Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation
Background: Clinical transcranial magnetic stimulation (TMS) for depression routinely relies on the scalp-based Beam/F3 targeting method to identify stimulation targets in the dorsolateral prefrontal cortex (dLPFC). Scalp-based targeting offers a low-cost and easily implemented method for TMS coil p...
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| Language: | English |
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Elsevier
2025-05-01
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| Series: | Brain Stimulation |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X25000841 |
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| author | Divya Rajasekharan Michelle R. Madore Paul Holtzheimer Kelvin O. Lim Leanne M. Williams Noah S. Philip |
| author_facet | Divya Rajasekharan Michelle R. Madore Paul Holtzheimer Kelvin O. Lim Leanne M. Williams Noah S. Philip |
| author_sort | Divya Rajasekharan |
| collection | DOAJ |
| description | Background: Clinical transcranial magnetic stimulation (TMS) for depression routinely relies on the scalp-based Beam/F3 targeting method to identify stimulation targets in the dorsolateral prefrontal cortex (dLPFC). Scalp-based targeting offers a low-cost and easily implemented method for TMS coil placement, enhancing treatment availability. However, limited anatomical and functional specificity of the Beam/F3 method may affect treatment outcomes, motivating assessment of the clinical standard. Methods: In a naturalistic clinical trial of TMS conduced at four Veterans Affairs hospitals, the authors evaluate the Beam/F3 method using neuroimaging incorporated before TMS, after five treatment sessions, and after all thirty sessions. Personalized anatomical and electric field (E-field) models were developed to assess target location and network engagement, as well as subsequent effects on clinical outcomes. Results: Anatomical models demonstrate that the Beam/F3 method produced reliable targets in the dLPFC across individuals and repeated treatment sessions. E-field models revealed that baseline anticorrelation between the stimulation center and the sgACC was associated with antidepressant symptom response after five TMS sessions (p=0.032,r2=0.100,N=46) and at the end of treatment (p=0.042,r2=0.107,N=39). Relatedly, E-field magnitude at the sgACC-anticorrelated peak in the prefrontal cortex correlated with symptom response throughout treatment (early treatment: p=0.001,r2=0.220,N=46; end of treatment: p=0.026,r2=0.127,N=39). Conclusions: This work establishes that scalp-based targeting can produce reliable targets in the dLPFC and be successfully evaluated using a combination of neuroimaging and E-field modeling in pragmatic, multisite applications. Importantly, this investigation also found that significant network effects occur early in treatment and that Beam/F3 targets can engage functional mechanisms in TMS. |
| format | Article |
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| institution | OA Journals |
| issn | 1935-861X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
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| series | Brain Stimulation |
| spelling | doaj-art-7f2388d5c39e4f1da8ee2c0391b9f3c22025-08-20T02:33:20ZengElsevierBrain Stimulation1935-861X2025-05-0118382983710.1016/j.brs.2025.04.003Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translationDivya Rajasekharan0Michelle R. Madore1Paul Holtzheimer2Kelvin O. Lim3Leanne M. Williams4Noah S. Philip5Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USADepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USAGeisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA; National Center for PTSD, VA Medical Center, U.S. Department of Veterans Affairs, 215 N Main St, White River Junction, VT 05009, USADepartment of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, 55455, USA; Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USADepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94305, USA; Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USADepartment of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02903, USA; Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, 830 Chalkstone Ave, Providence, RI 02908, USA; Corresponding author. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02903, USA.Background: Clinical transcranial magnetic stimulation (TMS) for depression routinely relies on the scalp-based Beam/F3 targeting method to identify stimulation targets in the dorsolateral prefrontal cortex (dLPFC). Scalp-based targeting offers a low-cost and easily implemented method for TMS coil placement, enhancing treatment availability. However, limited anatomical and functional specificity of the Beam/F3 method may affect treatment outcomes, motivating assessment of the clinical standard. Methods: In a naturalistic clinical trial of TMS conduced at four Veterans Affairs hospitals, the authors evaluate the Beam/F3 method using neuroimaging incorporated before TMS, after five treatment sessions, and after all thirty sessions. Personalized anatomical and electric field (E-field) models were developed to assess target location and network engagement, as well as subsequent effects on clinical outcomes. Results: Anatomical models demonstrate that the Beam/F3 method produced reliable targets in the dLPFC across individuals and repeated treatment sessions. E-field models revealed that baseline anticorrelation between the stimulation center and the sgACC was associated with antidepressant symptom response after five TMS sessions (p=0.032,r2=0.100,N=46) and at the end of treatment (p=0.042,r2=0.107,N=39). Relatedly, E-field magnitude at the sgACC-anticorrelated peak in the prefrontal cortex correlated with symptom response throughout treatment (early treatment: p=0.001,r2=0.220,N=46; end of treatment: p=0.026,r2=0.127,N=39). Conclusions: This work establishes that scalp-based targeting can produce reliable targets in the dLPFC and be successfully evaluated using a combination of neuroimaging and E-field modeling in pragmatic, multisite applications. Importantly, this investigation also found that significant network effects occur early in treatment and that Beam/F3 targets can engage functional mechanisms in TMS.http://www.sciencedirect.com/science/article/pii/S1935861X25000841TMSBeam/F3DepressionE-fieldModelingdLPFC |
| spellingShingle | Divya Rajasekharan Michelle R. Madore Paul Holtzheimer Kelvin O. Lim Leanne M. Williams Noah S. Philip Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation Brain Stimulation TMS Beam/F3 Depression E-field Modeling dLPFC |
| title | Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation |
| title_full | Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation |
| title_fullStr | Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation |
| title_full_unstemmed | Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation |
| title_short | Personalized models of Beam/F3 targeting in transcranial magnetic stimulation for depression: Implications for precision clinical translation |
| title_sort | personalized models of beam f3 targeting in transcranial magnetic stimulation for depression implications for precision clinical translation |
| topic | TMS Beam/F3 Depression E-field Modeling dLPFC |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X25000841 |
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