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Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression

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Abstract

Purpose

The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression.

Methods

Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of 99mTc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected).

Results

Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively.

Conclusion

This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features.

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Acknowledgments

This work was supported by INSERM (Centre d’Investigation Clinique, CIC, Hôpital de la Conception, Marseille), and AP-HM (PHRC 2007/09).

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Psychiatry, Sainte-Marguerite University Hospital, 13009, Marseille, France

    Raphaelle Richieri, Jean Farisse & Christophe Lancon

  2. EA 3279 - Self-perceived Health Assessment Research Unit, School of Medicine, La Timone University, 13005, Marseille, France

    Raphaelle Richieri, Laurent Boyer & Christophe Lancon

  3. Department of Public Health, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005, Marseille, France

    Laurent Boyer

  4. Service Central de Biophysique et Médecine Nucléaire, La Timone University Hospital, Assistance Publique - Hôpitaux de Marseille, 13005, Marseille, France

    Cecile Colavolpe, Olivier Mundler & Eric Guedj

  5. Centre Européen de Recherche en Imagerie Médicale (CERIMED), Université de la Méditerranée, Marseille, France

    Cecile Colavolpe, Olivier Mundler & Eric Guedj

  6. Service Central de Biophysique et de Médecine Nucléaire, Hôpital de la Timone, 264, rue Saint Pierre, 13385, Marseille Cedex 5, France

    Eric Guedj

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  1. Raphaelle Richieri
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Correspondence to Eric Guedj.

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Richieri, R., Boyer, L., Farisse, J. et al. Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression. Eur J Nucl Med Mol Imaging 38, 1715–1722 (2011). https://doi.org/10.1007/s00259-011-1850-9

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  • DOI: https://doi.org/10.1007/s00259-011-1850-9

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