Research On Precise Repetitive Transcranial Magnetic Stimulationtherapy For Depression Based On Brainnetome Atlas

Depression is a serious mental illness.The lifetime prevalence rate is 3.4% in China,which causes a serious burden on patients’ families and society.The clinical diagnosis mainly relies on symptomatic features and lacks objective biological markers.Therefore,the objective markers for diagnosis and treatment from the imaging gradually receive more attention.The methods of clinical treatment mainly include drug,physical and psychological treatment in depression.However,drug treatment may cause significant adverse and poor efficacy.Psychological treatment had long course of treatment and slowly response.These problems had caused the patient’s poor efficacy and low responds rate.Repetitive transcranial magnetic stimulation(rTMS)treatment in physiotherapy was a non-invasive,less adverse reactions and easily accepted treatment for patients.This method was widely used in clinical practice.However,due to the inaccurate stimulation of the target,the efficacy of depression was not good enough.Therefore,the precise positioning of the stimulating brain region and the realization of accurate rTMS treatment in patients with depression had received more attention.Therefore,this study was based on the newly Brainnetome Atlas to conduct accurate selection of brain regions in depression.Meanwhile,we used the near-infrared navigation system to conduct precise brain location.Therefore,our studies focus on the screening of objective marker for diagnosis and differential diagnosis in depression,the selection of best stimulation target,the accurated treatment of rTMS,the observation of treatment effects and the exploration of potential neural network mechanism with rTMS treatment.Firstly,the morphological analysis of voxel was used to research the volume change of gray matter in patients with treatment-resistant depression(TRD)and major depression(MDD).Meanwhile,we explored the objective biomarkers in depression.Secondly,we was used the method of anatomical connection to explored the optimal brain stimulation regions of rTMS in TRD patients and healthy control.Thirdly,we was achieved precise localization based on the latest new Brainnetome Atlas.Precise brain region treatment of rTMS was realized by the near-infrared navigation system.Furtherly,we were analyzed the treatment effect and characteristics of brain functional network before and after rTMS treatment.Finally,we was conducted an analysis of the common and specific brain function connection patterns of MDD,schizophrenia(SZ)and bipolardisorder(BD).The main findings include the following four aspects.In the first section,we found that the gray matter volume of ACC was decreased in TRD and MDD patients,especially in TRD.Meanwhile,we was only found that decreased gray matter volume of sACC in TRD patients when combined with the meta-analysis.Therefore,the decreasd gray matter volume in sACC may be an important brain imaging biomarker to distinguish TRD from remitted MDD.Those results will provide better imaging evidences for the early identification of TRD and further help to choose clinical treatment.In the second section,the abnormal of sACC may be a objective marker for differential diagnosis of depression.Meanwhile,sACC was the key nodes of antidepressant effect in depression.Through the method of probability imaging,we was found the sACC and prefrontal cortex(PFC)had closely connection mode.Therefore,the brain region of PFC was the best stimulation target for the rTMS treatment in depression.Moreover,the mechanism of the antidepression effect of rTMS treatment may be generated through the PFC-sACC pathway.This founding enriched the mechanism of rTMS treatment.In the third section,we found that the brain region of PFC was the best stimulation target for rTMS treatment in depression within the second section.Combined with previousd studies found that the left dorsolateral prefrontal cortex(DLPFC)was the most effective stimulation target.Meanwhile,the abnormality of insula may be closely related to depression.Therefore,the left DLPFC was accurated selection through the latest new Brainnetome Atlas.Furtherly,accurated rTMS treatment was realized by the near-infrared navigation.We was also explored the changes of brain network characteristics before and after rTMS treatment.In this section,we was used the Brainnetome Atlas to ensure the accurated selection of brain regions.This was the newly clinical application of Brainnetome Atlas.In addition,we was combined the near infrared navigation to achieve the accurated rTMS treatment.A valuable founding was the insula had decreased functional connectivity in depression.Moreover,the functional connection of insula was incresed after the rTMS treatment.Therefore,we were also found that the abnormality of insula and salience network may play a critical roles in emotion control of depression.In the fourth section,we was explored the commone and specific functionalactivity and connection changes in the MDD,SZ and BD.In this section,a total of 271 individuals underwent functional magnetic resonance imaging.We was conducted a validation analysis for the decresed functional connections of insula in depression and explored its specificity.Significantly decreased functional activity mainly in the right superior frontal gyrus,left middle frontal gyrus and middle cingulate,as well as the decreased functional connectivity with the insula.Most importantly,the decreased functional connectivity of the insula in patients with depression was verified in an independent sample.We was found that the decreased functional connectivity of the bilateral insula was a common feature of the three mental disorders.Moreover,this part of the study found that dysfunction of the salience network may play a role in the pathogenesis of MDD,SZ and BD.In addition,changes in specific brain regions provide neuroimaging evidences for differential diagnosis of MDD,SZ and BD.Therefore,our study verifies that decreased functional connectivity in the insula was closely related to depression.Meanwhile,those results enriched the evidence of brain network mechanism of MDD,SZ and BD.In conclusion,this study were carried out the systematic screening of objective imaging markers,the selection of optimal brain stimulation,the precise of brain stimulation therapy and the analysis of brain network before and after rTMS treatment in depression.Those not only enriches the possible mechanism of antidepression effect wtih rTMS treatment,but also provides an important method for accurate rTMS treatment in depression.