Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Robin F H Cash; Anne Weigand; Andrew Zalesky; Shan H Siddiqi; Jonathan Downar; Paul B Fitzgerald; Michael D Fox

doi:10.1016/j.biopsych.2020.05.033

Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression

Biol Psychiatry. 2021 Nov 15;90(10):689-700. doi: 10.1016/j.biopsych.2020.05.033. Epub 2020 Jun 7.

Authors

Robin F H Cash¹, Anne Weigand², Andrew Zalesky³, Shan H Siddiqi⁴, Jonathan Downar⁵, Paul B Fitzgerald⁶, Michael D Fox⁷

Affiliations

¹ Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia; Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia. Electronic address: robin.cash@unimelb.edu.au.
² Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
³ Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia; Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
⁴ Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Neurotherapeutics, McLean Hospital, Belmont, Massachusetts.
⁵ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Epworth Centre for Innovation and Mental Health, Epworth Healthcare and Monash University Central Clinical School, Camberwell, Victoria, Australia.
⁷ Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; Departments of Neurology and Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts; Departments of Neurology, Psychiatry, and Radiology, Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: foxmdphd@gmail.com.

PMID: 32800379
DOI: 10.1016/j.biopsych.2020.05.033

Abstract

Transcranial magnetic stimulation (TMS) is an effective treatment for depression but is limited in that the optimal therapeutic target remains unknown. Early TMS trials lacked a focal target and thus positioned the TMS coil over the prefrontal cortex using scalp measurements. Over time, it became clear that this method leads to variation in the stimulation site and that this could contribute to heterogeneity in antidepressant response. Newer methods allow for precise positioning of the TMS coil over a specific brain location, but leveraging these precise methods requires a more precise therapeutic target. We review how neuroimaging is being used to identify a more focal therapeutic target for depression. We highlight recent studies showing that more effective TMS targets in the frontal cortex are functionally connected to deep limbic regions such as the subgenual cingulate cortex. We review how connectivity might be used to identify an optimal TMS target for use in all patients and potentially even a personalized target for each individual patient. We address the clinical implications of this emerging field and highlight critical questions for future research.

Keywords: Depression; Functional connectivity; Magnetic resonance imaging; Subgenual cingulate cortex; Target; Transcranial magnetic stimulation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Brain / diagnostic imaging
Depression / therapy
Depressive Disorder, Major*
Humans
Neuroimaging
Transcranial Magnetic Stimulation*