Investigating EEG biomarkers of clinical response to low frequency rTMS in depression

Helena Voetterl; Jean-Philippe Miron; Farrokh Mansouri; Linsay Fox; Molly Hyde; Daniel M. Blumberger; Zafiris J. Daskalakis; Fidel Vila-Rodriguez; Alexander T. Sack; Jonathan Downar

Journal of Affective Disorders Reports (Dec 2021)

Investigating EEG biomarkers of clinical response to low frequency rTMS in depression

Helena Voetterl,
Jean-Philippe Miron,
Farrokh Mansouri,
Linsay Fox,
Molly Hyde,
Daniel M. Blumberger,
Zafiris J. Daskalakis,
Fidel Vila-Rodriguez,
Alexander T. Sack,
Jonathan Downar

Affiliations

Helena Voetterl: Research Institute Brainclinics, Nijmegen, Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Netherlands; Krembil Research Institute, University Health Network, Toronto, ON, Canada; Corresponding author.
Jean-Philippe Miron: Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
Farrokh Mansouri: Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Linsay Fox: Krembil Research Institute, University Health Network, Toronto, ON, Canada
Molly Hyde: Krembil Research Institute, University Health Network, Toronto, ON, Canada
Daniel M. Blumberger: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
Zafiris J. Daskalakis: Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
Fidel Vila-Rodriguez: Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
Alexander T. Sack: Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Netherlands
Jonathan Downar: Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

Journal volume & issue: Vol. 6
p. 100250

Abstract

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Background: Repetitive transcranial magnetic stimulation (rTMS) is an effective intervention for major depressive disorder (MDD). Completing a full treatment course, however, is costly and time-consuming. Biomarkers of clinical outcome such as baseline resting-state brain activity measured with electroencephalography (EEG) may spare people futile treatment and conserve limited clinical resources. Additionally, investigating changes in EEG power post-treatment could provide insights into the working mechanism of rTMS. Methods: 39 MDD patients received 6 daily sessions of accelerated low-frequency (LF) rTMS over the right dorsolateral prefrontal cortex (DLPFC) for 5 days followed by a tapering course of 25 once-daily sessions. Resting-state EEG and heart rate (HR) measures were acquired immediately before and after a single rTMS session at 3 different timepoints: baseline, one week after the final accelerated session, and upon completion of the tapering course. The primary clinical outcome measure was the Beck Depression Inventory II (BDI-II). Results: High relative baseline theta power in prefrontal areas and high baseline HR were associated with poorer clinical outcome. HR decreased acutely at the beginning of the patients’ first rTMS session but this effect was not associated with treatment outcome. Limitations: The main limitations were small sample size and a lack of sham and healthy control group. Conclusion: Our results suggest that high relative theta power at baseline may be a marker of poorer response to right-sided LF rTMS. If validated, this easily applicable measure could inform rTMS protocol choice for the individual, thereby potentially speeding up patient recovery and saving clinical resources.

Published in Journal of Affective Disorders Reports

ISSN: 2666-9153 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Other systems of medicine: Mental healing
Website: https://www.journals.elsevier.com/journal-of-affective-disorders-reports

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