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Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications

The measurement of the motor threshold (MT) is an important element in determining stimulation intensity during Transcranial Magnetic Stimulation treatment (rTMS). The current recommendations propose its realization at least once a week. The variability in this motor threshold is an important factor...

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Autores principales: Bourla, Alexis, Mouchabac, Stéphane, Lorimy, Léonard, Crette, Bertrand, Millet, Bruno, Ferreri, Florian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526536/
https://www.ncbi.nlm.nih.gov/pubmed/37759847
http://dx.doi.org/10.3390/brainsci13091246
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author Bourla, Alexis
Mouchabac, Stéphane
Lorimy, Léonard
Crette, Bertrand
Millet, Bruno
Ferreri, Florian
author_facet Bourla, Alexis
Mouchabac, Stéphane
Lorimy, Léonard
Crette, Bertrand
Millet, Bruno
Ferreri, Florian
author_sort Bourla, Alexis
collection PubMed
description The measurement of the motor threshold (MT) is an important element in determining stimulation intensity during Transcranial Magnetic Stimulation treatment (rTMS). The current recommendations propose its realization at least once a week. The variability in this motor threshold is an important factor to consider as it could translate certain neurophysiological specificities. We conducted a retrospective naturalistic study on data from 30 patients treated for treatment-resistant depression in an rTMS-specialized center. For each patient, weekly motor-evoked potential (MEP) was performed and several clinical elements were collected as part of our clinical interviews. Regarding response to treatment (Patient Health Questionnaire-9 (PHQ-9) before and after treatment), there was a mean difference of −8.88 (−21 to 0) in PHQ9 in the Theta Burst group, of −9.00 (−18 to −1) in the High-Frequency (10 Hz) group, and of −4.66 (−10 to +2) in the Low-Frequency (1 Hz) group. The mean improvement in depressive symptoms was 47% (p < 0.001, effect-size: 1.60). The motor threshold changed over the course of the treatment, with a minimum individual range of 1 point and a maximum of 19 points (total subset), and a greater concentration in the remission group (4 to 10) than in the other groups (3 to 10 in the response group, 1 to 8 in the partial response group, 3 to 19 in the stagnation group). We also note that the difference between MT at week 1 and week 6 was statistically significant only in the remission group, with a different evolutionary profile showing an upward trend in MT. Our findings suggest a potential predictive value of MT changes during treatment, particularly an increase in MT in patients who achieve remission and a distinct “break” in MT around the 4th week, which could predict nonresponse.
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spelling pubmed-105265362023-09-28 Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications Bourla, Alexis Mouchabac, Stéphane Lorimy, Léonard Crette, Bertrand Millet, Bruno Ferreri, Florian Brain Sci Article The measurement of the motor threshold (MT) is an important element in determining stimulation intensity during Transcranial Magnetic Stimulation treatment (rTMS). The current recommendations propose its realization at least once a week. The variability in this motor threshold is an important factor to consider as it could translate certain neurophysiological specificities. We conducted a retrospective naturalistic study on data from 30 patients treated for treatment-resistant depression in an rTMS-specialized center. For each patient, weekly motor-evoked potential (MEP) was performed and several clinical elements were collected as part of our clinical interviews. Regarding response to treatment (Patient Health Questionnaire-9 (PHQ-9) before and after treatment), there was a mean difference of −8.88 (−21 to 0) in PHQ9 in the Theta Burst group, of −9.00 (−18 to −1) in the High-Frequency (10 Hz) group, and of −4.66 (−10 to +2) in the Low-Frequency (1 Hz) group. The mean improvement in depressive symptoms was 47% (p < 0.001, effect-size: 1.60). The motor threshold changed over the course of the treatment, with a minimum individual range of 1 point and a maximum of 19 points (total subset), and a greater concentration in the remission group (4 to 10) than in the other groups (3 to 10 in the response group, 1 to 8 in the partial response group, 3 to 19 in the stagnation group). We also note that the difference between MT at week 1 and week 6 was statistically significant only in the remission group, with a different evolutionary profile showing an upward trend in MT. Our findings suggest a potential predictive value of MT changes during treatment, particularly an increase in MT in patients who achieve remission and a distinct “break” in MT around the 4th week, which could predict nonresponse. MDPI 2023-08-26 /pmc/articles/PMC10526536/ /pubmed/37759847 http://dx.doi.org/10.3390/brainsci13091246 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bourla, Alexis
Mouchabac, Stéphane
Lorimy, Léonard
Crette, Bertrand
Millet, Bruno
Ferreri, Florian
Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title_full Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title_fullStr Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title_full_unstemmed Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title_short Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications
title_sort variability in motor threshold during transcranial magnetic stimulation treatment for depression: neurophysiological implications
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10526536/
https://www.ncbi.nlm.nih.gov/pubmed/37759847
http://dx.doi.org/10.3390/brainsci13091246
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