Journal: Brain Stimulation (2017)
Authors: Tendler A, Sisko E, Barnea-Ygael N, DeLuca M, Rodriguez N, Corbett-Methott S, Sutton J, Zangen A
Background:
The current FDA-cleared TMS protocols for TRD target primarily the left DLPFC. These protocols fail to benefit a large population of TRD patients, probably due to the heterogeneity of the disorder that affects multiple cortical and subcortical networks. As such, novel approaches and targets are required in the treatment of MDD in general and TRD in particular. One such approach is to stimulate the dorsomedial PFC (dmPFC), including the anterior cingulate cortex (ACC), using the dTMS H7 coil.
Objective:
To examine the efficacy of dTMS over the dmPFC-ACC in patients who failed dTMS over the left DLPFC.
Methods:
9 severely depressed patients without current OCD or PTSD, who failed to respond to a course of H1 dTMS in the current episode consented to treatment with the H7 coil. dTMS was administered 5 days a week over the dmPFC–ACC. Stimulation was applied at 100% of the foot resting MT at 20 Hz. Each session included 50 trains of 40 pulses (2 sec/train) with an inter-train interval of 20 sec for a total of 2000 pulses over 18 minutes. Patients were told to expect <30 treatments before considering it a failed treatment trial. Once they responded, treatments would be decreased to 2 a week. Evaluations administered to patients weekly included: Beck depression and anxiety inventories (BDI, BAI), patient health questionnaire (PHQ), and the clinician’s global impression (CGI). Remission was defined as a CGI-S score <2, or BDI score <12; response to treatment was defined as a two-point drop in CGI, or 50% drop in BDI score.
Results:
5 out of 9 (56%) severely treatment resistant patients remitted after receiving the H7 treatment. One patient responded by CGI criteria but not BDI criteria. 3 patients did not benefit from the H7. Out of the 9 patients, 3 patients were administered less than 10 dTMS sessions and stopped treatment primarily due to cost (one remitted and two failed to respond). 2 patients did not complete BDIs at the appropriate time points due to a clerical error, but the drop in their CGI scores suggested remission, and thus, they were included. The only adverse events were local scalp discomfort and temporary headache.
Conclusions:
This is the first report of the H7 coil dTMS over the dmPFC-ACC for MDD. The demonstration that this coil led to remission in patients that failed to benefit from lateral PFC stimulation supports basic evidence that the dmPFC-ACC regions are implicated in the pathophysiology of MDD, and for a portion of individuals such treatment may be a first-line intervention.
Full Publication: Antidepressant remission to dTMS of the dmPFC and ACC in lateral PFC dTMS nonresponders: Case series – PubMed
