Cingulo-Opercular Connectivity Enhances the Repeatability of Transcranial Magnetic Stimulation Target Maps

Area of Science:

• Neuroscience
• Psychiatry
• Medical Imaging

Background:

• Transcranial magnetic stimulation (TMS) effectiveness for major depressive disorder (MDD) may improve with individualized dorsolateral prefrontal cortex (DLPFC) targeting.
• Current methods using subgenual anterior cingulate cortex (sgACC) or right anterior insula (rAI) connectivity show potential but face repeatability challenges.
• Novel depression core network model (CNM) based targeting offers a new approach to enhance TMS precision.

Purpose of the Study:

• To compare the repeatability of CNM-based DLPFC target maps against sgACC and rAI connectivity-based maps.
• To evaluate if a movie stimulus enhances the feasibility of individualized functional connectivity-based TMS targeting.

Main Methods:

• 31 patients with treatment-resistant MDD underwent repeated functional magnetic resonance imaging (fMRI) sessions.
• Repeatability of DLPFC target maps was assessed using within-subject spatial correlation.
• fMRI acquisition was compared between resting-state and movie stimulus conditions, measuring repeatability, head movement, and participant comfort.

Main Results:

• CNM functional connectivity-based DLPFC target maps demonstrated higher repeatability than sgACC or rAI-based maps, especially with a movie stimulus.
• Cingulo-opercular seeds within the CNM yielded highly repeatable target maps in both resting-state and movie conditions.
• The movie stimulus decreased head movement during fMRI but did not significantly improve targeting repeatability.

Conclusions:

• Findings support further research into multi-seed functional connectivity targeting, particularly using cingulo-opercular regions.
• Engaging naturalistic stimuli like movies warrant further investigation for improving individualized TMS targeting feasibility.