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• W2141014195 abstract "Back to table of contents Previous article Next article LettersFull AccessFurther Evidence of the Usefulness of MRI-Based Neuronavigation for the Treatment of Depression by rTMSBenoit Trojak, M.D., Vinvent Meille, M.D., Jean-Christophe Chauvet-Gelinier, M.D., and Bernard Bonin, M.D.Benoit TrojakSearch for more papers by this author, M.D., Vinvent MeilleSearch for more papers by this author, M.D., Jean-Christophe Chauvet-GelinierSearch for more papers by this author, M.D., and Bernard BoninSearch for more papers by this author, M.D.Published Online:1 Apr 2011AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: Repetitive transcranial magnetic stimulation (rTMS) is known to have therapeutic effects in drug-resistant depression when it is applied over the dorsolateral prefrontal cortex (DLPFC), both for high-frequency, left-sided rTMS and low-frequency, right-sided rTMS.1 The DLPFC, or “area 9/46,” is a large cortical area traditionally comprising both brodmann areas (BA) 9 and 46.2 Although rTMS is considered a promising therapy, its therapeutic effects remain modest. This may result from the fact that imaging studies to date have failed to identify which of the two subregions gives the optimal antidepressive effects.2 Furthermore, the “5-cm method,” the method used in almost all rTMS depression studies to date to target the DLPFC, may not be precise enough.3 We report, here, the case of a patient who recovered from a major drug-resistant depressive episode thanks to low-frequency rTMS with targeting of the BA 9, using MRI-based neuronavigation.Case ReportA 50-year-old man, suffering from a major drug-resistant depressive episode that had evolved over 2 years in a context of unipolar depression, was referred to our department for rTMS therapy. For this patient, we decided to delivered 1-Hz rTMS sessions (360 pulses per session, 120% motor threshold) 1 week after all psychotropic drugs were stopped. MRI-based neuronavigation was used to localize the cortical site of stimulation (eXimia NBS Navigation System). We first used the “5-cm method” to target the DLPFC, which consists in localizing the motor cortical site that stimulates the abductor pollicis brevis muscle of the contralateral hand, and then measuring 5 cm anteriorly along the scalp surface in order to target the DLPFC.3 However, in our patient, as this method gave a cortical site outside BA 9 (in fact, in BA 8), the coil was moved to 6 cm anterior to the primary motor cortex in order to target BA 9 (figure 1). After the patient had received daily rTMS sessions from monday through friday for 6 weeks and then two rTMS sessions per week for 4 weeks, the Montgomery-Asberg Depression Rating Scale and the Hamilton Rating Scale for Depression scores, initially evaluated at 32/60 and 23/63, dropped to 8/60 and 05/63.FIGURE 1. Areas to Receive Repetitive Transcranial Magnetic Stimulation (rTMS)[A] Cortical target 6 cm. anterior to motor cortex; [B] Cortical target defined by the “5-cm. method;” [C] Cortical site that stimulates the thumb.DiscussionThis case shows the importance of MRI-based neuronavigation to localize the DLPFC. First, MRI-based neuronavigation takes into account variations in individual brain anatomy and gives precise data which are not available with the “5-cm method.” In our patient, the “5-cm method” gave a target posterior to the DLPFC, as was the case in Herwig′s study, in which 15 of the 22 subjects studied had the target placed too far back to reach the DLPFC.4 Second, using MRI-based neuronavigation, various areas of DLPFC subregions such as BA 9 and BA 46 can be easily individualized. The choice to stimulate either area can increase the efficacy of the rTMS therapy. As in our case, targeting the BA with MRI-based neuronavigation can lead to clinical remission of drug-resistant depressive episodes. Thus, BA 9 appears to be a promising area to target in rTMS therapy.Dept. of Psychiatry and Addictology University of Dijon Dijon, France1. Daskalakis ZJ , Levinson AJ , Fitzgerald PB : Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Can J Psychiatry 2008; 53:555–566Crossref, Medline, Google Scholar2. Fitzgerald PB , Oxley TJ , Laird AR , et al.: Analysis of functional neuroimaging studies of dorsolateral prefrontal cortical activity in depression. Psychiatry Res 2006; 148:33–45Crossref, Medline, Google Scholar3. Fitzgerald PB , Hoy K , McQueen S , et al.: A randomized trial of rTMS targeted with MRI-based neuro-navigation in treatment-resistant depression. Neuropsychopharmacology 2009; 34:1255–1262Crossref, Medline, Google Scholar4. Herwig U , Padberg F , Unger J , et al.: Transcranial magnetic stimulation in therapy studies: examination of the reliability of “standard” coil positioning by neuronavigation. Biol Psychiatry 2001; 50:58–61Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByPersonalising transcranial magnetic stimulation for depression using neuroimaging: A systematic review21 April 2021 | The World Journal of Biological Psychiatry, Vol. 22, No. 9Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ?La Presse Médicale, Vol. 48, No. 6Clinical Psychopharmacology and Neuroscience, Vol. 11, No. 2 Volume 23Issue 2 Spring 2011Pages E30-E31 Metrics History Published online 1 April 2011 Published in print 1 April 2011" @default.
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• W2141014195 title "Further Evidence of the Usefulness of MRI-Based Neuronavigation for the Treatment of Depression by rTMS" @default.
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