1
|
Zangen A, Zibman S, Tendler A, Barnea-Ygael N, Alyagon U, Blumberger DM, Grammer G, Shalev H, Gulevski T, Vapnik T, Bystritsky A, Filipčić I, Feifel D, Stein A, Deutsch F, Roth Y, George MS. Pursuing personalized medicine for depression by targeting the lateral or medial prefrontal cortex with Deep TMS. JCI Insight 2023; 8:165271. [PMID: 36692954 PMCID: PMC9977507 DOI: 10.1172/jci.insight.165271] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUNDMajor 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.METHODSThe 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.RESULTSClinical 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.CONCLUSIONThis 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 REGISTRATIONClinicalTrials.gov NCT03012724.FUNDINGBrainsWay Ltd.
Collapse
Affiliation(s)
| | - Samuel Zibman
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aron Tendler
- Advanced Mental Health Care Inc., Royal Palm Beach, Florida, USA
| | | | - Uri Alyagon
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Hadar Shalev
- Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Psychiatry, Soroka Medical Center, Beer-Sheva, Israel
| | | | - Tanya Vapnik
- Pacific Institute of Medical Research, Los Angeles, California, USA
| | | | - Igor Filipčić
- Psychiatric Hospital Sveti Ivan and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David Feifel
- Kadima Neuropsychiatry Institute, La Jolla, California, USA
| | - Ahava Stein
- A. Stein - Regulatory Affairs Consulting Ltd, Kfar Saba, Israel
| | | | - Yiftach Roth
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mark S George
- Medical University of South Carolina, Columbia, South Carolina, USA.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| |
Collapse
|
2
|
Harmelech T, Roth Y, Tendler A. Deep TMS H7 Coil: Features, Applications & Future. Expert Rev Med Devices 2021; 18:1133-1144. [PMID: 34878347 DOI: 10.1080/17434440.2021.2013803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) uses magnetic pulses to induce electrical current in the underlying neuronal tissue. A variety of TMS coils exist on the market, differing primarily in configuration, orientation, and flexibility of the wire windings of the coil. Deep TMSTM utilizes H-Coils, flexible coils with different configurations for stimulating different brain regions implicated in different neuropsychiatric disorders. The H7 Coil, designed to target primarily the medial prefrontal cortex and the anterior cingulate cortex, is FDA-cleared for obsessive-compulsive disorder (OCD). It was chosen as the focus of this review since it recently showed promise in various neuropsychiatric populations in addition to growing understanding of its mechanism of action (MOA). AREAS COVERED Here we assembled all peer-reviewed publications on the H7 Coil to showcase its efficacy in: (a) various OCD patient populations (e.g., different degrees of symptom severity, treatment resistance, comorbidities) (b) other neuropsychiatric populations (e.g., addiction, major depressive disorder and autism spectrum disorder). EXPERT OPINION While substantial evidence pertaining to the H7 Coil's efficacy as well as its MOA has accumulated, much work remains. In the final section of this review, we highlight areas of ongoing and future research that will further elucidate the coil's MOA as well as its full efficacy potential.
Collapse
Affiliation(s)
| | - Yiftach Roth
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aron Tendler
- BrainsWay Ltd.,Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Advanced Mental Health Care Inc, FL, USA
| |
Collapse
|
3
|
Valiengo L, Maia A, Cotovio G, Gordon PC, Brunoni AR, Forlenza OV, Oliveira-Maia AJ. Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder in Older Adults: Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci 2021; 77:851-860. [PMID: 34432865 DOI: 10.1093/gerona/glab235] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) in older adults is a serious public health concern. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological intervention approved for Major Depressive Disorder (MDD) treatment in adults, but its value in older adults remains unknown. The present study aims to systematically review and meta-analyze evidence of rTMS efficacy in MDD treatment among older adults. METHODS We systematically reviewed the literature for randomized controlled trials (RCTs) and open-label studies assessing rTMS for the treatment of MDD in patients older than 50 years-old, published until June 2020. Random-effects meta-analyses using standardized mean differences (SMD) were conducted to assess change in depression severity score (primary outcome), while odds-ratios (OR) were used to assess secondary categorical outcomes (response and remission). Additionally, univariate meta-regression analyses were performed to identify potential predictors of change in depression severity scores. RESULTS Fourteen RCTs were included in meta-analyses and 26 studies (10 RCTs and 16 open-label studies) in meta-regression. Active rTMS was significantly superior to sham-treatment for reduction of severity (SMD=0.36; 95%CI=0.13-0.60), as well as response (OR=3.26; 95%CI=2.11-5.04) and remission (OR=4.63; 95%CI=2.24-9.55). Studies were of moderate to high quality, with funnel plots and Egger's regression test not suggestive of publication bias. In meta-regressions, higher mean age and number of sessions were significantly associated to greater improvement. CONCLUSIONS Our results support that rTMS is an effective, safe and well-tolerated treatment for MDD in older adults, and that it should be considered in the treatment of this vulnerable population.
Collapse
Affiliation(s)
- Leandro Valiengo
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Ana Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Pedro C Gordon
- Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - André R Brunoni
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil.,Serviço Interdisciplinar de Neuromodulação (SIN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Orestes V Forlenza
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Tendler A, Roth Y, Harmelech T. Deep repetitive TMS with the H7 coil is sufficient to treat comorbid MDD and OCD. Brain Stimul 2021; 14:658-661. [PMID: 33831605 DOI: 10.1016/j.brs.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Aron Tendler
- BrainsWay Ltd, USA; Advanced Mental Health Care Inc, USA; Department of Biology, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Yiftach Roth
- BrainsWay Ltd, Israel; Department of Life Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | |
Collapse
|