The Impact of Repetitive Transcranial Magnetic Stimulation on Functional Connectivity in Major Depressive Disorder and Bipolar Disorder Evaluated by Directed Transfer Function and Indices Based on Graph Theory

The objective of this work was to study the impact of repetitive Transcranial Magnetic Stimulation (rTMS) on the EEG connectivity evaluated by indices based on graph theory, derived from Directed Transfer Function (DTF), in patients with major depressive disorder (MDD) or with bipolar disorder (BD). The results showed the importance of beta and gamma rhythms. The indices density, degree and clustering coefficient increased in MDD responders in beta and gamma bands after rTMS. Interestingly, the density and the degree changed in theta band in both groups of nonresponders (decreased in MDD nonresponders but increased in BD nonresponders). Moreover, both indices of integration (the characteristic path length and the global efficiency) as well as the clustering coefficient increased in BD nonresponders for gamma band. In BD responders, the activity increased in the frontal lobe, mainly in the left hemisphere, while in MDD responders in the central posterior part of brain. The fronto-posterior asymmetry decreased in both groups of responders in delta and beta bands. Changes in inter-hemispheric asymmetry were found only in BD nonresponders in all bands, except gamma band. Comparison between groups showed that the degree increased in delta band independently on disease (BD, MDD). These preliminary results showed that the DTF may be a useful marker allowing for evaluation of effectiveness of the rTMS therapy as well for group differentiation between MDD and BD considering separately groups of responders and nonresponders. However, further investigation should be performed over larger groups of patients to confirmed our findings.