Citation

Nailong T, Yihuan C, Yangtao W, Chuanzhu S, Junchang L, Di W, Liang S, Yan M, Huan L, Xiang L, Qingrong T, Shun Q, Huaning W. Chinese Journal of Psychiatry 2022; 55(1): 14-23.

Copyright

(Copyright © 2022)

DOI

10.3760/cma.j.cn113661-20210527-00173

PMID

unavailable

Abstract

OBJECTIVE To explore the efficacy, safety and possible brain network mechanisms of individualized targeted robot assisted Stanford accelerated intelligent neuromodulation therapy (SAINT).

METHODS This was a small-sample, open-label study including 15 depressed patients with suicidal ideation. All participants were treated with SAINT in combination with SNRIs. The stimulation target was localized to the region of the left dorsolateral prefrontal cortex (DLPFC) that showed the most negative functional connectivity with the subgenual anterior cingulate cortex (sgACC) based on fMRI data. Stimulation sessions were delivered hourly. Ten sessions were applied per day (18, 000 pulses/day) for 5 consecutive days (90, 000 pulses in total). Stimulation was delivered at 90% resting motor threshold. The changes of functional connectivity of brain networks in various brain regions before and after treatment were compared and analyzed by rest software and functional connectivity analysis based on seed points. The Beck Suicidal Ideation Scale Chinese Version (BSI-CV), HAMD17, and MADRS were used to assess the suicidal ideation and depressive symptoms at baseline, post treatment, 15 days after treatment, and 30 days after treatment. Statistical analysis was performed using repeated measurements of ANOVA and paired t-tests.

RESULTS (1) After 5-day treatment, individual′s BSI-CV score decreased significantly (F=38.77, P<0.01), and their average score decreased by 11.80±1.17 (95%CI= 8.19-15.41), with a response rate of 86.67%. SAINT was well tolerated, and there were no significant side effects on individual′s cognitive function. (2) After treatment, patient′s MADRS score decreased significantly at all follow-up assessments (F=306.97, P<0.01), and the average score decreased by 22.53±1.10 (95%CI=19.15-25.91) after 5-day treatment, with a response rate of 93.33%. After 15 days and 30 days, the remission and response rates of treatment were 53.33%, 100.00%, 93.33% and 100.00%, respectively. (3) The functional network connectivity after individualized targeted robot assisted SAINT therapy showed significant improvement between sgACC, frontal lobe, temporal lobe, and parietal lobe.

CONCLUSION Individualized targeted robot assisted SAINT therapy showed satisfactory efficacy and safety in the reduction of suicidal ideation and depressive symptoms, and also improve the functional network connectivity of the injured brain network. Meanwhile, large-sample, randomized, and double-blind controlled studies are warranted to confirm the findings of the current study. © 2022 Chinese Journal of Psychiatry. All rights reserved.

Language: zh

Keywords

human; cognition; Depressive disorder; suicidal ideation; Suicidal ideation; functional magnetic resonance imaging; patient safety; major depression; Transcranial magnetic stimulation; clinical article; priority journal; psychopharmacotherapy; follow up; remission; treatment response; Montgomery Asberg Depression Rating Scale; Article; clinical effectiveness; open study; temporal lobe; serotonin noradrenalin reuptake inhibitor; neuromodulation; Neuronavigation; parietal lobe; nerve cell network; functional neuroimaging; Hamilton Depression Rating Scale; behavior disorder assessment; dorsolateral prefrontal cortex; functional connectivity; Beck Suicidal Ideation Scale Chinese Version; robot assisted Stanford accelerated intelligent neuromodulation therapy; subgenual anterior cingulate cortex