Highlights
- •There was no relationship between outcome and individual alpha frequency (IAF) in patients treated at multiple frequencies.
- •Post-hoc analysis showed a significant correlation between IAF measures and clinical outcome for patients treated at 10 Hz.
- •The highest IAF quartile of 10 Hz-treated subjects had significantly greater clinical improvement than the lowest quartile.
- •These findings indicate a relationship between endogenous oscillations and clinical outcome that differs across patients.
- •Research should examine how endogenous oscillations may guide selection of optimal stimulation frequency for each patient.
Abstract
Background
The individual α frequency (IAF) has been associated with the outcome of repetitive Transcranial Magnetic
Stimulation (rTMS) treatment of Major Depressive Disorder (MDD), but the association
has been inconsistent.
Hypothesis
Proximity of IAF to the stimulation frequency, rather than the value of IAF per se,
is associated with outcome for patients receiving 10 Hz rTMS.
Methods
We examined the relationships between IAF, rTMS stimulation frequency, and treatment
outcome in 147 patients. All patients initially received 10 Hz rTMS unilateral treatment
delivered to left dorsolateral prefrontal cortex (DLPFC) (10UL), with subsets of patients
changed to unilateral 5 Hz to left DLPFC (5UL) or sequential bilateral (SB) stimulation
(10 Hz/1Hz) to left and right DLPFC based upon worsening symptoms with or intolerance
of 10UL. Outcome was percent change in total score on the Inventory of Depressive
Symptomatology – Self Report (IDS-SR) scale from pre-treatment baseline to the 30th
treatment. IAF values and absolute difference between IAF and 10 Hz (|IAF-10Hz|) were
examined in relation to outcome for the overall sample and for each stimulation group
separately.
Results
There was no correlation between IAF value, or |IAF-10Hz| and outcome in the overall
sample. ANCOVA showed a significant interaction between IAF measures and treatment
type. Post-hoc analyses revealed that IAF and |IAF-10Hz| were both significantly associated
with degree of improvement (IDS-SR % change) for patients who received 10UL (P < 0.01)
but not 5UL or SB stimulation. There was a trend-level difference in IAF between responders
and non-responders only within the 10 Hz group, but not within the other treatment
groups (n.s.). For the 10UL group, membership in the highest IAF quartile was associated
with significantly greater clinical improvement than membership in the lowest IAF
quartile (p = 0.0034).
Conclusions
IAF measures were associated with clinical outcome of patients treated with 10UL but
not 5UL or SB rTMS treatment. This suggests that interactions between endogenous frequencies
and treatment outcome may be related to the selected stimulation parameters and/or
physiologic and clinical characteristics of patients who benefit from those parameters.
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Article Info
Publication History
Published online: July 25, 2019
Accepted:
July 23,
2019
Received in revised form:
July 4,
2019
Received:
December 3,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
