{"doi":"10.1016/j.brs.2023.07.008","title":"An agile, data driven approach for target selection in rTMS therapy for anxiety symptoms","abstract":"Background: Image-guided Transcranial Magnetic Stimulation (TMS) is becoming increasingly popular as it allows for more precise targeting compared to traditional methods. Functional Magnetic Resonance Imaging (fMRI) -based functional connectivity analysis may further increase precision by identifying anomalous circuits prior to treatment. This may in turn offer symptom-specific, individualized target selection, offering improved patient outcomes by aiming treatment at the most abnormal brain regions. Methods: 28 patients with treatment resistant Generalized Anxiety Disorder were recruited for this pilot study. Resting-state fMRI was performed to identify abnormal connectivity within and between the Default Mode Network (DMN) and Central Executive Network (CEN). The most anomalous regions within these networks were identified using a machine-learning based anomaly detection paradigm. Areas demonstrating hyperconnectivity were stimulated with image-guided, accelerated continuous theta burst stimulation, while those with hypoconnectivity received intermittent theta burst stimulation. Patients received 5 sessions per day for 5 days. The Generalized Anxiety Disorder (GAD-7) was used as the primary outcome. Results: In most patients, as is also our experience, the left DMN demonstrated the greatest anomalies in GAD, particularly in areas left 8Av and PGs. Our treatment paradigm demonstrated significant improvements in anxiety symptoms, which persisted at 1-month post-treatment. Only a few and minor complications were reported (fatigue (n = 2) and headache (n = 1)). Conclusion: Our proof-of-concept study suggests individualized, functional connectivity guided TMS may have therapeutic potential, though larger, controlled studies are necessary. Conflict of Interest: Isabella Young, Hugh Taylor, Peter Nicholas, Alana Mackenzie, Onur Tanglay, Karol Osipowicz, Stephane Doyen, and Michael Sughrue are employees of Omniscient Neurotechnology. Charles Teo, Stephane Doyen & Michael Sughrue are board members. Funding: None Disclosures: None","journal":"Brain stimulation","year":2023,"id":410671,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9481,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":693903,"name":"Hugh M. Taylor","orcid":"0000-0002-7368-5333","position":1,"is_corresponding":false},{"id":661724,"name":"Peter J. Nicholas","orcid":"0000-0002-1088-9072","position":2,"is_corresponding":false},{"id":665269,"name":"Alana Mackenzie","orcid":"0000-0001-7342-8006","position":3,"is_corresponding":false},{"id":489220,"name":"Onur Tanglay","orcid":"0000-0002-2071-6909","position":4,"is_corresponding":false},{"id":749492,"name":"Nicholas B. Dadario","orcid":"0000-0002-8657-187X","position":5,"is_corresponding":false},{"id":1190939,"name":"Karol Osipowicz","orcid":null,"position":6,"is_corresponding":false},{"id":661723,"name":"Stéphane Doyen","orcid":"0000-0002-7612-8655","position":7,"is_corresponding":false},{"id":665270,"name":"Charles Teo","orcid":"0000-0003-0593-7866","position":8,"is_corresponding":false},{"id":661726,"name":"Michael E. Sughrue","orcid":"0000-0001-5407-2585","position":9,"is_corresponding":false},{"id":489218,"name":"Isabella M. Young","orcid":"0000-0001-7639-6679","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T01:21:35.071397Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}