Vladas Valiulis1, Kastytis Dapšys1, Giedrius Gerulskis1, Aldona Šiurkutė1,2, Valentinas Mačiulis1,2
1Republican Vilnius psychiatric hospital, Vilnius, Lithuania
2Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
10 Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) is one of the most popular treatment options for drug resistant depression. However measured efficacy between the studies do tend to vary greatly. With increasing efforts to standardize 10 Hz rTMS protocol most variability seems to arise from the stimulation site selection. That is because differences in patient head sizes lead to great dispersion of stimulation sites in previously standard 5 cm rule and there is still an ongoing debate over which exact coordinate for DLPFC to use in a neuronavigated rTMS. In order to clarify the possible choices for TMS coil placement we decided to study three homogenous groups of patients in the same setting using three neuronavigated DLPFC sites suggested by previous studies. Patients with diagnosed drug resistant depressive disorder selected for 10 Hz rTMS treatment were randomly assigned to 3 groups differing in sites of stimulation. To account both factors of clinical effectiveness and physiological impact before the treatment course and after it patients were evaluated using MADRS, HAM-D and BDI clinical tests as well as an analysis of resting state EEG power spectrum. A considerable physiological difference in effect to the resting state EEG power was found between the groups. One group of patients also showed a larger decrease in clinical test scores.