TY - JOUR
T1 - Neurophysiological predictors of non-response to rTMS in depression
AU - Arns, Martijn
AU - Drinkenburg, Wilhelmus H
AU - Fitzgerald, Paul Bernard
AU - Kenemans, J Leon
PY - 2012
Y1 - 2012
N2 - The application of rTMS in Depression has been very well investigated over the last few years. However, little is known about predictors of non-response associated with rTMS treatment. Objective: This study examined neurophysiological parameters (EEG and ERP) in 90 depressed patients treated with rTMS and psychotherapy and sought to identify predictors of non-response. Methods: This study is a multi-site open-label study assessing pre-treatment EEG and ERP measures associated with non-response to rTMS treatment. Results: Non-responders were characterized by 1) Increased fronto-central theta EEG power, 2) a slower anterior individual alpha peak frequency, 3) a larger P300 amplitude, and 4) decreased pre-frontal delta and beta cordance. A discriminant analysis yielded a significant model, and subsequent ROC curve demonstrated an area under the curve of 0.814. Conclusions: Several EEG variables demonstrated clear differences between R and NR such as the anterior iAPF, fronto-central Theta and pre-frontal cordance in the Delta and Beta band (representative of increased relative pre-frontal perfusion). The increased P300 amplitude as a predictor for non-response requires further study, since this was the opposite as hypothesized and there were no correlations of this measure with clinical improvement for the whole sample. Combining these biomarkers in a discriminant analysis resulted in a reliable identification of non-responders with low false positive rates. Future studies should prospectively replicate these findings and also further investigate appropriate treatments for the sub-groups of non-responders identified in this study, given that most of these biomarkers have also been found in antidepressant medication studies.
AB - The application of rTMS in Depression has been very well investigated over the last few years. However, little is known about predictors of non-response associated with rTMS treatment. Objective: This study examined neurophysiological parameters (EEG and ERP) in 90 depressed patients treated with rTMS and psychotherapy and sought to identify predictors of non-response. Methods: This study is a multi-site open-label study assessing pre-treatment EEG and ERP measures associated with non-response to rTMS treatment. Results: Non-responders were characterized by 1) Increased fronto-central theta EEG power, 2) a slower anterior individual alpha peak frequency, 3) a larger P300 amplitude, and 4) decreased pre-frontal delta and beta cordance. A discriminant analysis yielded a significant model, and subsequent ROC curve demonstrated an area under the curve of 0.814. Conclusions: Several EEG variables demonstrated clear differences between R and NR such as the anterior iAPF, fronto-central Theta and pre-frontal cordance in the Delta and Beta band (representative of increased relative pre-frontal perfusion). The increased P300 amplitude as a predictor for non-response requires further study, since this was the opposite as hypothesized and there were no correlations of this measure with clinical improvement for the whole sample. Combining these biomarkers in a discriminant analysis resulted in a reliable identification of non-responders with low false positive rates. Future studies should prospectively replicate these findings and also further investigate appropriate treatments for the sub-groups of non-responders identified in this study, given that most of these biomarkers have also been found in antidepressant medication studies.
UR - http://www.sciencedirect.com.ezproxy.lib.monash.edu.au/science/article/pii/S1935861X11001720
U2 - 10.1016/j.brs.2011.12.003
DO - 10.1016/j.brs.2011.12.003
M3 - Article
SN - 1935-861X
VL - 5
SP - 569
EP - 576
JO - Brain Stimulation
JF - Brain Stimulation
IS - 4
ER -