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Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial.

Publication ,  Journal Article
Johnson, KA; Baig, M; Ramsey, D; Lisanby, SH; Avery, D; McDonald, WM; Li, X; Bernhardt, ER; Haynor, DR; Holtzheimer, PE; Sackeim, HA; Nahas, Z ...
Published in: Brain Stimul
March 2013

BACKGROUND: Motor cortex localization and motor threshold determination often guide Transcranial Magnetic Stimulation (TMS) placement and intensity settings for non-motor brain stimulation. However, anatomic variability results in variability of placement and effective intensity. OBJECTIVE: Post-study analysis of the OPT-TMS Study reviewed both the final positioning and the effective intensity of stimulation (accounting for relative prefrontal scalp-cortex distances). METHODS: We acquired MRI scans of 185 patients in a multi-site trial of left prefrontal TMS for depression. Scans had marked motor sites (localized with TMS) and marked prefrontal sites (5 cm anterior of motor cortex by the "5 cm rule"). Based on a visual determination made before the first treatment, TMS therapy occurred either at the 5 cm location or was adjusted 1 cm forward. Stimulation intensity was 120% of resting motor threshold. RESULTS: The "5 cm rule" would have placed stimulation in premotor cortex for 9% of patients, which was reduced to 4% with adjustments. We did not find a statistically significant effect of positioning on remission, but no patients with premotor stimulation achieved remission (0/7). Effective stimulation ranged from 93 to 156% of motor threshold, and no seizures were induced across this range. Patients experienced remission with effective stimulation intensity ranging from 93 to 146% of motor threshold, and we did not find a significant effect of effective intensity on remission. CONCLUSIONS: Our data indicates that individualized positioning methods are useful to reduce variability in placement. Stimulation at 120% of motor threshold, unadjusted for scalp-cortex distances, appears safe for a broad range of patients.

Duke Scholars

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Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

March 2013

Volume

6

Issue

2

Start / End Page

108 / 117

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Prefrontal Cortex
  • Neurology & Neurosurgery
  • Motor Cortex
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Female
 

Citation

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Johnson, K. A., Baig, M., Ramsey, D., Lisanby, S. H., Avery, D., McDonald, W. M., … Nahas, Z. (2013). Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul, 6(2), 108–117. https://doi.org/10.1016/j.brs.2012.02.003
Johnson, Kevin A., Mirza Baig, Dave Ramsey, Sarah H. Lisanby, David Avery, William M. McDonald, Xingbao Li, et al. “Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial.Brain Stimul 6, no. 2 (March 2013): 108–17. https://doi.org/10.1016/j.brs.2012.02.003.
Johnson KA, Baig M, Ramsey D, Lisanby SH, Avery D, McDonald WM, et al. Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul. 2013 Mar;6(2):108–17.
Johnson, Kevin A., et al. “Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial.Brain Stimul, vol. 6, no. 2, Mar. 2013, pp. 108–17. Pubmed, doi:10.1016/j.brs.2012.02.003.
Johnson KA, Baig M, Ramsey D, Lisanby SH, Avery D, McDonald WM, Li X, Bernhardt ER, Haynor DR, Holtzheimer PE, Sackeim HA, George MS, Nahas Z. Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul. 2013 Mar;6(2):108–117.
Journal cover image

Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

March 2013

Volume

6

Issue

2

Start / End Page

108 / 117

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Prefrontal Cortex
  • Neurology & Neurosurgery
  • Motor Cortex
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
  • Female