Baseline brain metabolism in resistant depression and response to transcranial magnetic stimulation.

Marie-Laure Paillère Martinot, Jean-Luc Martinot, Damien Ringuenet, André Galinowski, Thierry Gallarda, Frank Bellivier, Jean-Pascal Lefaucheur, Hervé Lemaitre, Eric Artiges
Neuropsychopharmacol. 2011-08-17; 36(13): 2710-2719
DOI: 10.1038/npp.2011.161

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Neuroimaging studies of patients with treatment-resistant depression (TRD) have
reported abnormalities in the frontal and temporal regions. We sought to
determine whether metabolism in these regions might be related to response to
repetitive transcranial magnetic stimulation (TMS) in patients with TRD. Magnetic
resonance images and baseline resting-state cerebral glucose uptake index (gluMI)
obtained using (18)F-fluorodeoxyglucose positron emission tomography were
analyzed in TRD patients who had participated in a double-blind, randomized,
sham-controlled trial of prefrontal 10 Hz TMS. Among the patients randomized to
active TMS, 17 responders, defined as having 50% depression score decrease, and
14 nonresponders were investigated for prestimulation glucose metabolism and
compared with 39 healthy subjects using a voxel-based analysis. In nonresponders
relative to responders, gluMI was lower in left lateral orbitofrontal cortex
(OFC), and higher in left amygdala and uncinate fasciculus. OFC and amygdala
gluMI negatively correlated in nonresponders, positively correlated in
responders, and did not correlate in healthy subjects. Relative to healthy
subjects, both responders and nonresponders displayed lower gluMI in right
dorsolateral prefrontal (DLPFC), right anterior cingulate (ACC), and left
ventrolateral prefrontal cortices. Additionally, nonresponders had lower gluMI in
left DLPFC, ACC, left and right insula, and higher gluMI in left amygdala and
uncus. Hypometabolisms were partly explained by gray matter reductions, whereas
hypermetabolisms were unrelated to structural changes. The findings suggest that
different patterns of frontal-temporal-limbic abnormalities may distinguish
responders and nonresponders to prefrontal magnetic stimulation. Both preserved
OFC volume and amygdala metabolism might precondition response to TMS.

DOI: 10.1038/npp.2011.161
PMCID: PMC3230494
PMID: 21849980 [Indexed for MEDLINE]

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