Pursuing personalized medicine for depression by targeting the lateral or medial prefrontal cortex with Deep TMS
Abraham Zangen, Samuel Zibman, Aron Tendler, Noam Barnea-Ygael, Uri Alyagon, Daniel M. Blumberger, Geoffrey Grammer, Hadar Shalev, Tatiana Gulevski, Tanya Vapnik, Alexander Bystritsky, Igor Filipčić, David Feifel, Ahava Stein, Frederic Deutsch, Yiftach Roth, Mark S. George
Abraham Zangen, Samuel Zibman, Aron Tendler, Noam Barnea-Ygael, Uri Alyagon, Daniel M. Blumberger, Geoffrey Grammer, Hadar Shalev, Tatiana Gulevski, Tanya Vapnik, Alexander Bystritsky, Igor Filipčić, David Feifel, Ahava Stein, Frederic Deutsch, Yiftach Roth, Mark S. George
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Clinical Research and Public Health Clinical trials Neuroscience

Pursuing personalized medicine for depression by targeting the lateral or medial prefrontal cortex with Deep TMS

Abstract

BACKGROUND Major depressive disorder (MDD) can benefit from novel interventions and personalization. Deep transcranial magnetic stimulation (Deep TMS) targeting the lateral prefrontal cortex (LPFC) using the H1 coil was FDA cleared for treatment of MDD. However, recent preliminary data indicate that targeting the medial prefrontal cortex (MPFC) using the H7 coil might induce outcomes that are as good or even better. Here, we explored whether Deep TMS targeting the MPFC is noninferior to targeting the LPFC and whether electrophysiological or clinical markers for patient selection can be identified.METHODS The present prospective, multicenter, randomized study enrolled 169 patients with MDD for whom antidepressants failed in the current episode. Patients were randomized to receive 24 Deep TMS sessions over 6 weeks, using either the H1 coil or the H7 coil. The primary efficacy endpoint was the change from baseline to week 6 in Hamilton Depression Rating Scale scores.RESULTS Clinical efficacy and safety profiles were similar and not significantly different between groups, with response rates of 60.9% for the H1 coil and 64.2% for the H7 coil. Moreover, brain activity measured by EEG during the first treatment session correlated with clinical outcomes in a coil-specific manner, and a cluster of baseline clinical symptoms was found to potentially distinguish between patients who can benefit from each Deep TMS target.CONCLUSION This study provides a treatment option for MDD, using the H7 coil, and initial guidance to differentiate between patients likely to respond to LPFC versus MPFC stimulation targets, which require further validation studies.TRIAL REGISTRATION ClinicalTrials.gov NCT03012724.FUNDING BrainsWay Ltd.

Authors

Abraham Zangen, Samuel Zibman, Aron Tendler, Noam Barnea-Ygael, Uri Alyagon, Daniel M. Blumberger, Geoffrey Grammer, Hadar Shalev, Tatiana Gulevski, Tanya Vapnik, Alexander Bystritsky, Igor Filipčić, David Feifel, Ahava Stein, Frederic Deutsch, Yiftach Roth, Mark S. George

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Figure 2

Response to treatment.

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Response to treatment. Box-and-whisker plots for changes in HDRS-21 scor...
Box-and-whisker plots for changes in HDRS-21 scores over the treatment course (A) and percentage of patients who experienced response (≥50% reduction from baseline in HDRS-21 score) and remission (HDRS-21 < 10) at the week 6 visit (B). Repeated measures ANCOVA models indicated that starting at the first measurement following treatment initiation (week 3), HDRS-21 scores were significantly reduced from baseline in both groups. No differences were observed between groups at any time point. The box plots depict the minimum value, first quartile, median, third quartile, and maximum value. The length of the box represents the interquartile range and dots represent outliers. *P < 0.0001, a repeated measures ANCOVA coefficient test for the change from baseline scores of that group. BL, baseline; W, week.