Efficacy of Intermediate Theta Burst Versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Treatment-Resistant Depressive Patients Using Electroencephalography
-
Mahmoud Bagheri
,
Javad Hosseini Nejad
,
Hassan Tavakoli
,
Seyed Abbas Tavallaie
,
Aliakbar Karimi Zarchi
Abstract
Purpose: This study was conducted to evaluate the comparative effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) and intermittent Theta Burst Stimulation (iTBS), in Treatment-Resistant Depression (TRD) patients using resting-state Electroencephalography (EEG). iTBS is a novel form of magnetic stimulation with the potential to produce similar anti-depressant effects but in a much shorter time.
Materials and Methods: In two stimulation protocols, 78 patients with TRD received 20 sessions. Depression symptoms were assessed based on the changes in the Hamilton Depression Rating Scale (HAM-D) and Beck Depression Inventory (BDI-II) scores at baseline, after the last session, and at 4 weeks after treatment. Resting-state EEG was measured at baseline and after the last session. EEG power spectrum was extracted and power changes were evaluated statistically.
Results: There was no significant difference in response and remission rates between the two groups. Following 10 Hz rTMS and iTBS, the clinical indexes improved by 48.5 ± 19.8 % (p-value < 0.05) and 50.4 ± 21.7 % (p-value < 0.05), respectively. There was a significant reduction in the mean depression scores for both treatment groups (p < 0.05). Following treatment, TRD patients showed considerable enhancement in gamma power at the left DLPFC site (F3, F5, and F7 electrode) in the iTBS group and significant increases in delta power at the F3 and F7 electrode sites in the 10 Hz rTMS group.
Conclusion: iTBS provides clinical advantages, which showed that the results did not contrast altogether with results from a standard course of rTMS treatment. It might be invaluable from a clinical, benefit, and understanding perspective. Biomarkers of clinical outcomes such as resting-state brain activity measured with EEG may save individuals worthless treatment and moderately limited clinical assets.
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13- Alexandria Pabst, Shannon Proksch, Butovens Mede, Daniel C Comstock, Jessica Marie Ross, and Ramesh Balasubramaniam, "A systematic review and meta-analysis of the efficacy of intermittent theta burst stimulation (iTBS) on cognitive enhancement." Neuroscience & Biobehavioral Reviews, Vol. 135p. 104587, (2022).
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21- Frank P MacMaster et al., "Repetitive transcranial magnetic stimulation in youth with treatment resistant major depression." Frontiers in psychiatry, Vol. 10p. 170, (2019).
22- Andrew Giam et al., "Comparing theta burst stimulation with standard left high frequency transcranial magnetic stimulation in the treatment of depression in a randomized controlled study: a preliminary comparison study." Journal of Affective Disorders Reports, Vol. 5p. 100162, (2021).
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24- Mark S George et al., "A controlled trial of daily left prefrontal cortex TMS for treating depression." Biological psychiatry, Vol. 48 (No. 10), pp. 962-70, (2000).
25- Dan Tuinstra et al., "Treatment of anxiety symptoms in patients receiving rTMS for treatment resistant depression." Psychiatry Research Communications, Vol. 2 (No. 1), p. 100014, (2022).
26- Keith Isenberg et al., "Low frequency rTMS stimulation of the right frontal cortex is as effective as high frequency rTMS stimulation of the left frontal cortex for antidepressant-free, treatment-resistant depressed patients." Annals of Clinical Psychiatry, Vol. 17 (No. 3), pp. 153-59, (2005).
27- PENG Zhengwu et al., "Mechanism of repetitive transcranial magnetic stimulation for depression." Shanghai archives of psychiatry, Vol. 30 (No. 2), p. 84, (2018).
28- Marcelo T Berlim, Frederique Van den Eynde, and Z Jeff Daskalakis, "Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials." Neuropsychopharmacology, Vol. 38 (No. 4), pp. 543-51, (2013).
29- Vladas Valiulis, Giedrius Gerulskis, Kastytis Dapšys, Giedre Vištartaite, Aldona Šiurkute, and Valentinas Mačiulis, "Electrophysiological differences between high and low frequency rTMS protocols in depression treatment." Acta Neurobiol Exp, Vol. 72 (No. 3), pp. 283-95, (2012).
30- Yoshihiro Noda et al., "Resting-state EEG gamma power and theta–gamma coupling enhancement following high-frequency left dorsolateral prefrontal rTMS in patients with depression." Clinical Neurophysiology, Vol. 128 (No. 3), pp. 424-32, (2017).
31- Chiara Spironelli, Alessandro Angrilli, Antonino Calogero, and Luciano Stegagno, "Delta EEG band as a marker of left hypofrontality for language in schizophrenia patients." Schizophrenia bulletin, Vol. 37 (No. 4), pp. 757-67, (2011).
32- Helena Voetterl et al., "Investigating EEG biomarkers of clinical response to low frequency rTMS in depression." Journal of Affective Disorders Reports, Vol. 6p. 100250, (2021).
2- Dawn F Ionescu, Jerrold F Rosenbaum, and Jonathan E Alpert, "Pharmacological approaches to the challenge of treatment-resistant depression." Dialogues in clinical neuroscience, (2015).
3- Maurizio Fava, "Diagnosis and definition of treatment-resistant depression." Biological psychiatry, Vol. 53 (No. 8), pp. 649-59, (2003).
4- Mahboubeh Masoumbeigi et al., "Altered Amplitude of Low-Frequency Fluctuations of rs-fMRI Signal followed by rTMS Analgesic Effects in Non-Specific Chronic Low Back Pain (CLBP) Patients." Journal of Biomedical Physics and Engineering, (2022).
5- Mahboubeh Masoumbeigi et al., "rTMS Pain Reduction Effectiveness in Non-specific Chronic Low Back Pain Patients using rs-fMRI Functional Connectivity." Journal of Medical and Biological Engineering, Vol. 42 (No. 5), pp. 647-57, (2022).
6- Hassan Tavakoli and Arsalan Heidarpanah, "Designing a circular coil of repetitive transcranial magnetic stimulation at frequencies of 0.5 and 1 Hz using CST studio suite software and comparison of results with theoretical calculations." Biomedical and Biotechnology Research Journal (BBRJ), Vol. 6 (No. 3), pp. 382-86, (2022).
7- Janna Marie Hoogendam, Geert MJ Ramakers, and Vincenzo Di Lazzaro, "Physiology of repetitive transcranial magnetic stimulation of the human brain." Brain stimulation, Vol. 3 (No. 2), pp. 95-118, (2010).
8- Hassan Tavakoli and Arsalan Heidarpanah, "Literature review of the efficacy of repetitive transcranial magnetic stimulation on epilepsy." Iranian Journal of Child Neurology, Vol. 17 (No. 1), p. 9, (2023).
9- Yoshihiro Noda et al., "Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review." Psychological medicine, Vol. 45 (No. 16), pp. 3411-32, (2015).
10- Fatemeh Asgharian Asl and Ladan Vaghef, "The effectiveness of high-frequency left DLPFC-rTMS on depression, response inhibition, and cognitive flexibility in female subjects with major depressive disorder." Journal of Psychiatric Research, Vol. 149pp. 287-92, (2022).
11- Daniel M Blumberger et al., "Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial." The Lancet, Vol. 391 (No. 10131), pp. 1683-92, (2018).
12- Romain Duprat et al., "Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: a fast road to remission?" Journal of affective disorders, Vol. 200pp. 6-14, (2016).
13- Alexandria Pabst, Shannon Proksch, Butovens Mede, Daniel C Comstock, Jessica Marie Ross, and Ramesh Balasubramaniam, "A systematic review and meta-analysis of the efficacy of intermittent theta burst stimulation (iTBS) on cognitive enhancement." Neuroscience & Biobehavioral Reviews, Vol. 135p. 104587, (2022).
14- Adriano H Moffa, Tjeerd W Boonstra, Ashley Wang, Donel Martin, Colleen Loo, and Stevan Nikolin, "Neuromodulatory effects of theta burst stimulation to the prefrontal cortex." Scientific data, Vol. 9 (No. 1), p. 717, (2022).
15- Mahsa Soufineyestani, Dale Dowling, and Arshia Khan, "Electroencephalography (EEG) technology applications and available devices." Applied Sciences, Vol. 10 (No. 21), p. 7453, (2020).
16- Elias Ebrahimzadeh, Mostafa Asgarinejad, Sarah Saliminia, Sarvenaz Ashoori, and Masoud Seraji, "Predicting clinical response to transcranial magnetic stimulation in major depression using time-frequency EEG signal processing." Biomedical Engineering: Applications, Basis and Communications, Vol. 33 (No. 06), p. 2150048, (2021).
17- Max Hamilton, "A rating scale for depression." Journal of neurology, neurosurgery, and psychiatry, Vol. 23 (No. 1), p. 56, (1960).
18- Aaron T Beck, Robert A Steer, and Gregory Brown, "Beck depression inventory–II." Psychological assessment, (1996).
19- Georgios Mikellides, Panayiota Michael, Lilia Psalta, Teresa Schuhmann, and Alexander T Sack, "A retrospective naturalistic study comparing the efficacy of ketamine and repetitive transcranial magnetic stimulation for treatment-resistant depression." Frontiers in psychiatry, Vol. 12p. 784830, (2022).
20- Premysl Vlcek, Martin Bares, Tomas Novak, and Martin Brunovsky, "Baseline difference in quantitative electroencephalography variables between responders and non-responders to low-frequency repetitive transcranial magnetic stimulation in depression." Frontiers in psychiatry, Vol. 11p. 83, (2020).
21- Frank P MacMaster et al., "Repetitive transcranial magnetic stimulation in youth with treatment resistant major depression." Frontiers in psychiatry, Vol. 10p. 170, (2019).
22- Andrew Giam et al., "Comparing theta burst stimulation with standard left high frequency transcranial magnetic stimulation in the treatment of depression in a randomized controlled study: a preliminary comparison study." Journal of Affective Disorders Reports, Vol. 5p. 100162, (2021).
23- Brendan D Hare and Ronald S Duman, "Prefrontal cortex circuits in depression and anxiety: contribution of discrete neuronal populations and target regions." Molecular psychiatry, Vol. 25 (No. 11), pp. 2742-58, (2020).
24- Mark S George et al., "A controlled trial of daily left prefrontal cortex TMS for treating depression." Biological psychiatry, Vol. 48 (No. 10), pp. 962-70, (2000).
25- Dan Tuinstra et al., "Treatment of anxiety symptoms in patients receiving rTMS for treatment resistant depression." Psychiatry Research Communications, Vol. 2 (No. 1), p. 100014, (2022).
26- Keith Isenberg et al., "Low frequency rTMS stimulation of the right frontal cortex is as effective as high frequency rTMS stimulation of the left frontal cortex for antidepressant-free, treatment-resistant depressed patients." Annals of Clinical Psychiatry, Vol. 17 (No. 3), pp. 153-59, (2005).
27- PENG Zhengwu et al., "Mechanism of repetitive transcranial magnetic stimulation for depression." Shanghai archives of psychiatry, Vol. 30 (No. 2), p. 84, (2018).
28- Marcelo T Berlim, Frederique Van den Eynde, and Z Jeff Daskalakis, "Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials." Neuropsychopharmacology, Vol. 38 (No. 4), pp. 543-51, (2013).
29- Vladas Valiulis, Giedrius Gerulskis, Kastytis Dapšys, Giedre Vištartaite, Aldona Šiurkute, and Valentinas Mačiulis, "Electrophysiological differences between high and low frequency rTMS protocols in depression treatment." Acta Neurobiol Exp, Vol. 72 (No. 3), pp. 283-95, (2012).
30- Yoshihiro Noda et al., "Resting-state EEG gamma power and theta–gamma coupling enhancement following high-frequency left dorsolateral prefrontal rTMS in patients with depression." Clinical Neurophysiology, Vol. 128 (No. 3), pp. 424-32, (2017).
31- Chiara Spironelli, Alessandro Angrilli, Antonino Calogero, and Luciano Stegagno, "Delta EEG band as a marker of left hypofrontality for language in schizophrenia patients." Schizophrenia bulletin, Vol. 37 (No. 4), pp. 757-67, (2011).
32- Helena Voetterl et al., "Investigating EEG biomarkers of clinical response to low frequency rTMS in depression." Journal of Affective Disorders Reports, Vol. 6p. 100250, (2021).
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How to Cite
1.
Bagheri M, Hosseini Nejad J, Tavakoli H, Tavallaie SA, Karimi Zarchi A. Efficacy of Intermediate Theta Burst Versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Treatment-Resistant Depressive Patients Using Electroencephalography. Frontiers Biomed Technol. 2024;.
