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The relationship between individual alpha peak frequency and clinical outcome with repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder (MDD)

  • Juliana Corlier
    Correspondence
    Corresponding author. Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, USA.
    Affiliations
    TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA

    Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Linda L. Carpenter
    Affiliations
    Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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  • Andrew C. Wilson
    Affiliations
    TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA

    Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • Eric Tirrell
    Affiliations
    Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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  • A. Polly Gobin
    Affiliations
    Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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  • Brian Kavanaugh
    Affiliations
    E. P. Bradley Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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  • Andrew F. Leuchter
    Affiliations
    TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA

    Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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      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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