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Activating the Path to Recovery: TMS-Evoked Functional Connectivity Response Predicts Clinical Changes in Closed-Loop Accelerated rTMS for Depression

Poster Session F - Tuesday, April 1, 2025, 8:00 – 10:00 am EDT, Back Bay Ballroom/Republic Ballroom
Also presenting in Data Blitz Session 4 - Saturday, March 29, 2025, 10:30 am – 12:00 pm EDT, Constitution B.

Gavin Doyle¹, Jayce Doose¹, Hengda He², Spiro P. Pantazatos², Xiaoxiao Sun², Chichi Chang², Sara Hashempour¹, Ruxue Gong¹, Linbi Hong², Corbin Ping¹, Jacob Eade¹, Christian Finetto¹, Brendan Murney¹, Abby Williams¹, Mark S. George¹, Robin Goldman³, Paul Sajda², Lisa McTeague¹; ¹Medical University of South Carolina, ²Columbia University, ³University of Wisconsin-Madison

Background: Transcranial Magnetic Stimulation (TMS) is a FDA-approved treatment for depression but it is not effective in half of patients and the underlying mechanisms remain unclear. Our prior work developed a fMRI-EEG-TMS (fET) instrument that acquires fMRI and EEG simultaneously while delivering TMS. This showed TMS-evoked functional connectivity (FC) between the dorsolateral prefrontal cortex (DLPFC) and the subgenual anterior cingulate cortex (sgACC) depended on an individual’s EEG phase at stimulation onset. TMS-evoked responses in the cognitive control and limbic networks significantly predicted clinical improvement for patients that received six weeks of once-daily closed-loop EEG-TMS treatment. We are investigating if our prior FC prediction results replicate in an accelerated repetitive TMS (rTMS) paradigm, where all treatment sessions are compressed into 1 week. Methods: Depressed patients undergo a fET session, then receive six closed-loop rTMS treatments a day for five days. fMRI and EEG data are processed to identify FC networks and alpha phase. Depression scores are evaluated over time. Results: Two patients have completed treatment and their fET session, with four more patients completing soon. We expect to see similar results to prior analysis on 22 fET datasets that FC between DLPFC and sgACC is modulated by EEG phase. We also expect to see that clinical improvement is predicted by TMS-evoked responses in the cognitive control and limbic networks, which was shown in prior analysis of 20 fET datasets. Conclusion: This work will demonstrate that FC predicts clinical improvement in a 1-week accelerated rTMS protocol, like our prior 6-week treatment protocol.

Topic Area: METHODS: Other