Cheng-Ta Li1, Mu-Hong Chen2, Chi-Hung Juan3, Ren-Shyan Liu4, Wei-Chen Lin2, Ya-Mei Bai2, Tung-Ping Su5. 1. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan. Electronic address: ctil2@vghtpe.gov.tw. 2. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan. 4. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Cheng-Hsin General Hospital, Taiwan.
Abstract
BACKGROUND:Theta-burst transcranial magnetic stimulation (TBS) can quickly modulate brain activity and can be used to treat treatment-resistant depression (TRD). Whole-brain analytical research has revealed that left high-frequency PFC rTMS modulates brain activity in anterior cingulate cortex (ACC) and the fronto-cingulo-temporal circuit. We aimed to investigate whether the prefrontal TBS's antidepressant mechanisms involve these regions. METHODS: We designed a randomized, double-blind, sham-controlled neuroimaging study to investigate different mechanisms of TBS [i.e., continuous TBS (cTBS) and intermittent TBS (iTBS)]. This study included 56 TRD patients [67.8%: women; mean age (SD): 45.5 (10.6) years], who were randomly assigned to one of four groups [A: right prefrontal cTBS; B: left prefrontal iTBS; C: combined right prefrontal cTBS and left prefrontal iTBS; and D: sham-TBS]. We measured standard uptake values (SUV) of cerebral glucose metabolism, at rest, both before and after ten daily treatment sessions. RESULTS: Group B and Group C had more responders than Group A and Group D (χ2 = 9.161, p = 0.027). In Group A, the SUV was significantly increased in the ACC and medial PFC (mPFC) after treatment, while the SUV was decreased in the right temporal cortex (p < 0.05, FWE-corrected for multiple comparisons). In contrast, in Group B, SUV was decreased in the ACC and mPFC and increased in the bilateral temporal cortex. Group C also had increased SUV in the bilateral temporal cortices. CONCLUSION: Instead of observing inhibitory or facilitatory effects on the targeted prefrontal cortex, we found that the two-week prefrontal TBS protocols primarily modulated the fronto-cingulo-temporal circuit.
RCT Entities:
BACKGROUND: Theta-burst transcranial magnetic stimulation (TBS) can quickly modulate brain activity and can be used to treat treatment-resistant depression (TRD). Whole-brain analytical research has revealed that left high-frequency PFC rTMS modulates brain activity in anterior cingulate cortex (ACC) and the fronto-cingulo-temporal circuit. We aimed to investigate whether the prefrontal TBS's antidepressant mechanisms involve these regions. METHODS: We designed a randomized, double-blind, sham-controlled neuroimaging study to investigate different mechanisms of TBS [i.e., continuous TBS (cTBS) and intermittent TBS (iTBS)]. This study included 56 TRD patients [67.8%: women; mean age (SD): 45.5 (10.6) years], who were randomly assigned to one of four groups [A: right prefrontal cTBS; B: left prefrontal iTBS; C: combined right prefrontal cTBS and left prefrontal iTBS; and D: sham-TBS]. We measured standard uptake values (SUV) of cerebral glucose metabolism, at rest, both before and after ten daily treatment sessions. RESULTS: Group B and Group C had more responders than Group A and Group D (χ2 = 9.161, p = 0.027). In Group A, the SUV was significantly increased in the ACC and medial PFC (mPFC) after treatment, while the SUV was decreased in the right temporal cortex (p < 0.05, FWE-corrected for multiple comparisons). In contrast, in Group B, SUV was decreased in the ACC and mPFC and increased in the bilateral temporal cortex. Group C also had increased SUV in the bilateral temporal cortices. CONCLUSION: Instead of observing inhibitory or facilitatory effects on the targeted prefrontal cortex, we found that the two-week prefrontal TBS protocols primarily modulated the fronto-cingulo-temporal circuit.
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