Individualized, parcel-guided rTMS to the left dorsolateral prefrontal cortex for treatment resistant depression

Efficacy of Transcranial Magnetic Stimulation (TMS) for depression has been shown to correlate with the proximity of stimulation to the region of LDLPFC most anti-correlated with subgenual anterior cingulate cortex (sgACC). Using the Human Connectome Project (HCP) surface-based reconstruction from a structural MRI, we observed that the region of DLPFC most anti-correlated with sgACC falls in anterior parcel 46 and encompasses the junction between adjacent parcels. Individual parcel mapped TMS directed at this target showed high efficacy for treatment resistant depression in a group of 15 patients. Pre-treatment anti-correlation between DLPFC (parcel 46) and sgACC correlated significantly with treatment response. These findings, along with our prior study, demonstrate the feasibility of individual, parcel-guided rTMS and suggest response/remission rates similar to those observed using individualized fMRI localization of the peak anti-correlated region.