[De rol van hart-hersenkoppeling bij het personaliseren van hersenstimulatie]

rTMS or TMS is an effective treatment method for the treatment of depression.

In clinical practice, different stimulation sites can be used for TMS. An important question is how knowledge of functional networks in depression, can lead to a better selection of TMS location, and thus a greater chance of treatment success.

In this essay, various localization methods that have been used and investigated in the application of TMS in depression are described.

Although heuristics used in practice, such as the 5-centimeter rule and the Beam-F3 method, are effective methods, there is a clear development in which ‘anatomy’ thinking is shifting to thinking in functional networks. Currently, there are two promising methods that may result in more personalized stimulation locations. These both utilize knowledge about known functional networks in depression, focused on the subgenual anterior cingulate cortex (sgACC). The first promising method, involves functional MRI (fMRI)-based TMS, targeting prefrontal locations anticorrelated to the sgACC. The second promising method is based on TMS-induced heart-brain coupling, utilizing the overlap between the depression network and the fronto-vagal network, including the sgACC.

Currently, the network hypothesis of depression is the most widely accepted explanatory model for TMS effects in depression. Although the new methods, namely the fMRI-based method and the heart-brain coupling method, are promising, it has not yet been sufficiently proven that they are superior to standard methods.