Dual-target Accelerated RTMS For Treatment-resistant Depression Study On The Effect Of Curative Effect And Resting-state Functional Connection

Objective: In this study,ar TMS was used to stimulate the left dorsolateral prefrontal cortex(L-DLPFC)and the right orbitofrontal cortex(R-OFC),To explore its efficacy on TRD and the neuroimaging mechanism of its targets,and to provide new stimulation targets and imaging biomarkers for clinical treatment of TRD.Methods: Seventy-five TRD patients were recruited and divided into three groups:single-target,double-target and pseudo-stimulation groups,Subjects underwent clinical scale assessment and resting-state functional magenetic resonance Imaging(rs-f MRI)scans before and after the intervention,respectively,And follow up 1 week after intervention and 4 weeks after intervention.In addition,The brain area of the stimulation site was used as the seed point,,and the functional connectivity(FC)between seed sites and the whole brain were calculated before and after intervention and compared across the three groups to investigate rs-FC differences and the reduction rate of the Hamilton Depression Scale(HAMD)before and after the intervention to conduct Pearson correlation.Results: Seventy-five patients were included,of which 4 were excluded due to unsatisfactory rs-f MRI scan quality.Another 10 dropped out due to failing to complete the entire course of treatment,and 1 dropped out due to palpitation symptoms.The last 60patients(13 males and 47 females)completed the entire course of treatment,and there were no significant differences in gender,age and disease duration among the three groups(P>0.05).There was no significant difference in the scores of HAMD-24,Montgomery and Asberg Depression Rating Scale(MADRS)and Patient Health Questionnaire-9 items(PHQ-9)before intervention(P> 0.05).after intervention,There was a significant difference between the double-target group and the pseudo-stimulation group(P<0.05),and there was a significant difference between the single-target group and the pseudo-stimulation group(P<0.05),there was no significant difference between the double-target and single-target group(P>0.05).),but the dual-target group had a faster onset of action than the single-target group,and more people responded.Analysis of f MRI data found,After ar TMS intervention,In the dual-target group,DLPFC and Rostral anterior cingulate cortex(r ACC)FC were enhanced,FC enhancement between OFC and subgenual anterior cingulated cortex(sg ACC).However,in single target group,there were no value changes between DLPFC/OFC and important nodes of limbic system.Conclusion: The dual-target therapy mode has a faster onset and better curative effect than single-target therapy.ar TMS can indirectly affect the anterior cingulate cortex(ACC)brain region by stimulating the two target brain regions of L-DLPFC and R-OFC,and significantly improve the FC changes between DLPFC-r ACC and OFC-sg ACC and thereby improve depressive symptoms in TRD patients.