Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder
Background: Intermittent theta-burst stimulation priming (iTBS-P) can improve clinical outcome of patients with Major Depressive Disorder (MDD) who do not show early benefit from 10 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC), also known as high-frequency left-sided (HFL) stimulati...
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Elsevier
2021-07-01
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Series: | Brain Stimulation |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X21001273 |
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doaj-a2710654bd50487eba105249e83b8421 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jonathan C. Lee Juliana Corlier Andrew C. Wilson Reza Tadayonnejad Katharine G. Marder Doan Ngo David E. Krantz Scott A. Wilke Jennifer G. Levitt Nathaniel D. Ginder Andrew F. Leuchter |
spellingShingle |
Jonathan C. Lee Juliana Corlier Andrew C. Wilson Reza Tadayonnejad Katharine G. Marder Doan Ngo David E. Krantz Scott A. Wilke Jennifer G. Levitt Nathaniel D. Ginder Andrew F. Leuchter Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder Brain Stimulation Repetitive transcranial magnetic stimulation (rTMS) Intermittent theta-burst (iTBS) Priming stimulation Augmentation Optimization Clinical efficacy |
author_facet |
Jonathan C. Lee Juliana Corlier Andrew C. Wilson Reza Tadayonnejad Katharine G. Marder Doan Ngo David E. Krantz Scott A. Wilke Jennifer G. Levitt Nathaniel D. Ginder Andrew F. Leuchter |
author_sort |
Jonathan C. Lee |
title |
Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder |
title_short |
Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder |
title_full |
Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder |
title_fullStr |
Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder |
title_full_unstemmed |
Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive Disorder |
title_sort |
subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for major depressive disorder |
publisher |
Elsevier |
series |
Brain Stimulation |
issn |
1935-861X |
publishDate |
2021-07-01 |
description |
Background: Intermittent theta-burst stimulation priming (iTBS-P) can improve clinical outcome of patients with Major Depressive Disorder (MDD) who do not show early benefit from 10 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC), also known as high-frequency left-sided (HFL) stimulation. The intensity and pulse number for iTBS-P needed to induce clinical benefit have not been systematically examined. Objective: To study the effect of intensity and pulse number on the clinical efficacy of iTBS-P. Methods: We conducted a retrospective review of 71 participants who received at least five sessions of HFL with limited clinical benefit and received iTBS-P augmentation for between 5 and 25 sessions. Intensity of iTBS-P priming stimuli ranged from 75 to 120% of motor threshold (MT) and pulse number ranged from 600 to 1800. Associations among intensity, pulse number, and clinical outcome were analyzed using a mixed methods linear model with change in IDS-SR as the primary outcome variable, priming stimulation intensity (subthreshold or suprathreshold), pulse number (<1200 or >1200 pulses), and gender as fixed factors, and number of iTBS-P treatments and age as continuous covariates. Results: Subjects who received subthreshold intensity iTBS-P experienced greater reduction in depressive symptoms than those who received suprathreshold iTBS-P (p = 0.011) with no effect of pulse number after controlling for stimulus intensity. Conclusions: Subthreshold intensity iTBS-P was associated with greater clinical improvement than suprathreshold stimulation. This finding is consistent with iTBS-P acting through homeostatic plasticity mechanisms. |
topic |
Repetitive transcranial magnetic stimulation (rTMS) Intermittent theta-burst (iTBS) Priming stimulation Augmentation Optimization Clinical efficacy |
url |
http://www.sciencedirect.com/science/article/pii/S1935861X21001273 |
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doaj-a2710654bd50487eba105249e83b84212021-07-23T04:48:34ZengElsevierBrain Stimulation1935-861X2021-07-0114410151021Subthreshold stimulation intensity is associated with greater clinical efficacy of intermittent theta-burst stimulation priming for Major Depressive DisorderJonathan C. Lee0Juliana Corlier1Andrew C. Wilson2Reza Tadayonnejad3Katharine G. Marder4Doan Ngo5David E. Krantz6Scott A. Wilke7Jennifer G. Levitt8Nathaniel D. Ginder9Andrew F. Leuchter10TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA; Corresponding author. 760 Westwood Plaza, 57-464, Los Angeles, CA, 90024, USA.TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA; California Institute of Technology, Division of the Humanities and Social Sciences, 1200 E California Blvd, Pasadena, CA, 91125, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USA; VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USATMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, And the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90024, USABackground: Intermittent theta-burst stimulation priming (iTBS-P) can improve clinical outcome of patients with Major Depressive Disorder (MDD) who do not show early benefit from 10 Hz stimulation of left dorsolateral prefrontal cortex (DLPFC), also known as high-frequency left-sided (HFL) stimulation. The intensity and pulse number for iTBS-P needed to induce clinical benefit have not been systematically examined. Objective: To study the effect of intensity and pulse number on the clinical efficacy of iTBS-P. Methods: We conducted a retrospective review of 71 participants who received at least five sessions of HFL with limited clinical benefit and received iTBS-P augmentation for between 5 and 25 sessions. Intensity of iTBS-P priming stimuli ranged from 75 to 120% of motor threshold (MT) and pulse number ranged from 600 to 1800. Associations among intensity, pulse number, and clinical outcome were analyzed using a mixed methods linear model with change in IDS-SR as the primary outcome variable, priming stimulation intensity (subthreshold or suprathreshold), pulse number (<1200 or >1200 pulses), and gender as fixed factors, and number of iTBS-P treatments and age as continuous covariates. Results: Subjects who received subthreshold intensity iTBS-P experienced greater reduction in depressive symptoms than those who received suprathreshold iTBS-P (p = 0.011) with no effect of pulse number after controlling for stimulus intensity. Conclusions: Subthreshold intensity iTBS-P was associated with greater clinical improvement than suprathreshold stimulation. This finding is consistent with iTBS-P acting through homeostatic plasticity mechanisms.http://www.sciencedirect.com/science/article/pii/S1935861X21001273Repetitive transcranial magnetic stimulation (rTMS)Intermittent theta-burst (iTBS)Priming stimulationAugmentationOptimizationClinical efficacy |