# Targeting Functional Improvement in rTMS Therapy

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Depressed patients inadequately responsive to medication and psychotherapy often live with serious
difficulties in psychosocial functioning; thus, repetitive transcranial magnetic stimulation (rTMS) is an important,
alternative, FDA approved therapy. During typical rTMS therapy, clinicians place a stimulation coil on the
patient's scalp that focally modulates the underlying cortical areas. The left dorsolateral prefrontal cortex region
(DLPFC) is the most established target for treating depression; however, clinicians miss this target in a third of
patients and treatment fails, likely contributing to the relatively low remission rate of 31%. The reason for errors
in targeting the DLPFC is that clinicians typically do not have access to MR image-guidance to identify the
underlying brain regions they target. Instead they use the current standard-of-care method to identify the
stimulation location that uses scalp landmarks and moves a fixed distance over the scalp. A new, promising
alternative scalp targeting approach based on EEG electrode placement, the Beam F3 accurately targeted the
DLPFC in 92% of Veterans from our pilot data (n=12). Our collaborator has adopted the Beam F3 as his
clinical standard and showed improved depression severity and changes in associated functional Magnetic
Resonance Imaging (fMRI) data. Other labs also, have indirect evidence that the Beam F3 scalp targeting
approach places the rTMS stimulation coil near an fMRI identified optimal subregion within the DLPFC that
involves control over emotional distraction and reactivity. The overall aim of the current proposal is to test the
feasibility of accurately reaching this fMRI based optimal subregion using the Beam F3 scalp-based targeting
approach. We further hypothesize that, since psychosocial functioning is related to cognitive control that
accurate stimulation of this fMRI region could also lead to improved psychosocial functioning (i.e. reduced
functional limitations and improved quality of life). Our plan is to collect fMRI and MRI's with markers identifying
where clinicians place the Beam F3 location in depressed Veterans. Our strategy is to test whether the Beam
F3 rule places the coil close enough (i.e. within the spatial resolution of rTMS) to reach an optimal DLPFC
subregion in 95% of Veterans. In Aim 1 we propose to use image-guidance to test with high precision how
accurately the Beam F3 targets this optimal, fMRI defined, brain region. In Aim 2 we demonstrate the accuracy
of the Beam F3 in rTMS clinic patients where treaters typically deviate from scalp rules to accommodate
patient comfort since frontal stimulation causes facial twitches and painful cranial nerve stimulation in some
scalp locations. To address clinical importance of our choice of brain targets, in our clinic-based sample we will
evaluate whether spatial deviations from the optimal brain target correlate with improvements in psychosocial
functioning on a composite score of the World Health Organ...

## Key facts

- **NIH application ID:** 10146202
- **Project number:** 5I01RX003152-03
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** ALLYSON C ROSEN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-05-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10146202

## Citation

> US National Institutes of Health, RePORTER application 10146202, Targeting Functional Improvement in rTMS Therapy (5I01RX003152-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10146202. Licensed CC0.

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