Stimulating target and rTMS parameters
Several regions of interest (ROIs) were defined in DLPFC and ACC according to previously reported coordinates from earlier studies on BD (−32, 42, 32) (−4, 50, 4) [After positioning the TMS coil over the V1 coordinates calculated from the individual MRI images, a 3D curvilinear reconstruction of the brain was generated (Brainsight TMS navigation system).The MRI-based neuro-navigation targeting and rTMS were performed by trained staff using Magstim Rapid2 rTMS devices (The Magstim Company, Whitland, UK) with a figure-of-eight coil. Each study participant received 20 days of rTMS treatment. The participants in groups A1 and B1 were treated with 10 days of active rTMS followed by 10 days of sham rTMS treatment, while, in contrast, groups A2 and B2 underwent 10 days of sham rTMS treatment before 10 days of active rTMS. Each daily rTMS treatment consisted of 60 five-second 10-Hz trains delivered at 110% of the resting motor threshold with inter-train intervals of 20 s (i.e., 3000 pulses per session). For the sham treatment, the coil was directed to the same target with the simulation of scalp sensations with the production of the same sounds, without the application of the magnetic field.