Clinical effectiveness of switching to right lateral orbitofrontal cortex-TMS after failure of sequential bilateral dorsolateral prefrontal-TMS in major depression
Bibliographic record
Abstract
Background When patients with major depression fail to respond to TMS using a conventional dorsolateral prefrontal cortex (DLPFC) protocol, several published case series have suggested that switching to or adding-on 1Hz right lateral orbitofrontal cortex (R-LOFC) TMS may succeed. However, many of these case series are hampered by relatively short courses of treatment (i.e., <25 sessions) for either the DLPFC, the R-LOFC, or both protocols. Methods Here we report clinical outcomes for a case series of N=54 patients in a community setting who underwent a full course of 36 sessions of sequential bilateral (SBL) DLPFC-TMS (right/left, 1Hz/20Hz, 60s on 30s off/2s on 4s off, 360 pulses/1200 pulses, both 120% RMT) without response, then completed a full course of another 36 sessions of 1 Hz-R-LOFC-TMS (1Hz, 60s on 30s off, 360 pulses). Results Following the R-LOFC course, 15/54 (27.8%) achieved response and 9/54 (16.7%) achieved remission on PHQ-9, with a mean score improving from 14.2±4.1 to 9.5±5.3 points. Responders showed a distinctive discontinuity in response trajectory immediately following the switch from DLPFC to R-LOFC, with a significant sharp drop in symptoms suggesting causal effect. Conclusion Switching to 1 Hz-R-LOFC-TMS yields a sharp change in response trajectory in a subset of SBL-DLPFC-TMS unresponsive patients, implying a distinctive therapeutic mechanism rather than the accumulative effects of additional sessions. Future randomized controlled studies may establish definitive efficacy for 1 Hz-R-LOFC-TMS in depression among non-responders to conventional DLPFC-TMS.
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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 | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 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) | 0.001 | 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".