Personalising transcranial magnetic stimulation for depression using neuroimaging: A systematic review

Abstract

Objectives

Transcranial magnetic stimulation (TMS) is a well-established and effective treatment for depression, though response rates are suboptimal. Personalising TMS for depression with neuroimaging can take into account inter-individual differences in anatomical and electrophysiological characteristics; and thereby provide a potentially more efficacious form of treatment. The current systematic review aimed to critically appraise the literature relating to personalising TMS for depression with neuroimaging.

Methods

PubMed, PsycINFO and Embase databases were used to identify relevant literature published up to November 2020.

Results

A total of 37 studies were included in the review. Across these studies, a total of 1451 patients with depression received TMS that was personalised using neuroimaging. The majority of the studies used structural or functional neuroimaging to personalise treatment target (n = 30), primarily through neuronavigation methodologies. Fewer studies used electroencephalography to personalise treatment frequency or stimulus timing (n = 7). Only 6 studies directly compared neuroimaging-personalised TMS to standard TMS.

Conclusions

The findings from this review suggest that personalising TMS with neuroimaging may be more effective in the treatment of depression compared to standard TMS. Further research is required to directly compare neuroimaging-personalised TMS with standard TMS, and to identify the optimal parameters for treatment personalisation.

Keywords:

• Transcranial magnetic stimulation
• depression
• magnetic resonance imaging
• electroencephalography
• precision medicine

Acknowledgements

None.

Statement of interest

PBF has received equipment for research from MagVenture A/S, Nexstim, Neuronetics and Brainsway Ltd. He is a founder of TMS Clinics Australia.