Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression
Background Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective non-pharmacological, non-invasive intervention for depression. However, the optimal strategy for localising the DLPFC treatment site on the patient’s scalp is heavily dis...
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BMJ Publishing Group
2025-05-01
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| Series: | BMJ Mental Health |
| Online Access: | https://mentalhealth.bmj.com/content/28/1/e301598.full |
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| author | Thomas Frodl Irene Neuner Katrin Sakreida Nicholas T Trapp Sarah Kreuzer Ulrike Rubin Dieter Schnabel Jana Hovančáková Alexander T Sack Timm B Poeppl |
| author_facet | Thomas Frodl Irene Neuner Katrin Sakreida Nicholas T Trapp Sarah Kreuzer Ulrike Rubin Dieter Schnabel Jana Hovančáková Alexander T Sack Timm B Poeppl |
| author_sort | Thomas Frodl |
| collection | DOAJ |
| description | Background Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective non-pharmacological, non-invasive intervention for depression. However, the optimal strategy for localising the DLPFC treatment site on the patient’s scalp is heavily disputed. Routine strategies were previously incrementally refined and compared in terms of anatomical accuracy, but little is known about their impact on clinical outcomes.Objective To assess the impact of three common scalp-based heuristics for magnetic coil positioning on the treatment outcome of rTMS.Methods This retrospective analysis of real-world clinical data involved patients suffering from a major depressive episode (n=94) who received a 4-week course of excitatory rTMS to the left DLPFC. The treatment target (ie, coil position) was either determined at an absolute distance anterior to the motor hotspot (‘6 cm rule’) or defined in reference to the EEG electrode position F3 using a traditional (‘Beam F3’) or optimised (‘Beam F3 Adjusted’) approach.Findings There was no statistically significant difference between the ‘6 cm rule’ and the ‘Beam F3’ method nor between the ‘Beam F3’ and the ‘Beam F3 Adjusted’ method in head-to-head comparisons of averaged per cent change of scores on depression rating scales (all p>0.605) and response rate (all p>0.475).Conclusions Enhancing targeting precision via scalp-based heuristics does not affect treatment outcomes.Clinical implications There is no need for clinicians to switch from their familiar to an ‘advanced’ approach among these common targeting heuristics. |
| format | Article |
| id | doaj-art-27eab4c43f6540c48963d5250d0eb23c |
| institution | OA Journals |
| issn | 2755-9734 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Mental Health |
| spelling | doaj-art-27eab4c43f6540c48963d5250d0eb23c2025-08-20T01:52:18ZengBMJ Publishing GroupBMJ Mental Health2755-97342025-05-0128110.1136/bmjment-2025-301598Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depressionThomas Frodl0Irene Neuner1Katrin Sakreida2Nicholas T Trapp3Sarah Kreuzer4Ulrike Rubin5Dieter Schnabel6Jana Hovančáková7Alexander T Sack8Timm B Poeppl9Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, GermanyDepartment of Psychiatry, University of Iowa, Iowa City, Iowa, USADepartment of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, GermanyDepartment of General Psychiatry, LVR-Klinik Düren, Düren, GermanyDepartment of General Psychiatry, LVR-Klinik Düren, Düren, GermanyDepartment of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, GermanyDepartment of Cognitive Neuroscience, Maastricht University, Maastricht, The NetherlandsDepartment of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, GermanyBackground Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective non-pharmacological, non-invasive intervention for depression. However, the optimal strategy for localising the DLPFC treatment site on the patient’s scalp is heavily disputed. Routine strategies were previously incrementally refined and compared in terms of anatomical accuracy, but little is known about their impact on clinical outcomes.Objective To assess the impact of three common scalp-based heuristics for magnetic coil positioning on the treatment outcome of rTMS.Methods This retrospective analysis of real-world clinical data involved patients suffering from a major depressive episode (n=94) who received a 4-week course of excitatory rTMS to the left DLPFC. The treatment target (ie, coil position) was either determined at an absolute distance anterior to the motor hotspot (‘6 cm rule’) or defined in reference to the EEG electrode position F3 using a traditional (‘Beam F3’) or optimised (‘Beam F3 Adjusted’) approach.Findings There was no statistically significant difference between the ‘6 cm rule’ and the ‘Beam F3’ method nor between the ‘Beam F3’ and the ‘Beam F3 Adjusted’ method in head-to-head comparisons of averaged per cent change of scores on depression rating scales (all p>0.605) and response rate (all p>0.475).Conclusions Enhancing targeting precision via scalp-based heuristics does not affect treatment outcomes.Clinical implications There is no need for clinicians to switch from their familiar to an ‘advanced’ approach among these common targeting heuristics.https://mentalhealth.bmj.com/content/28/1/e301598.full |
| spellingShingle | Thomas Frodl Irene Neuner Katrin Sakreida Nicholas T Trapp Sarah Kreuzer Ulrike Rubin Dieter Schnabel Jana Hovančáková Alexander T Sack Timm B Poeppl Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression BMJ Mental Health |
| title | Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| title_full | Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| title_fullStr | Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| title_full_unstemmed | Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| title_short | Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| title_sort | comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression |
| url | https://mentalhealth.bmj.com/content/28/1/e301598.full |
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