Right orbitofrontal rTMS benefits patients with treatment-resistant depression after unsuccessful DLPFC rTMS
Bibliographic record
Abstract
Abstract Repetitive transcranial magnetic stimulation (rTMS) is a clinically effective treatment in major depressive disorder (MDD) when targeting the dorsolateral prefrontal cortex (DLPFC). Yet, at least 44% of patients do not achieve remission, requiring validated alternatives, such as orbitofrontal cortex (OFC) targeted rTMS. Preliminary results employing 1Hz OFC-rTMS show 30% of patients achieving response (i.e. reduction of ≥50% in MDD symptoms) who were initially non-responsive to DMPFC-rTMS. In the current study, we aimed to replicate the previously reported results, and to identify variables that may predict treatment outcome and symptom response patterns specific to OFC-rTMS. Two groups of MDD patients (n1=25 and n2=17), located in the Netherlands and the United States respectively, underwent 1Hz OFC-rTMS after non-response to DLPFC-rTMS. On average, group 1 patients received 42 DLPFC sessions, followed by 24 OFC sessions. In group 2, 21 DLPFC sessions were followed by 21 OFC sessions. Collected data included age, sex, depression severity over the course of treatment (BDI-II), and medication use. The group 1 data also included sleep quality (PSQI, HSDQ), baseline anxiety and stress (DASS), and baseline EEG individual alpha peak frequency (iAPF). Our results show that both treatment groups achieved 24% remission (BDI score≤12). In group 1, said remission was irrespective of age, sex, medication use or baseline symptom severity. Similar analyses in group 2 are ongoing. Further results will be presented at the conference, clarifying whether a priori defined variables predict treatment outcome, such as an anhedonia symptom cluster, dysphoric vs anxiosomatic clusters, and the EEG derived iAPF. Moreover, we will explore the effects of OFC-rTMS on sleep quality and specific depression symptoms. OFC-rTMS may be an effective consideration for non-responders to DLPFC-rTMS. Predictors for response to OFC-rTMS may enable future treatment stratification, benefitting patients by reducing the number of rTMS sessions. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: TMS, OFC, DLPFC, Major depressive disorder
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".