial Registration Current Controlled Trials: ISCRT 19090862, http://www.controlled-trials.com

Can Medication be a Factor that Can Negatively Affect the Effect of Transcranial Magnetic Stimulation in Depression?

This study aims to evaluate the efficacy of transcranial magnetic stimulation (TMS) in patients with depression and whether concurrent psychotropic medication use negatively affects the treatment outcome of TMS. Patients' characteristics, predictors of treatment response, the relationship between demographics, and the selection of TMS as a treatment modality were also analyzed. Can psychotropic medication be a factor that can negatively affect the efficacy of TMS in patients with depression? This pilot-controlled study included 40 subjects from Romanian clinical practice who were treated with pharmacological treatment and TMS for major depressive disorder. The severity of depression and anxiety symptoms was measured using validated scales at baseline (day 1) and follow-up (day 30). All patients' characteristics and information were collected manually from the clinic's medical records, deidentified, and then introduced into an electronic database for analysis. Conducting the study in a clinical routine practice, it was not possible to include an active and/or sham control group. In addition, because TMS is not used as a monotherapy in this type of practice, we could not evaluate its safety and efficacy without concomitant pharmacological treatment. The study sample is small; therefore, the results cannot be generalized. Sixty percentage of patients (n = 24) included in this study obtained a clinical response, and 30% of patients (n = 12) obtained remission of depression. The group with pharmacological treatment obtained clinical responses in 80% of patients (n = 16) and remission of depression in 45% of patients (n = 9). The group with pharmacological treatment and TMS obtained clinical responses in 40% of patients (n = 8) and remission of depression in 15% (n = 3) of cases. The study results show a lack of efficacy for TMS as an adjunctive therapy to pharmacological treatment for patients with depression. In addition, a negative impact of psychotropic medication on TMS efficacy is observed in our study sample.

GABAA Receptor Availability in Relation to Cortical Excitability in Depressed and Healthy: A Positron Emission Tomography and Transcranial Magnetic Stimulation Study

Introduction: Gamma-aminobutyric acid (GABA) deficiency is suggested in depressive disorders, along with alterations in cortical excitability. However, whether these excitability changes are related to GABA_A receptor availability is largely unknown. Our aim was to assess the correlation between these measures in depressed patients and healthy controls. Methods: Twenty-eight patients with a major depressive episode, measured before and after participating in a clinical trial with repetitive transcranial magnetic stimulation (TMS), and 15 controls underwent [¹¹C]flumazenil positron emission tomography to assess GABA_A receptor availability and paired pulse TMS (ppTMS) to evaluate cortical excitability. Both whole-brain voxel-wise GABA_A receptor availability and mean values from left hand motor cortex and left paracentral lobule were correlated to the ppTMS outcomes: short-interval intracortical inhibition reflecting GABA_A receptor activity, long-interval intracortical inhibition representing GABA_B receptor activity, intracortical facilitation reflecting glutamate N-methyl-D-aspartate-receptor activity, as well as the resting motor threshold (rMT), considered a global measure of corticospinal excitability. Results: No significant differences in baseline GABA_A receptor availability or cortical excitability were found between patients and controls. Additionally, no correlations were observed between baseline measurements of GABA_A receptor availability and TMS outcomes. Changes in GABA_A receptor availability in the hand motor cortex, between pre- and post-assessments, were inversely related to pre-post changes in hand rMT. Conclusion: We found that a change in GABA_A receptor availability was inversely related to a change in rMT, suggesting a link between GABA deficiency and increased rMT previously observed in depressive episodes. The results highlight the complex mechanisms governing cortical excitability measures and offer new insight into their properties during the depressive state.

A prognostic model for ischemic stroke outcome

Aim to develop a mathematical model for the prognosis of ischemic stroke outcome in the acute period of the disease.
 Material and methods. The study included 103 patients with ischemic stroke in the carotid basin with existing hemiparesis. The comprehensive examination comprised clinical and anamnestic data, state assessment using clinical scales, brain computed tomography, ultrasound, transcranial magnetic stimulation, evoked potential tests, laboratory blood tests. The patients were examined at admission, at discharge and in 12-24 months after leaving hospital. According to the motor function recovery, the patients were divided into two groups with favorable and unfavorable outcome. Statistical methods identified the significantly different results in the two groups.
 Results. The most significant indicators affecting the prognosis of ischemic stroke were identified.The developed criteria served the basis for a mathematical model using the results of transcranial magnetic stimulation.
 Conclusion. The obtained mathematical model can be used to determine the outcome of ischemic stroke in the acute period. Transcranial magnetic stimulation is a method that allows for prognosis of the outcome in early period of stroke.

Altered brain activity in unipolar depression unveiled using connectomics

Over 20 years of neuroimaging experiments into aberrant task-based brain activity in unipolar depression have failed to reliably delineate a convergent set of anatomical regions. Here we examined whether study-derived coordinates might delineate a dysfunctional brain network in unipolar depression rather than isolated neuroanatomical foci, utilizing data from 57 studies with 99 individual neuroimaging task-based experiments, testing either emotional or cognitive processing (n = 1,058). We further assessed clinical relevance by computing optimal network-based personalized targets in 26 individuals who previously received transcranial magnetic stimulation for unipolar depression. Although coordinates were neuroanatomically heterogeneous, they localized to highly robust distributed brain networks. Importantly, these networks closely recapitulated clinically meaningful and independently derived models of depression circuitry, quantified by spatial correlation (P < 0.00002). Therapeutic outcome of transcranial magnetic stimulation was dependent on how effectively this circuit was targeted (P = 0.018). These findings indicate that neuroimaging findings in depression, which previously appeared irreconcilable, localize to highly robust and clinically meaningful distributed brain networks. Cash et al. examined whether coordinates derived from neuroimaging studies might delineate a dysfunctional brain network in unipolar depression rather than isolated neuroanatomical foci. The authors found highly robust distributed brain networks that closely recapitulate clinically meaningful models of depression circuitry.

Reliability of corticospinal excitability and intracortical inhibition in biceps femoris during different contraction modes.

This study aimed to determine the test-retest reliability of a range of transcranial magnetic stimulation (TMS) outcomes in the biceps femoris during isometric, eccentric and concentric contractions. Corticospinal excitability (active motor threshold 120% [AMT120%] and area under recruitment curve [AURC]), short- and long-interval intracortical inhibition (SICI and LICI) and intracortical facilitation (ICF) were assessed from the biceps femoris in 10 participants (age 26.3 ± 6.0 years; height 180.2 ± 6.6 cm, body mass 77.2 ± 8.0 kg) in three sessions. Single- and paired-pulse stimuli were delivered under low-level muscle activity (5% ± 2% of maximal isometric root mean squared surface electromyography [rmsEMG]) during isometric, concentric and eccentric contractions. Participants were provided visual feedback on their levels of rmsEMG during all contractions. Single-pulse outcomes measured during isometric contractions (AURC, AMT110%, AMT120%, AMT130%, AMT150%, AMT170%) demonstrated fair to excellent reliability (ICC range, .51 to .92; CV%, 21% to 37%), whereas SICI, LICI and ICF demonstrated good to excellent reliability (ICC range, .62 to .80; CV%, 19 to 42%). Single-pulse outcomes measured during concentric contractions demonstrated excellent reliability (ICC range, .75 to .96; CV%, 15% to 34%), whereas SICI, LICI and ICF demonstrated good to excellent reliability (ICC range, .65 to .76; CV%, 16% to 71%). Single-pulse outcomes during eccentric contractions demonstrated fair to excellent reliability (ICC range, .56 to .96; CV%, 16% to 41%), whereas SICI, LICI and ICF demonstrated good to excellent (ICC range, .67 to .86; CV%, 20% to 42%). This study found that both single- and paired-pulse TMS outcomes can be measured from the biceps femoris muscle across all contraction modes with fair to excellent reliability. However, coefficient of variation values were typically greater than the smallest worthwhile change which may make tracking physiological changes in these variables difficult without moderate to large effect sizes.

An effective brain connectivity technique to predict repetitive transcranial magnetic stimulation outcome for major depressive disorder patients using EEG signals.

One of the most effective treatments for drug-resistant Major depressive disorder (MDD) patients is repetitive transcranial magnetic stimulation (rTMS). To improve treatment efficacy and reduce health care costs, it is necessary to predict the treatment response. In this study, we intend to predict the rTMS treatment response in MDD patients from electroencephalogram (EEG) signals before starting the treatment using machine learning approaches. Effective brain connectivity of 19-channel EEG data of MDD patients was calculated by the direct directed transfer function (dDTF) method. Then, using three feature selection methods, the best features were selected and patients were classified as responders or non-responders to rTMS treatment by using the support vector machine (SVM). Results on the 34 MDD patients indicated that the Fp2 region in the delta and theta frequency bands has a significant difference between the two groups and can be used as a significant brain biomarker to assess the rTMS treatment response. Also, the highest accuracy (89.6%) using the SVM classifier for the best features of the dDTF method based on the area under the receiver operating characteristic curve (AUC-ROC) criteria was obtained by combining the delta and theta frequency bands. Consequently, the proposed method can accurately detect the rTMS treatment response in MDD patients before starting treatment on the EEG signal to avoid financial and time costs to patients and medical centers.

Adverse childhood experiences and repetitive transcranial magnetic stimulation outcomes for depression

BackgroundHistory of adverse childhood experiences (ACEs) is associated with poorer treatment outcomes in depression. How ACEs affect outcomes from repetitive transcranial magnetic stimulation (rTMS) is not well-defined. The primary aim was to investigate whether ACEs affect depression outcomes in patients receiving high frequency rTMS, either deep TMS (dTMS) or intermittent theta burst stimulation (iTBS), to the left dorsolateral prefrontal cortex. MethodsThe Hamilton Depression Rating Scale (HAMD-17) was collected at baseline and every 2 weeks for 4–6 weeks. Outcomes included improvement in HAMD-17 and remission. The ACE-10 questionnaire was used to quantify categories of ACEs. Data from 99 patients with MDD receiving an acute rTMS course were analyzed. ResultsPatients had a mean of 2.4 ACEs (SD 2.5). No significant differences in outcomes were found between dTMS or iTBS so these data were pooled. Using a continuous ACE variable showed no significant impact on outcomes. Using a categorical ACE variable (0, 1, 2, 3, 4 or more) did not reveal significant effects of ACEs on outcomes. Higher ACE was associated with steeper decrease in HAMD-17 only from baseline to week 2 but not at other times. LimitationsThis was an open-label study. The well-validated ACE questionnaire does not measure severity or frequency of adversities. ConclusionsPatients with depression receiving rTMS reported on average 2.4 ACEs. ACE scores may lead to a steeper early decline in HAMD-17 but did not otherwise impact depression outcomes. Presence of high levels of ACEs should not preclude consideration of rTMS for depression.

Personalized brain stimulation of memory networks

BackgroundThe finding that transcranial magnetic stimulation (TMS) can enhance memory performance via stimulation of parietal sites within the Cortical-Hippocampal Network counts as one of the most exciting findings in this field in the past decade. However, the first independent effort aiming to fully replicate this finding found no discernible influence of TMS on memory performance. ObjectiveWe examined whether this might relate to interindividual spatial variation in brain connectivity architecture, and the capacity of personalisation methodologies to overcome the noise inherent across independent scanners and cohorts. MethodsWe implemented recently detailed personalisation methodology to retrospectively compute individual-specific parietal targets and then examined relation to TMS outcomes. ResultsCloser proximity between actual and novel fMRI-personalized targets associated with greater improvement in memory performance. ConclusionThese findings demonstrate the potential importance of aligning brain stimulation targets according to individual-specific differences in brain connectivity, and extend upon recent findings in prefrontal cortex.

Mapping Inter-individual Functional Connectivity Variability in TMS Targets for Major Depressive Disorder.

Transcranial magnetic stimulation (TMS) is an emerging alternative to existing treatments for major depressive disorder (MDD). The effects of TMS on both brain physiology and therapeutic outcomes are known to be highly variable from subject to subject, however. Proposed reasons for this variability include individual differences in neurophysiology, in cortical geometry, and in brain connectivity. Standard approaches to TMS target site definition tend to focus on coordinates or landmarks within the individual brain regions implicated in MDD, such as the dorsolateral prefrontal cortex (dlPFC) and orbitofrontal cortex (OFC). Additionally considering the network connectivity of these sites (i.e., the wider set of brain regions that may be mono- or poly-synaptically activated by TMS stimulation) has the potential to improve subject-specificity of TMS targeting and, in turn, improve treatment outcomes. In this study, we looked at the functional connectivity (FC) of dlPFC and OFC TMS targets, based on induced electrical field (E-field) maps, estimated using the SimNIBS library. We hypothesized that individual differences in spontaneous functional brain dynamics would contribute more to downstream network engagement than individual differences in cortical geometry (i.e., E-field variability). We generated individualized E-field maps on the cortical surface for 121 subjects (67 female) from the Human Connectome Project database using tetrahedral head models generated from T1- and T2-weighted MR images. F3 and Fp1 electrode positions were used to target the left dlPFC and left OFC, respectively. We analyzed inter-subject variability in the shape and location of these TMS target E-field patterns, their FC, and the major functional networks to which they belong. Our results revealed the key differences in TMS target FC between the dlPFC and OFC, and also how this connectivity varies across subjects. Three major functional networks were targeted across the dlPFC and OFC: the ventral attention, fronto-parietal and default-mode networks in the dlPFC, and the fronto-parietal and default mode networks in the OFC. Inter-subject variability in cortical geometry and in FC was high. Our analyses showed that the use of normative neuroimaging reference data (group-average or representative FC and subject E-field) allows prediction of which networks are targeted, but fails to accurately quantify the relative loading of TMS targeting on each of the principal networks. Our results characterize the FC patterns of canonical therapeutic TMS targets, and the key dimensions of their variability across subjects. The high inter-individual variability in cortical geometry and FC, leading to high variability in distributions of targeted brain networks, may account for the high levels of variability in physiological and therapeutic TMS outcomes. These insights should, we hope, prove useful as part of the broader effort by the psychiatry, neurology, and neuroimaging communities to help improve and refine TMS therapy, through a better understanding of the technology and its neurophysiological effects.

Transcranial Magnetic Stimulation and Neocortical Neurons: The Micro-Macro Connection.

Understanding the operation of cortical circuits is an important and necessary task in both neuroscience and neurorehabilitation. The functioning of the neocortex results from integrative neuronal activity, which can be probed non-invasively by transcranial magnetic stimulation (TMS). Despite a clear indication of the direct involvement of cortical neurons in TMS, no explicit connection model has been made between the microscopic neuronal landscape and the macroscopic TMS outcome. Here we have performed an integrative review of multidisciplinary evidence regarding motor cortex neurocytology and TMS-related neurophysiology with the aim of elucidating the micro–macro connections underlying TMS. Neurocytological evidence from animal and human studies has been reviewed to describe the landscape of the cortical neurons covering the taxonomy, morphology, circuit wiring, and excitatory–inhibitory balance. Evidence from TMS studies in healthy humans is discussed, with emphasis on the TMS pulse and paradigm selectivity that reflect the underlying neural circuitry constitution. As a result, we propose a preliminary neuronal model of the human motor cortex and then link the TMS mechanisms with the neuronal model by stimulus intensity, direction of induced current, and paired-pulse timing. As TMS bears great developmental potential for both a probe and modulator of neural network activity and neurotransmission, the connection model will act as a foundation for future combined studies of neurocytology and neurophysiology, as well as the technical advances and application of TMS.

Transcranial magnetic stimulation as biomarker of excitability in drug development: A randomized, double-blind, placebo-controlled, cross-over study.

AimsThe purpose of this study was to investigate pharmacodynamic effects of drugs targeting cortical excitability using transcranial magnetic stimulation (TMS) combined with electromyography (EMG) and electroencephalography (EEG) in healthy subjects, to further develop TMS outcomes as biomarkers for proof‐of‐mechanism in early‐phase clinical drug development. Antiepileptic drugs presumably modulate cortical excitability. Therefore, we studied effects of levetiracetam, valproic acid and lorazepam on cortical excitability in a double‐blind, placebo‐controlled, 4‐way cross‐over study.MethodsIn 16 healthy male subjects, single‐ and paired‐pulse TMS‐EMG–EEG measurements were performed predose and 1.5, 7 and 24 hours postdose. Treatment effects on motor‐evoked potential, short and long intracortical inhibition and TMS‐evoked potential amplitudes, were analysed using a mixed model ANCOVA and cluster‐based permutation analysis.ResultsWe show that motor‐evoked potential amplitudes decreased after administration of levetiracetam (estimated difference [ED] −378.4 μV; 95%CI: −644.3, −112.5 μV; P < .01), valproic acid (ED −268.8 μV; 95%CI: −532.9, −4.6 μV; P = .047) and lorazepam (ED −330.7 μV; 95%CI: −595.6, −65.8 μV; P = .02) when compared with placebo. Long intracortical inhibition was enhanced by levetiracetam (ED −60.3%; 95%CI: −87.1%, −33.5%; P < .001) and lorazepam (ED −68.2%; 95%CI: −94.7%, −41.7%; P < .001) at a 50‐ms interstimulus interval. Levetiracetam increased TMS‐evoked potential component N45 (P = .004) in a central cluster and decreased N100 (P < .001) in a contralateral cluster.ConclusionThis study shows that levetiracetam, valproic acid and lorazepam decrease cortical excitability, which can be detected using TMS‐EMG–EEG in healthy subjects. These findings provide support for the use of TMS excitability measures as biomarkers to demonstrate pharmacodynamic effects of drugs that influence cortical excitability.

Effect of low-cost transcranial magnetic stimulation navigation on hotspot targeting and motor evoked potential variability in the biceps brachii.

Transcranial magnetic stimulation (TMS) can monitor or modulate brain excitability. However, reliability of TMS outcomes depends on consistent coil placement during stimulation. Neuronavigated TMS systems can address this issue, but their cost limits their use outside of specialist research environments. The objective was to evaluate the performance of a low-cost navigated TMS approach in improving coil placement consistency and its effect on motor evoked potentials (MEPs) when targeting the biceps brachii at rest and during voluntary contractions. We implemented a navigated TMS system using a low-cost 3D camera system and open-source software environment programmed using the Unity 3D engine. MEPs were collected from the biceps brachii at rest and during voluntary contractions across two sessions in ten non-disabled individuals. Motor hotspots were recorded and targeted via two conditions: navigated and conventional. The low-cost navigated TMS system reduced coil orientation error (pitch: 1.18°±1.2°, yaw: 1.99°±1.9°, roll: 1.18°±2.2° with navigation, versus pitch: 3.7°±5.7°, yaw: 3.11°±3.1°, roll: 3.8°±9.1° with conventional). The improvement in coil orientation had no effect on MEP amplitudes and variability. The low-cost system is a suitable alternative to expensive systems in tracking the motor hotspot between sessions and quantifying the error in coil placement when delivering TMS. Biceps MEP variability reflects physiological variability across a range of voluntary efforts, that can be captured equally well with navigated or conventional approaches of coil locating.

Adverse childhood experiences and repetitive transcranial magnetic stimulation outcomes for depression

Abstract Background: History of adverse childhood experiences (ACEs) is associated with poorer treatment outcomes in depression; this has been found for psychotherapy, pharmacotherapy, and their combination. However, how ACEs affect neuromodulation outcomes, such as repetitive transcranial magnetic stimulation (rTMS), remains unexplored. Objective: Characterize the prevalence of ACEs in patients receiving rTMS for depression at a tertiary care centre in Canada. Investigate whether ACEs affect depression outcomes in these patients. Methods: The Hamilton Depression Rating Scale, HAMD-17) was collected at baseline and every 2 weeks until the end of treatment at 4-6 weeks. The primary outcome was remission (HAMD-17 of 7 or less). The ACE-10 questionnaire was used to quantify categories of ACEs. Data from the first round of treatment from 94 patients with ACE-10, baseline and end-of-acute treatment HAMD-17 scores were included in analyses. Results: Patients had a median of 2 and mean of 2.9 ACEs (range 0-10, standard deviation 2.7). 78% had at least 1, 63% at least 2, 48% at least 3, and 35% at least 4 ACEs. Remission rates at end-of-acute treatment were not significantly different between low and high ACE groups (2 or fewer vs 3 or more ACEs; 9/49, 18% and 12/45, 27% respectively; chi2 = 0.93, p = 0.34). Logistic regression using ACE-10 or its sub-scales revealed no significant deleterious effects of total score, abuse, neglect, or household dysfunction on remission. Linear mixed models of longitudinal data revealed similar decreases in HAMD-17 from baseline over time that did not significantly differ based on ACE score. Conclusions: Patients with depression receiving rTMS at a tertiary care centre in Toronto, Canada reported on average 3 ACEs. ACE scores were not predictive of poorer antidepressant outcomes from acute treatment with rTMS for depression. Presence of high levels of ACEs should not preclude consideration of rTMS for depression. Keywords: adverse childhood experience, childhood maltreatment, transcranial magnetic stimulation, major depressive disorder

Theta-Burst Stimulation of Forearm Muscles in Patients With Complex Regional Pain Syndrome: Influence on Brain and Clinical Outcomes.

Objective: Complex regional pain syndrome (CRPS) is a common pain condition characterized by the changes in the brain that are not yet addressed by conventional treatment regimens. Repetitive peripheral magnetic stimulation (rPMS) of muscles is painless and non-invasive and can influence these changes (the induction of brain plasticity) to reduce pain and improve motricity. In patients with CRPS, this open-label pilot study tested rPMS after-effects on the pain intensity and sensorimotor control of the upper limb along with the excitability changes of the primary motor cortex (M1).Methods: Eight patients with CRPS were enrolled in a single-session program. Patients were tested at pre- and post-rPMS over the flexor digitorum superficialis (FDS) muscle. The clinical outcomes were pain intensity, proprioception, active range of motion (ROM), and grip strength. M1 excitability was tested using the single- and paired-pulse transcranial magnetic stimulation (TMS) of M1.Results: In our small sample study, rPMS reduced instant and week pain, improved proprioception and ROM, and reduced the hemispheric imbalance of several TMS outcomes. The more M1 contralateral to the CRPS side was hyperactivated at baseline, the more pain was reduced.Discussion: This open-label pilot study provided promising findings for the use of rPMS in CRPS with a focus on M1 plastic changes. Future randomized, placebo-controlled clinical trials should confirm the existence of a causal relationship between the TMS outcomes and post-rPMS decrease of pain. This will favor the development of personalized treatments of peripheral non-invasive neurostimulation in CRPS.

Relationship of Childhood Trauma with Transcranial Magnetic Stimulation Outcome for Depression

Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown.Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks.Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present.Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS.Conflicts of Interest: None to reportFunding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding. Background: Childhood trauma has lasting effects on treatment outcomes for many illnesses including major depressive disorder (MDD) but the relationship with transcranial magnetic stimulation (TMS) is unknown. Methods: Childhood Trauma Questionnaire (CTQ), a questionnaire to assess severity and type of childhood trauma, was collected in a naturalistic outpatient setting from patients receiving TMS for treatment resistant MDD. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used to assess depression symptom severity, clinical response and remission. Standard treatment was given at 10 Hz stimulation to the dorsolateral left prefrontal cortex at 120% maximum intensity relative to their motor threshold for 3000-4000 pulses/daily for six weeks. Results: 117 patients receiving TMS completed CTQ. More severe trauma showed less improvement after TMS as seen via a negative correlation between IDS-SR %change and CTQ total score (r=-.251, p<0.01). Specifically, less improvement correlated with degree of physical abuse (r=-.245, p<0.01) and physical neglect (r=-.251, p<0.01). Non-responders had significantly worse scores in physical abuse (p<.01), sexual abuse (p<.05), and physical neglect (p<.05) compared to responders. Significant chi-square associations between physical neglect and non-response (χ=8.623, p<0.05); and sexual abuse and non-remission (χ=9.214, p<0.05) were present. Conclusion: Our data show that certain types of trauma may have more impact on TMS outcomes than others. Based on these results, future studies examining the possible biological pathways and mechanisms contributing to the differences in severely depressed patients with and without certain types of childhood trauma could lead to a more personalized treatment algorithm leading to improved efficacy of TMS. Conflicts of Interest: None to report Funding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding.

Astrocyte Protein Levels Change Depending on Outcome of Transcranial Magnetic Stimulation in Depression: New Star of the Show?

Astrocyte Protein Levels Change Depending on Outcome of Transcranial Magnetic Stimulation in Depression: New Star of the Show?

Transcranial Magnetic Stimulation Outcomes by Age: A Retrospective Chart Review in a Naturalistic Clinic Setting

Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment for major depressive disorder (MDD) in the general adult population. The effect of age on rTMS outcomes remains unclear. We evaluated rTMS response and remission rates by age in a naturalistic, clinical setting.

Astrocytic Proteins in Serum Show Differential Changes Depending on Clinical Outcome of Transcranial Magnetic Stimulation in Treatment Refractory Depression

Transcranial magnetic stimulation (TMS) is effective for depression (MDD) but the therapeutic mechanism is being elucidated. Astrocytes have not been explored in TMS. Peripheral astrocyte proteins before and after TMS in MDD was studied.