![]() 2 More studies with better methods are needed in order to confirm the preliminary clinical findings of mPFC TMS. ![]() 2 The authors consider that the main limitation of the evidence was the high risk of bias in the majority of the studies and differences in landmarks for coil positioning, which made it likely that different divisions of the mPFC were stimulated in each study. Despite significant differences between mPFC TMS treatment and placebo in patients with OCD and acrophobia, the results of the remaining trials (in substance use disorders, autism spectrum disorders, depression, and posttraumatic stress disorder) were only significant in within-group analyses. The final aspect that deserves mention regards the review authors’ conclusions. Nonetheless, the mPFC has been much less investigated than DLPFC stimulation, and safety and tolerability aspects remain a concern. ![]() used resting-state connectivity from depressed patients to identify four “biotype” patterns, and then showed that two of them were associated with higher rates of response to rTMS over the dorsomedial prefrontal cortex (> 60%), whereas two were not ( 10 Hz) and the incidence of headache with the use of coils that reach deeper into the brain. 1 This newborn precision psychiatry no longer relies solely on a set of clinical information gathered in a diagnostic interview, but also on information from other research domains (i.e., molecular biosignatures, big data, neurocircuits, and the omics). 3įrom a wider scientific perspective, identifying different target areas for rTMS strengthens a new paradigm in psychiatry, based on neurobiological diagnostic precision outcomes and the unveiling of biomarkers to tailor treatment strategies. Interest in mPFC thus represents a novel venue for TMS research in psychiatry, particularly for treatment of major depressive disorder. In fact, rTMS is only moderately effective in depression, which has encouraged researchers to target areas other than the usual dorsolateral prefrontal cortex (DLPFC). 2 So-called “precision noninvasive brain stimulation (NIBS)” carries an added level of complexity: the spatial coil or electrode localization should be taken into account. examined the results of six randomized controlled trials involving the use of repetitive transcranial magnetic stimulation (rTMS) on the medial prefrontal cortex (mPFC) for different psychiatric disorders. These questions resonate in the systematic review recently published in this journal. But is precision psychiatry precise? Is it needed? 1 This new conceptualization states that “one-size-fits-all” treatments will be soon surpassed by personalized interventions. The emerging field of “precision psychiatry” proposes that a multitude of data can be used to match subgroups of patients with treatment interventions to improve treatment outcomes and reduce adverse effects. Portuguese poet Fernando Pessoa, when translating this famous quote from Pompey, conferred it a unique interpretation by using the word “ preciso” – which means both “precise” and “needed” – in his verses. (To navigate is necessary, to live is not) Navigare necesse est, vivere non est necesse
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