Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression
Background: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative...
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Format: | Article |
Language: | English |
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Elsevier
2018-01-01
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Series: | Brain Stimulation |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X17309439 |
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doaj-43ed039af42a4d42ba073b92736e616f |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kfir Feffer Hyewon Helen Lee Farrokh Mansouri Peter Giacobbe Fidel Vila-Rodriguez Sidney H. Kennedy Zafiris J. Daskalakis Daniel M. Blumberger Jonathan Downar |
spellingShingle |
Kfir Feffer Hyewon Helen Lee Farrokh Mansouri Peter Giacobbe Fidel Vila-Rodriguez Sidney H. Kennedy Zafiris J. Daskalakis Daniel M. Blumberger Jonathan Downar Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression Brain Stimulation rTMS Depression Prediction Response Dorsomedial Case series |
author_facet |
Kfir Feffer Hyewon Helen Lee Farrokh Mansouri Peter Giacobbe Fidel Vila-Rodriguez Sidney H. Kennedy Zafiris J. Daskalakis Daniel M. Blumberger Jonathan Downar |
author_sort |
Kfir Feffer |
title |
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression |
title_short |
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression |
title_full |
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression |
title_fullStr |
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression |
title_full_unstemmed |
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression |
title_sort |
early symptom improvement at 10 sessions as a predictor of rtms treatment outcome in major depression |
publisher |
Elsevier |
series |
Brain Stimulation |
issn |
1935-861X |
publishDate |
2018-01-01 |
description |
Background: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80–90%. This approach has recently been extended to ECT, but never before to rTMS. Objective: To assess the accuracy of 2-week clinical response in predicting rTMS treatment outcome. Methods: We reviewed clinical symptom scores for 101 patients who underwent 20 sessions of dorsomedial prefrontal rTMS for unipolar major depression in a naturalistic retrospective case series, defining nonresponders both at the conventional <50% improvement criterion and at a more stringent <35% criterion. Results: Patients achieving <20% improvement at session 10 were correctly predicted as nonresponders with NPVs of 88.2% by the conventional and 80.4% by the stringent criterion. Achieving <10% improvement at session 10 predicted nonresponse with NPVs of 89.5% and 86.8% by conventional and stringent criteria, respectively. Using the least-depressed score of either session 5 or 10, <20% improvement predicted nonresponse with NPVs of 91.3% and 82.6%, and <10% improvement predicted nonresponse with NPVs of 93.5% and 93.5%, by conventional and stringent criteria. Conclusion: For DMPFC-rTMS, a ‘<20% improvement at 2 weeks’ rule concurred with previous pharmacotherapy and ECT studies on predicting nonresponse, and could prove useful for treatment decision-making in clinical settings. |
topic |
rTMS Depression Prediction Response Dorsomedial Case series |
url |
http://www.sciencedirect.com/science/article/pii/S1935861X17309439 |
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doaj-43ed039af42a4d42ba073b92736e616f2021-03-19T07:11:19ZengElsevierBrain Stimulation1935-861X2018-01-01111181189Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depressionKfir Feffer0Hyewon Helen Lee1Farrokh Mansouri2Peter Giacobbe3Fidel Vila-Rodriguez4Sidney H. Kennedy5Zafiris J. Daskalakis6Daniel M. Blumberger7Jonathan Downar8MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Shalvata Mental Health Center, Hod-Hasharon, IsraelDepartment of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, CanadaInstitute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, CanadaMRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, CanadaNon-invasive Neurostimulation Therapies Lab, UBC Hospital, Department of Psychiatry, University of British Columbia, Vancouver, CanadaDepartment of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Li Ka-Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, CanadaDepartment of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, CanadaDepartment of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, CanadaMRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada; Corresponding author. Toronto Western Hospital, 399 Bathurst St, Room 7M-415, Toronto, ON M5T 2S8, Canada.Background: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80–90%. This approach has recently been extended to ECT, but never before to rTMS. Objective: To assess the accuracy of 2-week clinical response in predicting rTMS treatment outcome. Methods: We reviewed clinical symptom scores for 101 patients who underwent 20 sessions of dorsomedial prefrontal rTMS for unipolar major depression in a naturalistic retrospective case series, defining nonresponders both at the conventional <50% improvement criterion and at a more stringent <35% criterion. Results: Patients achieving <20% improvement at session 10 were correctly predicted as nonresponders with NPVs of 88.2% by the conventional and 80.4% by the stringent criterion. Achieving <10% improvement at session 10 predicted nonresponse with NPVs of 89.5% and 86.8% by conventional and stringent criteria, respectively. Using the least-depressed score of either session 5 or 10, <20% improvement predicted nonresponse with NPVs of 91.3% and 82.6%, and <10% improvement predicted nonresponse with NPVs of 93.5% and 93.5%, by conventional and stringent criteria. Conclusion: For DMPFC-rTMS, a ‘<20% improvement at 2 weeks’ rule concurred with previous pharmacotherapy and ECT studies on predicting nonresponse, and could prove useful for treatment decision-making in clinical settings.http://www.sciencedirect.com/science/article/pii/S1935861X17309439rTMSDepressionPredictionResponseDorsomedialCase series |