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Hum Brain Mapp. 2019 Feb 1;40(2):432-450. doi: 10.1002/hbm.24384. Epub 2018 Oct 1.

Focal application of accelerated iTBS results in global changes in graph measures.

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Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.
Department of Neurology, Ghent University Hospital, Ghent, Belgium.
School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.
Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands.
Australian Catholic University, Melbourne, Australia.
University of Pennsylvania, Pennsylvania, Philadelphia.
Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
University Hospital Brussels, Jette, Belgium.
Ghent University, Ghent Experimental Psychiatry GHEP Lab, Ghent, Belgium.


Graph analysis was used to study the effects of accelerated intermittent theta burst stimulation (aiTBS) on the brain's network topology in medication-resistant depressed patients. Anatomical and resting-state functional MRI (rs-fMRI) was recorded at baseline and after sham and verum stimulation. Depression severity was assessed using the Hamilton Depression Rating Scale (HDRS). Using various graph measures, the different effects of sham and verum aiTBS were calculated. It was also investigated whether changes in graph measures were correlated to clinical responses. Furthermore, by correlating baseline graph measures with the changes in HDRS in terms of percentage, the potential of graph measures as biomarker was studied. Although no differences were observed between the effects of verum and sham stimulation on whole-brain graph measures and changes in graph measures did not correlate with clinical response, the baseline values of clustering coefficient and global efficiency showed to be predictive of the clinical response to verum aiTBS. Nodal effects were found throughout the whole brain. The distribution of these effects could not be linked to the strength of the functional connectivity between the stimulation site and the node. This study showed that the effects of aiTBS on graph measures distribute beyond the actual stimulation site. However, additional research into the complex interactions between different areas in the brain is necessary to understand the effects of aiTBS in more detail.


accelerated intermittent theta burst stimulation; functional connectivity; graph analysis; transcranial magnetic stimulation


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