Mar 19, 2009

A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression

PMID: 19145228
TITLE: A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression.
AUTHORS: Paul B Fitzgerald, Kate Hoy, Susan McQueen, Jerome J Maller, Sally Herring, Rebecca Segrave, Michael Bailey, Greg Been, Jayashri Kulkarni, Zafiris J Daskalakis
AFFILIATION: Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Commercial Rd Melbourne, Victoria, Australia.
REFERENCE: Neuropsychopharmacology 2009 Apr 34(5):1255-62
The aim of this study is to investigate whether repetitive transcranial
magnetic stimulation (rTMS) targeted to a specific site in the
dorsolateral prefrontal cortex (DLPFC), with a neuro-navigational method
based on structural MRI, would be more effective than rTMS applied
using the standard localization technique. Fifty-one patients with
treatment-resistant depression were randomized to receive a 3-week
course (with a potential 1-week extension) of high-frequency (10 Hz)
left-sided rTMS. Thirty trains (5 s duration) were applied daily 5 days
per week at 100% of the resting motor threshold. Treatment was targeted
with either the standard 5 cm technique (n=27) or using a neuro-
navigational approach (n=24). This involved localizing the scalp
location that corresponds to a specific site at the junction of Brodmann
areas 46 and 9 in the DLPFC based on each individual subject's MRI scan
There was an overall significant reduction in the Montgomery-Asberg
Depression Rating Scale scores over the course of the trial, and a
better outcome in the targeted group compared with the standard
localization group at 4 weeks (p=0.02). Significant differences were
also found on secondary outcome variables. The use of neuro-navigational
methods to target a specific DLPFC site appears to enhance response to
rTMS treatment in depression. Further research is required to confirm
this in larger samples, or to establish whether an alternate method
based on surface anatomy, including measurement from motor cortex, can
be substituted for the standard 5 cm method.