51
|
Ozcan S, Gica S, Gulec H. Suicidal behavior in treatment resistant major depressive disorder patients treated with transmagnetic stimulation(TMS) and its relationship with cognitive functions. Psychiatry Res 2020; 286:112873. [PMID: 32114209 DOI: 10.1016/j.psychres.2020.112873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/28/2022]
Abstract
The aim of this study is to investigate the effects of rTMS treatment on suicidal thoughts/behaviors and to determine the cognitive mechanisms underlying the effects of rTMS treatment on suicidal thoughts/behaviors in treatment-resistant depression(TRD). Thirty patients with TRD received rTMS 5 sessions per week for 4-6 weeks. Montgomery-Asberg Depression Rating Scale(MADRS), Columbia Suicide Severity Rating Scale(C-SSRS), Suicidal Ideation Scale(SIS), Beck Hopelessness Scale(BHS) and Cambridge Neuropsychological Test Automated Battery(CANTAB) were administered before and after treatment. After rTMS treatment, there was a significant decrease in depressive complaints and suicidal thoughts and improvement in emotional recognition. However, there was no significant change in cognitive functions such as cognitive flexibility, motor response inhibition and decision making. Pre-treatment decision-making and flexible thinking skills were related to the change in suicidal ideation. In TRD patients, rTMS has a positive effect on depressive symptoms and suicidal thoughts/behaviors and emotion recognition abilities. Although there is no negative effect on other cognitive functions, the positive effect of rTMS on cognitive functions is limited. At this point, we think that the TRD would be treated more effectively with treatments targeting specific symptom clusters such as other cognitive functions and suicidal thoughts.
Collapse
Affiliation(s)
- Selma Ozcan
- University of Health Sciences Antalya Training and Research Hospital, Department of Psychiatry, Antalya, Turkey
| | - Sakir Gica
- Necmettin Erbakan University, Meram Medical Faculty, Department of Psychiatry, Konya, Turkey.
| | - Huseyin Gulec
- University of Health Sciences Istanbul Erenkoy Mental Health and Neurological Disease Education and Research Hospital Psychiatry, Istanbul, Turkey
| |
Collapse
|
52
|
Kayser S, Bewernick BH, Wagner S, Schlaepfer TE. Effects of magnetic seizure therapy on anterograde and retrograde amnesia in treatment-resistant depression. Depress Anxiety 2020; 37:125-133. [PMID: 31682325 DOI: 10.1002/da.22958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/17/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is the gold standard for treatment-resistant depression (TRD). However, cognitive side effects, mainly anterograde and retrograde amnesia, frequently occur. Magnetic seizure therapy (MST) is tested using more focal seizure induction. However, the suggestion MST may be more beneficial than ECT because it causes fewer amnesia have not yet been comprehensively investigated using common neuropsychological testing specifically for ECT. We aimed to examine whether MST causes anterograde and retrograde amnesia. METHODS Ten patients with TRD were treated with MST (8.9 [2] treatments) at 100% machine output, a frequency of 100 Hz and 657.4 (62) pulses per train. The short form of the Autobiographical Memory Inventory was administered to test retrograde amnesia. Furthermore, an extended neuropsychological test battery, including verbal and nonverbal recall as well as recognition tasks, was used. RESULTS We observed changes in retrograde amnesia, although they were not clinically relevant (mean: -0.42 ± 0.14). Furthermore, no anterograde amnesia as well as no effects on global cognitive status, attention, language, and executive functions after MST were measured. CONCLUSIONS The cognitive safety and efficacy of MST in patients with TRD were indicated. However, the main limitations of the present study were the small sample and as a consequence, the low statistical power to detect changes after treatment. Therefore, our findings require replication in further studies. In addition, a direct comparison between MST and ECT in a larger sample should be performed before MST can be discussed as an alternative treatment approach to ECT in clinical practice.
Collapse
Affiliation(s)
- Sarah Kayser
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Bettina H Bewernick
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Geriatric Psychiatry and Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Stefanie Wagner
- Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Thomas E Schlaepfer
- Department of Geriatric Psychiatry and Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Division of Interventional Biological Psychiatry, University Hospital Freiburg, Freiburg, Germany.,Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
53
|
Jiang J, Li C, Chen Z, Cao X, Wang H, Li W, Wang J. Magnetic seizure therapy for treatment-resistant depression. Hippokratia 2020. [DOI: 10.1002/14651858.cd013528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jiangling Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Zhimin Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Xinyi Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Hongyan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Wei Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Department of EEG Source Imaging; Shanghai Shanghai China 200030
| |
Collapse
|
54
|
Jiang J, Truong DQ, Esmaeilpour Z, Huang Y, Badran BW, Bikson M. Enhanced tES and tDCS computational models by meninges emulation. J Neural Eng 2020; 17:016027. [PMID: 31689695 PMCID: PMC7254922 DOI: 10.1088/1741-2552/ab549d] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Understanding how current reaches the brain during transcranial electrical stimulation (tES) underpins efforts to rationalize outcomes and optimize interventions. To this end, computational models of current flow relate applied dose to brain electric field. Conventional tES modeling considers distinct tissues like scalp, skull, cerebrospinal fluid (CSF), gray matter and white matter. The properties of highly conductive CSF are especially important. However, modeling the space between skull and brain as entirely CSF is not an accurate representation of anatomy. The space conventionally modeled as CSF is approximately half meninges (dura, arachnoid, and pia) with lower conductivity. However, the resolution required to describe individual meningeal layers is computationally restrictive in an MRI-derived head model. Emulating the effect of meninges through CSF conductivity modification could improve accuracy with minimal cost. APPROACH Models with meningeal layers were developed in a concentric sphere head model. Then, in a model with only CSF between skull and brain, CSF conductivity was optimized to emulate the effect of meningeal layers on cortical electric field for multiple electrode positions. This emulated conductivity was applied to MRI-derived models. MAIN RESULTS Compared to a model with conventional CSF conductivity (1.65 S m-1), emulated CSF conductivity (0.85 S m-1) produced voltage fields better correlated with intracranial recordings from epilepsy patients. SIGNIFICANCE Conventional tES models have been validated using intracranial recording. Residual errors may nonetheless impact model utility. Because CSF is so conductive to current flow, misrepresentation of the skull-brain interface as entirely CSF is not realistic for tES modeling. Updating the conventional model with a CSF conductivity emulating the effect of the meninges enhances modeling accuracy without increasing model complexity. This allows existing modeling pipelines to be leveraged with a simple conductivity change. Using 0.85 S m-1 emulated CSF conductivity is recommended as the new standard in non-invasive brain stimulation modeling.
Collapse
Affiliation(s)
- Jimmy Jiang
- Department of Biomedical Engineering, Neural Engineering Laboratory, City College of New York of the City University of New York, New York, NY 10031, United States of America. Authors contributed equally
| | | | | | | | | | | |
Collapse
|
55
|
Magnetic seizure therapy (MST) for major depressive disorder. Neuropsychopharmacology 2020; 45:276-282. [PMID: 31486777 PMCID: PMC6901571 DOI: 10.1038/s41386-019-0515-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 11/08/2022]
Abstract
Electroconvulsive therapy (ECT) is effective for major depressive disorder (MDD) but its effects on memory limit its widespread use. Magnetic seizure therapy (MST) is a potential alternative to ECT that may not adversely affect memory. In the current trial, consecutive patients with MDD consented to receive MST applied over the prefrontal cortex according to an open-label protocol. Depressive symptoms and cognition were assessed prior to, during and at the end of treatment. Patients were treated two to three times per week with high-frequency MST (i.e., 100 Hz) (N = 24), medium frequency MST (i.e., 60 or 50 Hz) (N = 26), or low-frequency MST (i.e., 25 Hz MST) (N = 36) using 100% stimulator output. One hundred and forty patients were screened; 86 patients with MDD received a minimum of eight treatments and were deemed to have an adequate course of MST; and 47 completed the trial per protocol, either achieving remission (i.e., 24-item Hamilton Rating Scale for Depression score <10 and a relative reduction of >60% at two consecutive assessments; n = 17) or received a maximum of 24 sessions (n = 30). High-frequency (100 Hz) MST produced the highest remission rate (33.3%). Performance on most cognitive measures remained stable, with the exception of significantly worsened recall consistency of autobiographical information and significantly improved brief visuospatial memory task performance. Under open conditions, MST led to clinically meaningful reduction in depressive symptoms in patients with MDD and produced minimal cognitive impairment. Future studies should compare MST and ECT under double-blind randomized condition.
Collapse
|
56
|
Argyelan M, Oltedal L, Deng ZD, Wade B, Bikson M, Joanlanne A, Sanghani S, Bartsch H, Cano M, Dale AM, Dannlowski U, Dols A, Enneking V, Espinoza R, Kessler U, Narr KL, Oedegaard KJ, Oudega ML, Redlich R, Stek ML, Takamiya A, Emsell L, Bouckaert F, Sienaert P, Pujol J, Tendolkar I, van Eijndhoven P, Petrides G, Malhotra AK, Abbott C. Electric field causes volumetric changes in the human brain. eLife 2019; 8:49115. [PMID: 31644424 PMCID: PMC6874416 DOI: 10.7554/elife.49115] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
Recent longitudinal neuroimaging studies in patients with electroconvulsive therapy (ECT) suggest local effects of electric stimulation (lateralized) occur in tandem with global seizure activity (generalized). We used electric field (EF) modeling in 151 ECT treated patients with depression to determine the regional relationships between EF, unbiased longitudinal volume change, and antidepressant response across 85 brain regions. The majority of regional volumes increased significantly, and volumetric changes correlated with regional electric field (t = 3.77, df = 83, r = 0.38, p=0.0003). After controlling for nuisance variables (age, treatment number, and study site), we identified two regions (left amygdala and left hippocampus) with a strong relationship between EF and volume change (FDR corrected p<0.01). However, neither structural volume changes nor electric field was associated with antidepressant response. In summary, we showed that high electrical fields are strongly associated with robust volume changes in a dose-dependent fashion. Electroconvulsive therapy, or ECT for short, can be an effective treatment for severe depression. Many patients who do not respond to medication find that their symptoms improve after ECT. During an ECT session, the patient is placed under general anesthesia and two electrodes are attached to the scalp to produce an electric field that generates currents within the brain. These currents activate neurons and make them fire, causing a seizure, but it remains unclear how this reduces symptoms of depression. For many years, researchers thought that the induced seizure must be key to the beneficial effects of ECT, but recent studies have cast doubt on this idea. They show that increasing the strength of the electric field alters the clinical effects of ECT, without affecting the seizure. This suggests that the benefits of ECT depend on the electric field itself. Argyelan et al. now show that electric fields affect the brain by making a part of the brain known as the gray matter expand. In a large multinational study, 151 patients with severe depression underwent brain scans before and after a course of ECT. The scans revealed that the gray matter of the patients’ brains expanded during the treatment. The patients who experienced the strongest electric fields showed the largest increase in brain volume, and individual brain areas expanded if the electric field within them exceeded a certain threshold. This effect was particularly striking in two areas, the hippocampus and the amygdala. Both of these areas are critical for mood and memory. Further studies are needed to determine why the brain expands after ECT, and how long the effect lasts. Another puzzle is why the improvements in depression that the patients reported after their treatment did not correlate with changes in brain volume. Disentangling the relationships between ECT, brain volume and depression will ultimately help develop more robust treatments for this disabling condition.
Collapse
Affiliation(s)
- Miklos Argyelan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Leif Oltedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, United States
| | - Benjamin Wade
- Department of Neurology, Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, New York, United States
| | - Andrea Joanlanne
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Sohag Sanghani
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States
| | - Hauke Bartsch
- Department of Radiology, Haukeland University Hospital, Mohn Medical Imaging and Visualization Centre, Bergen, Norway.,Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States
| | - Marta Cano
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBERSAM, Carlos III Health Institute, Barcelona, Spain
| | - Anders M Dale
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, United States.,Department of Radiology, University of California, San Diego, San Diego, United States.,Department of Neurosciences, University of California, San Diego, San Diego, United States
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Annemiek Dols
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Verena Enneking
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Randall Espinoza
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Katherine L Narr
- Department of Neurology, University of California, Los Angeles, Los Angeles, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, United States
| | - Ketil J Oedegaard
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Mardien L Oudega
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Max L Stek
- Department of Psychiatry, Amsterdam UMC, location VUmc, GGZinGeest, Old Age Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Center for Psychiatry and Behavioral Science, Komagino Hospital, Tokyo, Japan
| | - Louise Emsell
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium.,Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Pascal Sienaert
- Academic center for ECT and Neurostimulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium
| | - Jesus Pujol
- CIBERSAM, Carlos III Health Institute, Barcelona, Spain.,MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands.,Faculty of Medicine and LVR Clinic for Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands.,Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, Nijmegen, Netherlands
| | - Georgios Petrides
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Anil K Malhotra
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, United States.,Center for Neuroscience, Feinstein Institute for Medical Research, Manhasset, United States.,Department of Psychiatry, Zucker School of Medicine, Hempstead, United States
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, United States
| |
Collapse
|
57
|
Caulfield KA, George MS. How long would a single session of maximum settings electroconvulsive therapy (ECT) power a 60W lightbulb? Brain Stimul 2019; 12:1612-1613. [PMID: 31431392 DOI: 10.1016/j.brs.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Laboratory, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, USA.
| | - Mark S George
- Brain Stimulation Laboratory, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, 29425, USA
| |
Collapse
|
58
|
Abstract
Magnetic seizure therapy (MST) is a noninvasive neuromodulation therapy under investigation for the treatment of severe neuropsychiatric disorders. MST involves inducing a therapeutic seizure under anesthesia in a setting similar to electroconvulsive therapy (ECT). To date, randomized controlled trials suggest that MST has similar antidepressant efficacy as ECT, but without significant cognitive adverse effects. Large scale clinical trials are currently underway to confirm these preliminary findings. So far, there has only been one study evaluating the clinical predictors of response to MST and more research is needed. This study found that patients with fewer episodes of depression and a positive family history of depression had a better response to MST. Overall, the ability of MST to focus the delivery of the electric field and the resultant seizure makes targeting seizure therapy to specific brain regions possible, and further research will be helpful in identifying personalized targets to maximize clinical benefit. In this review, we describe MST methodology and how it could be individualized to each patient. We also summarize the clinical and cognitive effects of MST and provide indications of which patients may be most likely to benefit. Finally, we summarize the studied neurophysiological predictors of response.
Collapse
|
59
|
Kraus C, Kadriu B, Lanzenberger R, Zarate Jr. CA, Kasper S. Prognosis and improved outcomes in major depression: a review. Transl Psychiatry 2019; 9:127. [PMID: 30944309 PMCID: PMC6447556 DOI: 10.1038/s41398-019-0460-3] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023] Open
Abstract
Treatment outcomes for major depressive disorder (MDD) need to be improved. Presently, no clinically relevant tools have been established for stratifying subgroups or predicting outcomes. This literature review sought to investigate factors closely linked to outcome and summarize existing and novel strategies for improvement. The results show that early recognition and treatment are crucial, as duration of untreated depression correlates with worse outcomes. Early improvement is associated with response and remission, while comorbidities prolong course of illness. Potential biomarkers have been explored, including hippocampal volumes, neuronal activity of the anterior cingulate cortex, and levels of brain-derived neurotrophic factor (BDNF) and central and peripheral inflammatory markers (e.g., translocator protein (TSPO), interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor alpha (TNFα)). However, their integration into routine clinical care has not yet been fully elucidated, and more research is needed in this regard. Genetic findings suggest that testing for CYP450 isoenzyme activity may improve treatment outcomes. Strategies such as managing risk factors, improving clinical trial methodology, and designing structured step-by-step treatments are also beneficial. Finally, drawing on existing guidelines, we outline a sequential treatment optimization paradigm for selecting first-, second-, and third-line treatments for acute and chronically ill patients. Well-established treatments such as electroconvulsive therapy (ECT) are clinically relevant for treatment-resistant populations, and novel transcranial stimulation methods such as theta-burst stimulation (TBS) and magnetic seizure therapy (MST) have shown promising results. Novel rapid-acting antidepressants, such as ketamine, may also constitute a paradigm shift in treatment optimization for MDD.
Collapse
Affiliation(s)
- Christoph Kraus
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria ,0000 0001 2297 5165grid.94365.3dSection on Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Bashkim Kadriu
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Rupert Lanzenberger
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Carlos A. Zarate Jr.
- 0000 0001 2297 5165grid.94365.3dSection on Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD USA
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
60
|
|
61
|
McClintock SM, Kallioniemi E, Martin DM, Kim JU, Weisenbach SL, Abbott CC. A Critical Review and Synthesis of Clinical and Neurocognitive Effects of Noninvasive Neuromodulation Antidepressant Therapies. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:18-29. [PMID: 31975955 PMCID: PMC6493152 DOI: 10.1176/appi.focus.20180031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a plethora of current and emerging antidepressant therapies in the psychiatric armamentarium for the treatment of major depressive disorder. Noninvasive neuromodulation therapies are one such therapeutic category; they typically involve the transcranial application of electrical or magnetic stimulation to modulate cortical and subcortical brain activity. Although electroconvulsive therapy (ECT) has been used since the 1930s, with the prevalence of major depressive disorder and treatment-resistant depression (TRD), the past three decades have seen a proliferation of noninvasive neuromodulation antidepressant therapeutic development. The purpose of this critical review was to synthesize information regarding the clinical effects, neurocognitive effects, and possible mechanisms of action of noninvasive neuromodulation therapies, including ECT, transcranial magnetic stimulation, magnetic seizure therapy, and transcranial direct current stimulation. Considerable research has provided substantial information regarding their antidepressant and neurocognitive effects, but their mechanisms of action remain unknown. Although the four therapies vary in how they modulate neurocircuitry and their resultant antidepressant and neurocognitive effects, they are nonetheless useful for patients with acute and chronic major depressive disorder and TRD. Continued research is warranted to inform dosimetry, algorithm for administration, and integration among the noninvasive neuromodulation therapies and with other antidepressant strategies to continue to maximize their safety and antidepressant benefit.
Collapse
Affiliation(s)
- Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Elisa Kallioniemi
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Donel M Martin
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Joseph U Kim
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Sara L Weisenbach
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| | - Christopher C Abbott
- Neurocognitive Research Laboratory, Department of Psychiatry, University of Texas (UT) Southwestern Medical Center, Dallas, Texas (McClintock, Kallioniemi, Martin); Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (McClintock); Black Dog Institute, Sydney, Australia, and School of Psychiatry, University of New South Wales, Sydney (Martin); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Kim, Weisenbach); VA Salt Lake City, Mental Health Program (Weisenbach); Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Abbott)
| |
Collapse
|
62
|
Sun Y, Blumberger DM, Mulsant BH, Rajji TK, Fitzgerald PB, Barr MS, Downar J, Wong W, Farzan F, Daskalakis ZJ. Magnetic seizure therapy reduces suicidal ideation and produces neuroplasticity in treatment-resistant depression. Transl Psychiatry 2018; 8:253. [PMID: 30470735 PMCID: PMC6251931 DOI: 10.1038/s41398-018-0302-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/05/2018] [Accepted: 06/05/2018] [Indexed: 12/28/2022] Open
Abstract
Therapeutic seizures may work for treatment-resistant depression (TRD) by producing neuroplasticity. We evaluated whether magnetic seizure therapy (MST) produces changes in suicidal ideation and neuroplasticity as indexed through transcranial magnetic stimulation and electroencephalography (TMS-EEG) of the dorsolateral prefrontal cortex (DLPFC). Twenty-three patients with TRD were treated with MST. Changes in suicidal ideation was assessed through the Scale for Suicidal Ideation (SSI). Before and after the treatment course, neuroplasticity in excitatory and inhibitory circuits was assessed with TMS-EEG measures of cortical-evoked activity (CEA) and long-interval cortical inhibition (LICI) from the left DLPFC, and the left motor cortex as a control condition. As in our previous report, the relationship between TMS-EEG measures and suicidal ideation was examined with the SSI. Results show that 44.4% of patients experienced resolution of suicidal ideation. Based on DLPFC assessment, MST produced significant CEA increase over the frontal central electrodes (cluster p < 0.05), but did not change LICI on a group level. MST also reduced the SSI scores (p < 0.005) and the amount of reduction correlated with the decrease in LICI over the right frontal central electrodes (cluster p < 0.05; rho = 0.73 for Cz). LICI change identified patients who were resolved of suicidal ideation with 90% sensitivity and 88% specificity (AUC = 0.9, p = 0.004). There was no significant finding with motor cortex assessment. Overall, MST produced significant rates of resolution of suicidal ideation. MST also produced neuroplasticity in the frontal cortex, likely through long-term potentiation (LTP)-like mechanisms. The largest reduction in suicidal ideation was demonstrated in patients showing concomitant decreases in cortical inhibition-a mechanism linked to enhanced LTP-like plasticity. These findings provide insights into the mechanisms through which patients experience resolution of suicidal ideation following seizure treatments in depression.
Collapse
Affiliation(s)
- Yinming Sun
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Daniel M. Blumberger
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Benoit H. Mulsant
- 0000 0001 2157 2938grid.17063.33Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Tarek K. Rajji
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Paul B. Fitzgerald
- Epworth Healthcare and Monash Alfred Psychiatry Research Centre, Alfred and Monash University Central Clinical School, Melbourne, VIC Australia
| | - Mera S. Barr
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Jonathan Downar
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON Canada
| | - Willy Wong
- 0000 0001 2157 2938grid.17063.33Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON Canada
| | - Faranak Farzan
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada
| | - Zafiris J. Daskalakis
- 0000 0001 2157 2938grid.17063.33Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON Canada
| |
Collapse
|
63
|
Variations in Hippocampal White Matter Diffusivity Differentiate Response to Electroconvulsive Therapy in Major Depression. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:300-309. [PMID: 30658916 DOI: 10.1016/j.bpsc.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/03/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective treatment for severe depression and is shown to increase hippocampal volume and modulate hippocampal functional connectivity. Whether variations in hippocampal structural connectivity occur with ECT and relate to clinical response is unknown. METHODS Patients with major depression (n = 36, 20 women, age 41.49 ± 13.57 years) underwent diffusion magnetic resonance imaging at baseline and after ECT. Control subjects (n = 32, 17 women, age 39.34 ± 12.27 years) underwent scanning twice. Functionally defined seeds in the left and right anterior hippocampus and probabilistic tractography were used to extract tract volume and diffusion metrics (fractional anisotropy and axial, radial, and mean diffusivity). Statistical analyses determined effects of ECT and time-by-response group interactions (>50% change in symptoms before and after ECT defined response). Differences between baseline measures across diagnostic groups and in association with treatment outcome were also examined. RESULTS Significant effects of ECT (all p < .01) and time-by-response group interactions (all p < .04) were observed for axial, radial, and mean diffusivity for right, but not left, hippocampal pathways. Follow-up analyses showed that ECT-related changes occurred in responders only (all p < .01) as well as in relation to change in mood examined continuously (all p < .004). Baseline measures did not relate to symptom change or differ between patients and control subjects. All measures remained stable across time in control subjects. No significant effects were observed for fractional anisotropy and volume. CONCLUSIONS Structural connectivity of hippocampal neural circuits changed with ECT and distinguished treatment responders. The findings suggested neurotrophic, glial, or inflammatory response mechanisms affecting axonal integrity.
Collapse
|
64
|
Atluri S, Wong W, Moreno S, Blumberger DM, Daskalakis ZJ, Farzan F. Selective modulation of brain network dynamics by seizure therapy in treatment-resistant depression. NEUROIMAGE-CLINICAL 2018; 20:1176-1190. [PMID: 30388600 PMCID: PMC6214861 DOI: 10.1016/j.nicl.2018.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
Background Electroconvulsive therapy (ECT) is highly effective for treatment-resistant depression, yet its mechanism of action is still unclear. Understanding the mechanism of action of ECT can advance the optimization of magnetic seizure therapy (MST) towards higher efficacy and less cognitive impairment. Given the neuroimaging evidence for disrupted resting-state network dynamics in depression, we investigated whether seizure therapy (ECT and MST) selectively modifies brain network dynamics for therapeutic efficacy. Methods EEG microstate analysis was used to evaluate resting-state network dynamics in patients at baseline and following seizure therapy, and in healthy controls. Microstate analysis defined four classes of brain states (labelled A, B, C, D). Source localization identified the brain regions associated with these states. Results An increase in duration and decrease in frequency of microstates was specific to responders of seizure therapy. Significant changes in the dynamics of States A, C and D were observed and predicted seizure therapy outcome (specifically ECT). Relative change in the duration of States C and D was shown to be a strong predictor of ECT response. Source localization partly associated C and D to the salience and frontoparietal networks, argued to be impaired in depression. An increase in duration and decrease in frequency of microstates was also observed following MST, however it was not specific to responders. Conclusion This study presents the first evidence for the modulation of global brain network dynamics by seizure therapy. Successful seizure therapy was shown to selectively modulate network dynamics for therapeutic efficacy. The (electric or magnetic) induction of seizures is effective for severe depression but its mechanism of action is unclear. We investigated whether the modulation of brain network dynamics underlies the therapeutic efficacy of seizure therapy. Global brain-network dynamics were studied using EEG microstate analysis. Significant changes in microstate characteristics were specific to responders of electroconvulsive therapy (ECT). Relative change in the duration of microstates C and D was shown to be a strong predictor of response to ECT.
Collapse
Affiliation(s)
- Sravya Atluri
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON M6J 1A8, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building, Room 407, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Willy Wong
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Building, Room 407, 164 College St, Toronto, ON M5S 3G9, Canada; The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, 10 King's College Road, Toronto, ON M5S 3G4, Canada
| | - Sylvain Moreno
- School of Interactive Art and Technology, Simon Fraser University, 250-13450 102 avenue, Surrey, BC V3T 0A3, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Faranak Farzan
- Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON M6J 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 avenue, Surrey, BC V3T 0A3, Canada.
| |
Collapse
|
65
|
Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy. Biol Psychiatry 2018; 84:574-581. [PMID: 30006199 PMCID: PMC6697556 DOI: 10.1016/j.biopsych.2018.05.017] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/29/2018] [Accepted: 05/13/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hippocampal enlargements are commonly reported after electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT-induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. METHODS Longitudinal neuroimaging and clinical data from 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. RESULTS The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p < .001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p < .0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p = .36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery-Åsberg Depression Rating Scale change -1.0 [SE 0.35], per 1% volume increase, p = .005), although the effects were not significant after controlling for ECT number (slope -0.69 [SE 0.38], p = .069). CONCLUSIONS The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.
Collapse
|
66
|
A Blind Module Identification Approach for Predicting Effective Connectivity Within Brain Dynamical Subnetworks. Brain Topogr 2018; 32:28-65. [PMID: 30076488 DOI: 10.1007/s10548-018-0666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
Model-based network discovery measures, such as the brain effective connectivity, require fitting of generative process models to measurements obtained from key areas across the network. For distributed dynamic phenomena, such as generalized seizures and slow-wave sleep, studying effective connectivity from real-time recordings is significantly complicated since (i) outputs from only a subnetwork can be practically measured, and (ii) exogenous subnetwork inputs are unobservable. Model fitting, therefore, constitutes a challenging blind module identification or model inversion problem for finding both the parameters and the many unknown inputs of the subnetwork. We herein propose a novel estimation framework for identifying nonlinear dynamic subnetworks in the case of slowly-varying, otherwise unknown local inputs. Starting with approximate predictions obtained using Cubature Kalman filtering, residuals of local output predictions are utilized to improve upon local input estimates. The algorithm performance is tested on both simulated and clinical EEG of induced seizures under electroconvulsive therapy (ECT). For the simulated network, the algorithm significantly boosted the estimation accuracy for inputs and connections from noisy EEG. For the clinical data, the algorithm predicted increased subnetwork inputs during the pre-stimulus anesthesia condition. Importantly, it predicted an increased frontocentral connectivity during the generalized seizure that is commensurate with electrode placement and that corroborates the clinical hypothesis of increased frontal focality of therapeutic ECT seizures. The proposed framework can be extended to account for several input configurations and can in principle be applied to study effective connectivity within brain subnetworks defined at the microscale (cortical lamina interaction) or at the macroscale (sensory integration).
Collapse
|
67
|
Stimulation frequency of magnetic seizure therapy contributes to the adequacy of seizures. Clin Neurophysiol 2018; 129:1718-1719. [DOI: 10.1016/j.clinph.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022]
|
68
|
Abstract
OBJECTIVE Evidence suggests that magnetic seizure therapy (MST) results in fewer side effects than electroconvulsive treatment, both in humans treated with electroconvulsive therapy (ECT) as well as in the animal preclinical model that uses electroconvulsive shock (ECS). Evidence suggests that MST results in fewer cognitive side effects than ECT. Although MST offers enhanced control over seizure induction and spread, little is known about how MST and ECT seizures differ. Seizure characteristics are associated with treatment effect. This study presents quantitative analyses of electroencephalogram (EEG) power after electrical and magnetic seizure induction and anesthesia-alone sham in an animal model. The aim was to test whether differential neurophysiological characteristics of the seizures could be identified that support earlier observations that the powers of theta, alpha, and beta but not delta frequency bands were lower after MST when compared with those after ECS. METHODS In a randomized, sham-controlled trial, 24 macaca mulatte received 6 weeks of daily sessions while scalp EEG was recorded. Electroencephalogram power was quantified within delta, theta, alpha, and beta frequency bands. RESULTS Magnetic seizure therapy induced lower ictal expression in the theta, alpha and beta frequencies than ECS, but MST and ECS were indistinguishable in the delta band. Magnetic seizure therapy showed less postictal suppression than ECS. Increasing electrical dosage increased ictal power, whereas increasing MST dosage had no effect on EEG expression. CONCLUSIONS Magnetic seizure therapy seizures have less robust electrophysiological expression than ECS, and these differences are largest in the alpha and beta bands. The relevance of these differences in higher frequency bands to clinical outcomes deserves further exploration. SIGNIFICANCE Contrasting EEG in ECS and MST may lead to insights on the physiological underpinnings of seizure-induced amnesia and to finding ways to reduce cognitive side effects.
Collapse
|
69
|
Backhouse FA, Noda Y, Knyahnytska Y, Farzan F, Downar J, Rajji TK, Mulsant BH, Daskalakis ZJ, Blumberger DM. Characteristics of ictal EEG in Magnetic Seizure Therapy at various stimulation frequencies. Clin Neurophysiol 2018; 129:1770-1779. [PMID: 29735419 DOI: 10.1016/j.clinph.2018.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The first objective of this study aimed to elucidate the relationship between seizure characteristics and Magnetic Seizure Therapy (MST) treatment outcome. The second objective was to determine the effect of stimulation frequency on seizure characteristics. METHODS Using a between-subjects design, we compared the seizures of patients with unipolar depression receiving MST at three separate stimulation frequencies: 25 Hz (n = 34), 50 Hz (n = 16) and 100 Hz (n = 11). Seizures were rated for overall seizure adequacy on a scale of 0-6, with one point given for each measure that was considered to be adequate according to the ECT literature: (1) seizure EEG duration (2) motor duration, (3) post-ictal suppression, (4) ictal EEG maximum amplitude, (5) Global Seizure Strength, and (6) Symmetry. Mixed-effect models were used to evaluate the effect of frequency on seizure characteristics and the relationships between seizure characteristics and clinical outcome. RESULTS (1) 100 Hz induced seizures that were less adequate than seizures induced with 50 Hz and 25 Hz stimulations. Seizures induced by 50 Hz stimulations had longer slow-wave phase durations and total EEG durations than the 100 Hz and 25 Hz groups. Global seizure strength was less robust in seizures induced by 100 Hz MST compared to the other stimulation frequencies. (2) Shorter polyspike durations and smaller slow-wave amplitude predicted reductions in overall symptoms of depression as measured by the 24-item Hamilton Depression Scale. CONCLUSION Analysis of our first objective revealed stimulation frequency significantly influences measures of overall seizure adequacy. However, our results also revealed these descriptions of seizure adequacy based on ECT literature may not be useful for MST-induced seizures, as the characteristics of MST-induced seizure characteristics may predict clinical response in a different manner. SIGNIFICANCE These results may help to distinguish the biological processes impacted by stimulation frequency and may suggest different mechanisms of action between convulsive therapies and challenge the current understanding of seizure adequacy for MST.
Collapse
Affiliation(s)
- Felicity A Backhouse
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Yoshihiro Noda
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Faranak Farzan
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Downar
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; MRI-Guided TMS Clinic, University Health Network, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Division, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Division, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Division, Department of Psychiatry, University of Toronto, Ontario, Canada.
| |
Collapse
|
70
|
Makarov SN, Noetscher GM, Raij T, Nummenmaa A. A Quasi-Static Boundary Element Approach With Fast Multipole Acceleration for High-Resolution Bioelectromagnetic Models. IEEE Trans Biomed Eng 2018; 65:2675-2683. [PMID: 29993385 DOI: 10.1109/tbme.2018.2813261] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We develop a new accurate version of the boundary element fast multipole method for transcranial magnetic stimulation (TMS) related problems. This method is based on the surface-charge formulation and is using the highly efficient fast multipole accelerator along with analytical computations of neighbor surface integrals. RESULTS The method accuracy is demonstrated by comparison with the proven commercial finite-element method (FEM) software ANSYS Maxwell 18.2 2017 operating on unstructured grids and with adaptive mesh refinement. Five realistic high-definition head models from the Population Head Repository (IT'IS Foundation, Switzerland) have been acquired and augmented with a commercial TMS coil model (MRi-B91, MagVenture, Denmark). For each head model, simulations with our method and simulations with the FEM software ANSYS Maxwell 18.2 2017 have been performed. These simulations have been compared with each other and an excellent agreement was established in every case. SIGNIFICANCE At the same time, our new method runs approximately 500 times faster than the ANSYS FEM, finishes in about 200 s on a standard server, and naturally provides a submillimeter field resolution, which is justified using mesh refinement. CONCLUSIONS Our method can be applied to modeling of brain stimulation and recording technologies such as TMS and magnetoencephalography, and has the potential to become a real-time high-resolution simulation tool.
Collapse
|
71
|
Jiang J, Li Q, Sheng J, Yang F, Cao X, Zhang T, Jia Y, Wang J, Li C. 25 Hz Magnetic Seizure Therapy Is Feasible but Not Optimal for Chinese Patients With Schizophrenia: A Case Series. Front Psychiatry 2018; 9:224. [PMID: 29896130 PMCID: PMC5986936 DOI: 10.3389/fpsyt.2018.00224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022] Open
Abstract
Magnetic seizure therapy (MST) is a potential alternative to electroconvulsive therapy (ECT), but there is currently a lack of reports about MST in Chinese patients with schizophrenia. Our objective was to investigate the feasibility and acceptability of add-on MST in the treatment of patients with schizophrenia. Eight patients with schizophrenia were enrolled in a case series study to receive 10 sessions of add-on MST over 4 weeks. The MST was administrated using 25 Hz at 100% output with a titration duration ranging from 4 to 20 s by 4 s. The Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were employed to measure the symptom improvements and the cognitive effects, respectively. Six patients completed at least one-half of the planned sessions. Five showed a reduction in PANSS total score, and three achieved clinical response (≥30% reduction). Three of the participants receiving the RBANS, showed either improvements or no changes in the memory function. Regarding the subjective complaints about MST, two reported dizziness, and only one reported memory loss. Approximately one-fourth of the treatment sessions produced only brief seizures (<15 s). Overall, employing MST to treat Chinese patients with schizophrenia appeared feasible and acceptable. However, further evidence is needed to determine the therapeutic efficacy and effects of MST on the cognitive functions of patients with schizophrenia.
Collapse
Affiliation(s)
- Jiangling Jiang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Qingwei Li
- Department of Psychiatry, Tongji Hospital of Tongji University, Shanghai, China
| | - Jianhua Sheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuzhong Yang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Cao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuping Jia
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Science, Shanghai, China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
72
|
Bikson M, Paneri B, Mourdoukoutas A, Esmaeilpour Z, Badran BW, Azzam R, Adair D, Datta A, Fang XH, Wingeier B, Chao D, Alonso-Alonso M, Lee K, Knotkova H, Woods AJ, Hagedorn D, Jeffery D, Giordano J, Tyler WJ. Limited output transcranial electrical stimulation (LOTES-2017): Engineering principles, regulatory statutes, and industry standards for wellness, over-the-counter, or prescription devices with low risk. Brain Stimul 2017; 11:134-157. [PMID: 29122535 DOI: 10.1016/j.brs.2017.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/16/2017] [Accepted: 10/15/2017] [Indexed: 01/17/2023] Open
Abstract
We present device standards for low-power non-invasive electrical brain stimulation devices classified as limited output transcranial electrical stimulation (tES). Emerging applications of limited output tES to modulate brain function span techniques to stimulate brain or nerve structures, including transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), and transcranial pulsed current stimulation (tPCS), have engendered discussion on how access to technology should be regulated. In regards to legal regulations and manufacturing standards for comparable technologies, a comprehensive framework already exists, including quality systems (QS), risk management, and (inter)national electrotechnical standards (IEC). In Part 1, relevant statutes are described for medical and wellness application. While agencies overseeing medical devices have broad jurisdiction, enforcement typically focuses on those devices with medical claims or posing significant risk. Consumer protections regarding responsible marketing and manufacture apply regardless. In Part 2 of this paper, we classify the electrical output performance of devices cleared by the United States Food and Drug Administration (FDA) including over-the-counter (OTC) and prescription electrostimulation devices, devices available for therapeutic or cosmetic purposes, and devices indicated for stimulation of the body or head. Examples include iontophoresis devices, powered muscle stimulators (PMS), cranial electrotherapy stimulation (CES), and transcutaneous electrical nerve stimulation (TENS) devices. Spanning over 13 FDA product codes, more than 1200 electrical stimulators have been cleared for marketing since 1977. The output characteristics of conventional tDCS, tACS, and tPCS techniques are well below those of most FDA cleared devices, including devices that are available OTC and those intended for stimulation on the head. This engineering analysis demonstrates that with regard to output performance and standing regulation, the availability of tDCS, tACS, or tPCS to the public would not introduce risk, provided such devices are responsibly manufactured and legally marketed. In Part 3, we develop voluntary manufacturer guidance for limited output tES that is aligned with current regulatory standards. Based on established medical engineering and scientific principles, we outline a robust and transparent technical framework for ensuring limited output tES devices are designed to minimize risks, while also supporting access and innovation. Alongside applicable medical and government activities, this voluntary industry standard (LOTES-2017) further serves an important role in supporting informed decisions by the public.
Collapse
Affiliation(s)
- Marom Bikson
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA.
| | - Bhaskar Paneri
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA
| | - Andoni Mourdoukoutas
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA
| | - Zeinab Esmaeilpour
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA
| | - Bashar W Badran
- U.S. Army Research Laboratory, Aberdeen Proving Ground, MD, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | | | - Devin Adair
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA
| | | | - Xiao Hui Fang
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031, USA
| | | | - Daniel Chao
- Halo Neuroscience Inc., San Francisco, CA 94103, USA
| | - Miguel Alonso-Alonso
- Harvard Medical School, Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Boston, MA, USA
| | - Kiwon Lee
- Ybrain Inc., Sampyeong-dong, Seongnam-si, South Korea
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, USA
| | | | | | - James Giordano
- Department of Neurology and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - William J Tyler
- Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ 85287, USA
| |
Collapse
|
73
|
Degree of Postictal Suppression Depends on Seizure Induction Time in Magnetic Seizure Therapy and Electroconvulsive Therapy. J ECT 2017. [PMID: 28640168 DOI: 10.1097/yct.0000000000000425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anesthesia is required for both magnetic seizure therapy (MST) and electroconvulsive therapy (ECT), although it has anticonvulsant properties. In this case, bispectral index (BIS) monitoring, a specific electroencephalogram-derived monitoring, can be used to find the optimal seizure induction time during anesthesia to elicit adequate seizures. A measurement of seizure adequacy in electroencephalogram is the postictal suppression. The purpose of this study was to investigate the influence of seizure induction time on the degree of postictal suppression by comparing BIS versus no-BIS monitoring in MST and ECT. METHODS Twenty patients with treatment-resistant depression were randomly assigned to either MST or ECT. Each patient underwent 3 treatments with the determination of seizure induction time by defined prestimulation BIS (BIS condition) and 3 treatments with determination of seizure induction time by controlled clinical trial protocol (no-BIS condition). Statistical analysis was calculated by repeated-measures analysis of variance. RESULTS The degree of postictal suppression was more pronounced in both MST and ECT, with BIS monitoring. In this connection, no differences between MST and ECT were found. Seizure induction time was significantly later in the BIS condition (181.3 ± 6 seconds) compared with the no-BIS condition (114.3 ± 12 seconds) (P < 0.001). CONCLUSIONS Adequacy of seizures, in the form of the degree of postictal suppression, was superior by determining the seizure induction time with BIS in both MST and ECT. Further research is needed to investigate the correlation between the degree of postictal suppression and treatment response.
Collapse
|
74
|
Mohtadi Jafari A, Abdolali A. Adopting reciprocity theorem in deep transcranial magnetic stimulation problem to design an efficient single source coil array based on nerve cell direction. Med Biol Eng Comput 2017; 56:13-23. [PMID: 28664353 DOI: 10.1007/s11517-017-1663-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/10/2017] [Indexed: 11/30/2022]
Abstract
Deep transcranial magnetic stimulation (dTMS) plays an important role in the treatment of many diseases. Previous designs rarely considered the direction of the induced electric field (E) with respect to nerve fibers. However, it can be observed from related formulae that the tangential component of E (E effective) has a more significant role in the stimulation of nerve cells. In this paper, a new approach is proposed for designing a single-source coil array (CA) by combining tractography and the reciprocity theorem (RT). This method is a non-iterative procedure that can directly design CAs for the stimulation of each desired target zone without any complicated and slow iterative algorithm. Specifications of CA such as the optimum spatial angle and the best placement of coils are important because the location of the coil around the head and its spatial angle have been shown to have a major effect on induced E. Adoption of the RT yields the optimum specifications of CA and maximum E effective at the stimulation zone. This novel technique can introduce a new approach for the application of CA since it entails a high flexibility, high speed, and good accuracy.
Collapse
Affiliation(s)
- Ali Mohtadi Jafari
- BioElectromagnetic Group, Applied Electromagnetics Laboratory, Department of Electrical Engineering, Iran University of Science and Technology, Tehran, 16846-13114, Iran
| | - Ali Abdolali
- BioElectromagnetic Group, Applied Electromagnetics Laboratory, Department of Electrical Engineering, Iran University of Science and Technology, Tehran, 16846-13114, Iran.
| |
Collapse
|
75
|
Wu H, Jiang J, Wang J, Cao X, Li C. Magnetic seizure therapy for people with schizophrenia. Hippokratia 2017. [DOI: 10.1002/14651858.cd012697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hui Wu
- Shanghai General Hospital, Shanghai Jiao Tong University; Department of Medical Psychology; Shanghai China 200030
| | - Jiangling Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Department of Psychiatry; 600 Wan Ping Nan Road Shanghai China 200030
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Department of EEG Source Imaging; Shanghai Shanghai China 200030
| | - Xinyi Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China
| |
Collapse
|
76
|
Lee WH, Lisanby SH, Laine AF, Peterchev AV. Minimum Electric Field Exposure for Seizure Induction with Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology 2017; 42:1192-1200. [PMID: 27934961 PMCID: PMC5437889 DOI: 10.1038/npp.2016.276] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/05/2016] [Accepted: 12/04/2016] [Indexed: 11/09/2022]
Abstract
Lowering and individualizing the current amplitude in electroconvulsive therapy (ECT) has been proposed as a means to produce stimulation closer to the neural activation threshold and more focal seizure induction, which could potentially reduce cognitive side effects. However, the effect of current amplitude on the electric field (E-field) in the brain has not been previously linked to the current amplitude threshold for seizure induction. We coupled MRI-based E-field models with amplitude titrations of motor threshold (MT) and seizure threshold (ST) in four nonhuman primates (NHPs) to determine the strength, distribution, and focality of stimulation in the brain for four ECT electrode configurations (bilateral, bifrontal, right-unilateral, and frontomedial) and magnetic seizure therapy (MST) with cap coil on vertex. At the amplitude-titrated ST, the stimulated brain subvolume (23-63%) was significantly less than for conventional ECT with high, fixed current (94-99%). The focality of amplitude-titrated right-unilateral ECT (25%) was comparable to cap coil MST (23%), demonstrating that ECT with a low current amplitude and focal electrode placement can induce seizures with E-field as focal as MST, although these electrode and coil configurations affect differently specific brain regions. Individualizing the current amplitude reduced interindividual variation in the stimulation focality by 40-53% for ECT and 26% for MST, supporting amplitude individualization as a means of dosing especially for ECT. There was an overall significant correlation between the measured amplitude-titrated ST and the prediction of the E-field models, supporting a potential role of these models in dosing of ECT and MST. These findings may guide the development of seizure therapy dosing paradigms with improved risk/benefit ratio.
Collapse
Affiliation(s)
- Won H Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Department of Biomedical Engineering, Duke University, Durham, NC, USA,Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, Box 3620 DUMC, Durham, NC 27710, USA, Tel: 919 684 0383, Fax: 919 681 9962, E-mail:
| |
Collapse
|
77
|
Goetz SM, Deng ZD. The development and modelling of devices and paradigms for transcranial magnetic stimulation. Int Rev Psychiatry 2017; 29:115-145. [PMID: 28443696 PMCID: PMC5484089 DOI: 10.1080/09540261.2017.1305949] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
Magnetic stimulation is a non-invasive neurostimulation technique that can evoke action potentials and modulate neural circuits through induced electric fields. Biophysical models of magnetic stimulation have become a major driver for technological developments and the understanding of the mechanisms of magnetic neurostimulation and neuromodulation. Major technological developments involve stimulation coils with different spatial characteristics and pulse sources to control the pulse waveform. While early technological developments were the result of manual design and invention processes, there is a trend in both stimulation coil and pulse source design to mathematically optimize parameters with the help of computational models. To date, macroscopically highly realistic spatial models of the brain, as well as peripheral targets, and user-friendly software packages enable researchers and practitioners to simulate the treatment-specific and induced electric field distribution in the brains of individual subjects and patients. Neuron models further introduce the microscopic level of neural activation to understand the influence of activation dynamics in response to different pulse shapes. A number of models that were designed for online calibration to extract otherwise covert information and biomarkers from the neural system recently form a third branch of modelling.
Collapse
Affiliation(s)
- Stefan M Goetz
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- b Department of Electrical & Computer Engineering , Duke University , Durham , NC , USA
- c Department of Neurosurgery , Duke University , Durham , NC , USA
| | - Zhi-De Deng
- a Department of Psychiatry & Behavioral Sciences, Division for Brain Stimulation & Neurophysiology , Duke University , Durham , NC , USA
- d Intramural Research Program, Experimental Therapeutics & Pathophysiology Branch, Noninvasive Neuromodulation Unit , National Institutes of Health, National Institute of Mental Health , Bethesda , MD , USA
- e Duke Institute for Brain Sciences , Duke University , Durham , NC , USA
| |
Collapse
|
78
|
Radman T, Lisanby SH. New directions in the rational design of electrical and magnetic seizure therapies: individualized Low Amplitude Seizure Therapy (iLAST) and Magnetic Seizure Therapy (MST). Int Rev Psychiatry 2017; 29:63-78. [PMID: 28430533 DOI: 10.1080/09540261.2017.1304898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Electroconvulsive therapy remains a key treatment option for severe cases of depression, but undesirable side-effects continue to limit its use. Innovations in the design of novel seizure therapies seek to improve its risk benefit ratio through enhanced control of the focality of stimulation. The design of seizure therapies with increased spatial precision is motivated by avoiding stimulation of deep brain structures implicated in memory retention, including the hippocampus. The development of two innovations in seizure therapy-individualized low-amplitude seizure therapy (iLAST) and magnetic seizure therapy (MST), are detailed. iLAST is a method of seizure titration involving reducing current spread in the brain by titrating current amplitude from the traditional fixed amplitudes. MST, which can be used in conjunction with iLAST dosing methods, involves the use of magnetic stimulation to reduce shunting and spreading of current by the scalp occurring during electrical stimulation. Evidence is presented on the rationale for increasing the focality of ECT in hopes of preserving its effectiveness, while reducing cognitive side-effects. Finally, the value of electric field and neural modelling is illustrated to explain observed clinical effects of modifications to ECT technique, and their utility in the rational design of the next generation of seizure therapies.
Collapse
Affiliation(s)
- Thomas Radman
- a National Institute of Mental Health , Bethesda , MD , USA
| | | |
Collapse
|
79
|
de Oliveira MM, Wen P, Ahfock T. Bio-heat transfer model of electroconvulsive therapy: Effect of biological properties on induced temperature variation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:3997-4000. [PMID: 28269161 DOI: 10.1109/embc.2016.7591603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A realistic human head model consisting of six tissue layers was modelled to investigate the behavior of temperature profile and magnitude when applying electroconvulsive therapy stimulation and different biological properties. The thermo-electrical model was constructed with the use of bio-heat transfer equation and Laplace equation. Three different electrode montages were analyzed as well as the influence of blood perfusion, metabolic heat and electric and thermal conductivity in the scalp. Also, the effect of including the fat layer was investigated. The results showed that temperature increase is inversely proportional to electrical and thermal conductivity increase. Furthermore, the inclusion of blood perfusion slightly drops the peak temperature. Finally, the inclusion of fat is highly recommended in order to acquire more realistic results from the thermo-electrical models.
Collapse
|
80
|
Tang VM, Blumberger DM, McClintock SM, Kaster TS, Rajji TK, Downar J, Fitzgerald PB, Daskalakis ZJ. Magnetic Seizure Therapy in Treatment-Resistant Schizophrenia: A Pilot Study. Front Psychiatry 2017; 8:310. [PMID: 29387022 PMCID: PMC5775974 DOI: 10.3389/fpsyt.2017.00310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/26/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Electroconvulsive therapy is effective in treatment-resistant schizophrenia (TRS) but use is limited due to stigma and concerns around cognitive adverse effects. Magnetic seizure therapy (MST) is a promising new neuromodulation technique that uses transcranial magnetic stimulation to induce therapeutic seizures. Studies of MST in depression have shown clinical improvement with a favorable adverse effect profile. No studies have examined the clinical utility of MST in schizophrenia. METHODS We conducted an open-label pilot clinical trial of MST in eight TRS patients. Up to 24 MST treatments were delivered depending on treatment response. We assessed clinical outcome through the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Cognitive testing included a neuropsychological test battery, the Autobiographical Memory Inventory (AMI), Montreal Cognitive Assessment (MoCA), and reorientation time. RESULTS Four patients completed the trial as per protocol. For all patients and for trial completers alone, there was a significant clinical and quality of life improvement. Three met pre-determined criteria for remission (total score ≤25 on the BPRS) and one met criteria for response (i.e., ≥25% BPRS improvement from baseline for two consecutive assessments). Pre and post neurocognitive data showed no significant cognitive adverse effects apart from a decrease in AMI scores. CONCLUSION In this pilot study, MST demonstrated evidence for feasibility in patients with TRS, with promise for clinical efficacy and negligible cognitive side effects. Further study in larger clinical populations is needed. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, Identifier NCT01596608.
Collapse
Affiliation(s)
- Victor M Tang
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shawn M McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Tyler S Kaster
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada.,MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
81
|
McDonald WM. Neuromodulation Treatments for Geriatric Mood and Cognitive Disorders. Am J Geriatr Psychiatry 2016; 24:1130-1141. [PMID: 27889282 DOI: 10.1016/j.jagp.2016.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 01/05/2023]
Abstract
There is increasing evidence for the efficacy of neuromodulation in the treatment of resistant mood disorders and emerging data supporting the use of neuromodulation in cognitive disorders. A significant minority of depressed elders do not respond to pharmacotherapy and/or psychotherapy. This has led clinicians to recommend the increasing use of electroconvulsive therapy (ECT) in the treatment of medication-resistant or life-threatening geriatric depression. Multiple studies have supported the safety and efficacy of ECT in the elderly, yet ECT is associated with side effects including cardiovascular and cognitive side effects. Neuromodulation therapies have the potential for providing effective treatment for treatment-resistant older adults with reduced side effects and this review will outline the risks and benefits of neuromodulation treatment in geriatric psychiatry. There is also emerging evidence of the efficacy of neuromodulation devices in the treatment of cognitive disorders. Pharmacotherapy has been largely ineffective in changing the course of neurodegenerative diseases causing dementia and other treatments are clearly needed. This review will outline the available evidence for neuromodulation in the treatment of mood and cognitive disorders in the elderly.
Collapse
Affiliation(s)
- William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
| |
Collapse
|
82
|
Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? J Psychosoc Nurs Ment Health Serv 2016; 54:39-43. [DOI: 10.3928/02793695-20161208-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
83
|
Grehl S, Martina D, Goyenvalle C, Deng ZD, Rodger J, Sherrard RM. In vitro Magnetic Stimulation: A Simple Stimulation Device to Deliver Defined Low Intensity Electromagnetic Fields. Front Neural Circuits 2016; 10:85. [PMID: 27857683 PMCID: PMC5093126 DOI: 10.3389/fncir.2016.00085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/10/2016] [Indexed: 01/10/2023] Open
Abstract
Non-invasive brain stimulation (NIBS) by electromagnetic fields appears to benefit human neurological and psychiatric conditions, although the optimal stimulation parameters and underlying mechanisms remain unclear. Although, in vitro studies have begun to elucidate cellular mechanisms, stimulation is delivered by a range of coils (from commercially available human stimulation coils to laboratory-built circuits) so that the electromagnetic fields induced within the tissue to produce the reported effects are ill-defined. Here, we develop a simple in vitro stimulation device with plug-and-play features that allow delivery of a range of stimulation parameters. We chose to test low intensity repetitive magnetic stimulation (LI-rMS) delivered at three frequencies to hindbrain explant cultures containing the olivocerebellar pathway. We used computational modeling to define the parameters of a stimulation circuit and coil that deliver a unidirectional homogeneous magnetic field of known intensity and direction, and therefore a predictable electric field, to the target. We built the coil to be compatible with culture requirements: stimulation within an incubator; a flat surface allowing consistent position and magnetic field direction; location outside the culture plate to maintain sterility and no heating or vibration. Measurements at the explant confirmed the induced magnetic field was homogenous and matched the simulation results. To validate our system we investigated biological effects following LI-rMS at 1 Hz, 10 Hz and biomimetic high frequency, which we have previously shown induces neural circuit reorganization. We found that gene expression was modified by LI-rMS in a frequency-related manner. Four hours after a single 10-min stimulation session, the number of c-fos positive cells increased, indicating that our stimulation activated the tissue. Also, after 14 days of LI-rMS, the expression of genes normally present in the tissue was differentially modified according to the stimulation delivered. Thus we describe a simple magnetic stimulation device that delivers defined stimulation parameters to different neural systems in vitro. Such devices are essential to further understanding of the fundamental effects of magnetic stimulation on biological tissue and optimize therapeutic application of human NIBS.
Collapse
Affiliation(s)
- Stephanie Grehl
- Sorbonne Universités, UPMC Univ Paris 06 & CNRS, IBPS-B2A, UMR 8256 Biological Adaptation and AgeingParis, France; Experimental and Regenerative Neuroscience, School of Animal Biology, the University of Western Australia, PerthWA, Australia
| | - David Martina
- Institut Langevin, ESPCI ParisTech & CNRS, UMR7587 INSERM ERL U979 Paris, France
| | - Catherine Goyenvalle
- Sorbonne Universités, UPMC Univ Paris 06 & CNRS, IBPS-B2A, UMR 8256 Biological Adaptation and Ageing Paris, France
| | - Zhi-De Deng
- Non-invasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, BethesdaMD, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DurhamNC, USA
| | - Jennifer Rodger
- Experimental and Regenerative Neuroscience, School of Animal Biology, the University of Western Australia, Perth WA, Australia
| | - Rachel M Sherrard
- Sorbonne Universités, UPMC Univ Paris 06 & CNRS, IBPS-B2A, UMR 8256 Biological Adaptation and Ageing Paris, France
| |
Collapse
|
84
|
Rosenquist PB, McCall WV, Youssef N. Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed? Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160927-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
85
|
Menezes de Oliveira M, Wen P, Ahfock T. Heat transfer due to electroconvulsive therapy: Influence of anisotropic thermal and electrical skull conductivity. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 133:71-81. [PMID: 27393801 DOI: 10.1016/j.cmpb.2016.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES This paper focuses on electroconvulsive therapy (ECT) and head models to investigate temperature profiles arising when anisotropic thermal and electrical conductivities are considered in the skull layer. The aim was to numerically investigate the threshold for which this therapy operates safely to the brain, from the thermal point of view. METHODS A six-layer spherical head model consisting of scalp, fat, skull, cerebro-spinal fluid, grey matter and white matter was developed. Later on, a realistic human head model was also implemented. These models were built up using the packages from COMSOL Inc. and Simpleware Ltd. In these models, three of the most common electrode montages used in ECT were applied. Anisotropic conductivities were derived using volume constraint and included in both spherical and realistic head models. The bio-heat transferring problem governed by Laplace equation was solved numerically. RESULTS The results show that both the tensor eigenvalues of electrical conductivity and the electrode montage affect the maximum temperature, but thermal anisotropy does not have a significant influence. Temperature increases occur mainly in the scalp and fat, and no harm is caused to the brain by the current applied during ECT. CONCLUSIONS The work assures the thermal safety of ECT and also provides a numerical method to investigate other non-invasive therapies.
Collapse
Affiliation(s)
- Marilia Menezes de Oliveira
- School of Mechanical and Electrical Engineering, University of Southern Queensland, Toowoomba, Queensland 4350, Australia.
| | - Peng Wen
- School of Mechanical and Electrical Engineering, University of Southern Queensland, Toowoomba, Queensland 4350, Australia
| | - Tony Ahfock
- School of Mechanical and Electrical Engineering, University of Southern Queensland, Toowoomba, Queensland 4350, Australia
| |
Collapse
|
86
|
Lee WH, Lisanby SH, Laine AF, Peterchev AV. Stimulation strength and focality of electroconvulsive therapy and magnetic seizure therapy in a realistic head model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:410-3. [PMID: 25569983 DOI: 10.1109/embc.2014.6943615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examines the characteristics of the electric field (E-field) induced in the brain by electroconvulsive therapy (ECT) and magnetic seizure therapy (MST). The electric field induced by five ECT electrode configurations (bilateral, bifrontal, right unilateral, focal electrically administered seizure therapy, and frontomedial) as well as an MST coil configuration (circular) was computed in an anatomically realistic finite element model of the human head. We computed the maps of the electric field strength relative to an estimated neural activation threshold, and used them to evaluate the stimulation strength and focality of the various ECT and MST paradigms. The results show that the median ECT stimulation strength in the brain is 3-11 times higher than that for MST, and that the stimulated brain volume is substantially higher with ECT (47-100%) than with MST (21%). Our study provides insight into the observed reduction of cognitive side effects in MST compared to ECT, and supports arguments for lowering ECT current amplitude as a means of curbing its side effects.
Collapse
|
87
|
Bernabei JM, Lee WH, Peterchev AV. Modeling transcranial electric stimulation in mouse: a high resolution finite element study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:406-9. [PMID: 25569982 DOI: 10.1109/embc.2014.6943614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mouse models are widely used in studies of various forms of transcranial electric stimulation (TES). However, there is limited knowledge of the electric field distribution induced by TES in mice, and computational models to estimate this distribution are lacking. This study examines the electric field and current density distribution in the mouse brain induced by TES. We created a high-resolution finite element mouse model incorporating ear clip electrodes commonly used in mouse TES to study, for example, electroconvulsive therapy (ECT). The electric field strength and current density induced by an ear clip electrode configuration were computed in the anatomically realistic, inhomogenous mouse model. The results show that the median electric field strength induced in the brain at 1 mA of stimulus current is 5.57 V/m, and the strongest field of 20.19 V/m was observed in the cerebellum. Therefore, to match the median electric field in human ECT at 800 mA current, the electrode current in mouse should be set to approximately 15 mA. However, the location of the strongest electric field in posterior brain regions in the mouse does not model well human ECT which targets more frontal regions. Therefore, the ear clip electrode configuration may not be a good model of human ECT. Using high-resolution realistic models for simulating TES in mice may guide the establishment of appropriate stimulation parameters for future in vivo studies.
Collapse
|
88
|
Lee WH, Lisanby SH, Laine AF, Peterchev AV. Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model. Eur Psychiatry 2016; 36:55-64. [PMID: 27318858 DOI: 10.1016/j.eurpsy.2016.03.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study examines the strength and spatial distribution of the electric field induced in the brain by electroconvulsive therapy (ECT) and magnetic seizure therapy (MST). METHODS The electric field induced by standard (bilateral, right unilateral, and bifrontal) and experimental (focal electrically administered seizure therapy and frontomedial) ECT electrode configurations as well as a circular MST coil configuration was simulated in an anatomically realistic finite element model of the human head. Maps of the electric field strength relative to an estimated neural activation threshold were used to evaluate the stimulation strength and focality in specific brain regions of interest for these ECT and MST paradigms and various stimulus current amplitudes. RESULTS The standard ECT configurations and current amplitude of 800-900mA produced the strongest overall stimulation with median of 1.8-2.9 times neural activation threshold and more than 94% of the brain volume stimulated at suprathreshold level. All standard ECT electrode placements exposed the hippocampi to suprathreshold electric field, although there were differences across modalities with bilateral and right unilateral producing respectively the strongest and weakest hippocampal stimulation. MST stimulation is up to 9 times weaker compared to conventional ECT, resulting in direct activation of only 21% of the brain. Reducing the stimulus current amplitude can make ECT as focal as MST. CONCLUSIONS The relative differences in electric field strength may be a contributing factor for the cognitive sparing observed with right unilateral compared to bilateral ECT, and MST compared to right unilateral ECT. These simulations could help understand the mechanisms of seizure therapies and develop interventions with superior risk/benefit ratio.
Collapse
Affiliation(s)
- W H Lee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - S H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA; Department of Psychology & Neuroscience, Duke University, Durham, NC 27708, USA; Department of Psychiatry, Columbia University, New York, NY 10032, USA; National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - A F Laine
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - A V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA.
| |
Collapse
|
89
|
Advances in the Application of Electroconvulsive Therapy. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
90
|
Downar J, Blumberger DM, Daskalakis ZJ. The Neural Crossroads of Psychiatric Illness: An Emerging Target for Brain Stimulation. Trends Cogn Sci 2016; 20:107-120. [DOI: 10.1016/j.tics.2015.10.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/19/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
|
91
|
Blumberger DM, Hsu JH, Daskalakis ZJ. A Review of Brain Stimulation Treatments for Late-Life Depression. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2015; 2:413-421. [PMID: 27398288 PMCID: PMC4938011 DOI: 10.1007/s40501-015-0059-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Opinion Statement Recurrence, relapse and resistance to first-line therapies are common and pervasive issues in the treatment of depression in older adults. As a result, brain stimulation modalities are essential treatment options in this population. The majority of data for the effectiveness of brain stimulation modalities comes from electroconvulsive therapy (ECT) studies. Current ECT trials are focused on prolonging response after a successful course and mitigating the cognitive adverse effects. Newer forms of brain stimulation have emerged; unfortunately, as with most advances in medicine older adults have not been systematically included in clinical trials. Repetitive transcranial magnetic stimulation has demonstrated efficacy in younger adults and there is emerging data to support its use in late-life depression (LLD). It will be imperative that older adults be included in future transcranial direct current stimulation and magnetic seizure therapy clinical trials. Unclear efficacy results are a concern for both vagus nerve stimulation and deep brain stimulation.
Collapse
Affiliation(s)
- Daniel M. Blumberger
- Temerty Centre for Therapuetic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan H. Hsu
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapuetic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, 1001 Queen St. W., Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
92
|
Park HJ, Seol JH, Ku J, Kim S. Computational Study on the Thermal Effects of Implantable Magnetic Stimulation Based on Planar Coils. IEEE Trans Biomed Eng 2015; 63:158-67. [PMID: 26468905 DOI: 10.1109/tbme.2015.2490244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
GOAL Micromagnetic stimulation using coils sufficiently small to be implanted has been suggested as a potential method to overcome the limitations of electrical stimulation. We investigated the temperature increases in the brain implanted with planar coils. METHODS We conducted computational simulations on the thermal effects of implantable magnetic stimulation in a brain model using finite-element analysis, by varying geometric parameters of planar spiral coils, and repetitive stimulation pulse patterns. RESULTS It was revealed that the temperature increase in the brain can be controlled by a careful design of coils to implant. The coil diameter greater than 8 mm was required to induce a temperature rise in the brain of less than 1 °C. If the coil diameter was larger than 10 mm, the subsequent temperature rises in the brain tissue was maintained consistently at about 0.24 °C or lower. CONCLUSION Selection of the number of coil turns must rely on tradeoffs between the required current and voltage that the implanted source can generate, as the required voltage increases while the required current decreases with increasing number of coil turns. Additionally, the coil insulation with a thickness of a few micrometers was found to suppress the temperature rise in the brain effectively. SIGNIFICANCE Although these simulations employed only one threshold value of 10 V/m, which is rather on the lower end of stimulation threshold, the simulation results are expected to serve as guidelines for designing planar coils to be implanted in the brain for magnetic stimulation.
Collapse
|
93
|
Vaghefi E, Cai P, Fang F, Byblow WD, Stinear CM, Thompson B. MRI Guided Brain Stimulation without the Use of a Neuronavigation System. BIOMED RESEARCH INTERNATIONAL 2015; 2015:647510. [PMID: 26413537 PMCID: PMC4564628 DOI: 10.1155/2015/647510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/13/2014] [Accepted: 09/09/2014] [Indexed: 11/23/2022]
Abstract
A key issue in the field of noninvasive brain stimulation (NIBS) is the accurate localization of scalp positions that correspond to targeted cortical areas. The current gold standard is to combine structural and functional brain imaging with a commercially available "neuronavigation" system. However, neuronavigation systems are not commonplace outside of specialized research environments. Here we describe a technique that allows for the use of participant-specific functional and structural MRI data to guide NIBS without a neuronavigation system. Surface mesh representations of the head were generated using Brain Voyager and vectors linking key anatomical landmarks were drawn on the mesh. Our technique was then used to calculate the precise distances on the scalp corresponding to these vectors. These calculations were verified using actual measurements of the head and the technique was used to identify a scalp position corresponding to a brain area localized using functional MRI.
Collapse
Affiliation(s)
- Ehsan Vaghefi
- Department of Optometry and Vision Science, University of Auckland, Building 502, Level 4, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Peng Cai
- Department of Psychology, Peking University, Haidian Road, Haidian, Beijing 100871, China
| | - Fang Fang
- Department of Psychology, Peking University, Haidian Road, Haidian, Beijing 100871, China
| | - Winston D. Byblow
- Department of Sport and Exercise Science, University of Auckland, Symonds Street, Auckland 1023, New Zealand
| | - Cathy M. Stinear
- Department of Medicine, University of Auckland, Symonds Street, Auckland 1023, New Zealand
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland, Building 502, Level 4, 85 Park Road, Grafton, Auckland 1023, New Zealand
- School of Optometry and Vision Science, University of Waterloo, 200 Columbia Street W, Waterloo, ON, Canada N2L 3G1
| |
Collapse
|
94
|
Peterchev AV, Krystal AD, Rosa MA, Lisanby SH. Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology 2015; 40:2076-84. [PMID: 25920013 PMCID: PMC4613599 DOI: 10.1038/npp.2015.122] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/31/2015] [Accepted: 04/24/2015] [Indexed: 11/09/2022]
Abstract
Electroconvulsive therapy (ECT) at conventional current amplitudes (800-900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown. We titrated the amplitude of long stimulus trains (500 pulses) as a means of determining the minimum current amplitude required to induce a seizure with ECT (bilateral, right unilateral, bifrontal, and frontomedial electrode placements) and MST (round coil on vertex) in nonhuman primates. Furthermore, we investigated a novel method of predicting this amplitude-titrated seizure threshold (ST) by a non-convulsive measurement of motor threshold (MT) using single pulses delivered through the ECT electrodes or MST coil. Average STs were substantially lower than conventional pulse amplitudes (112-174 mA for ECT and 37.4% of maximum device amplitude for MST). ST was more variable in ECT than in MST. MT explained 63% of the ST variance and is hence the strongest known predictor of ST. These results indicate that seizures can be induced with less intense electric fields than conventional ECT that may be safer; efficacy and side effects should be evaluated in clinical studies. MT measurement could be a faster and safer alternative to empirical ST titration for ECT and MST.
Collapse
Affiliation(s)
- Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Moacyr A Rosa
- Institute for Advanced Research in Neurostimulation, São Paulo, Brazil
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| |
Collapse
|
95
|
Kim D, Jeong J, Jeong S, Kim S, Jun SC, Chung E. Validation of Computational Studies for Electrical Brain Stimulation With Phantom Head Experiments. Brain Stimul 2015. [PMID: 26209594 DOI: 10.1016/j.brs.2015.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Although computational studies of electrical brain stimulation (EBS) have received attention as a cost-effective tool, few studies have validated the technique, particularly in invasive cortical stimulation. OBJECTIVE In order to validate such studies, we used EBS to compare electric potential distributions generated by both numerical simulations and empirical measurements in three phantom head models (one-/three-layered spherical heads and MRI-based head). METHODS We constructed spherical phantom heads that consisted of one or three layers, and an anatomical, MRI-based phantom that consisted of three layers and represented the brain or brain/skull/scalp in order to perform both numerical simulations using the finite element method (FEM) and experimental measurements. Two stimulation electrodes (cathode and anode) were implanted in the phantoms to inject regulated input voltage, and the electric potential distributions induced were measured at various points located either on the surface or deep within the phantoms. RESULTS We observed that both the electric potential distributions from the numerical simulations and experiments behaved similarly and resulted in average relative differences of 5.4% (spherical phantom) and 10.3% (MRI-based phantom). CONCLUSIONS This study demonstrated that numerical simulation is reasonably consistent with actual experimental measurements; thus, because of its cost-effectiveness, EBS computational studies may be an attractive approach for necessary intensive/extensive studies.
Collapse
Affiliation(s)
- Donghyeon Kim
- School of Information and Communications, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 500-712, South Korea
| | - Jinmo Jeong
- School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Sangdo Jeong
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Sohee Kim
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea; School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Sung Chan Jun
- School of Information and Communications, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 500-712, South Korea.
| | - Euiheon Chung
- Department of Medical System Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea; School of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea.
| |
Collapse
|
96
|
|
97
|
Magnetic Seizure Therapy for Unipolar and Bipolar Depression: A Systematic Review. Neural Plast 2015; 2015:521398. [PMID: 26075100 PMCID: PMC4444586 DOI: 10.1155/2015/521398] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED Objective. Magnetic seizure therapy (MST) is a novel, experimental therapeutic intervention, which combines therapeutic aspects of electroconvulsive therapy (ECT) and transcranial magnetic stimulation, in order to achieve the efficacy of the former with the safety of the latter. MST might prove to be a valuable tool in the treatment of mood disorders, such as major depressive disorder (MDD) and bipolar disorder. Our aim is to review current literature on MST. Methods. OVID and MEDLINE databases were used to systematically search for clinical studies on MST. The terms "magnetic seizure therapy," "depression," and "bipolar" were employed. Results. Out of 74 studies, 8 met eligibility criteria. There was considerable variability in the methods employed and samples sizes were small, limiting the generalization of the results. All studies focused on depressive episodes, but few included patients with bipolar disorder. The studies found reported significant antidepressant effects, with remission rates ranging from 30% to 40%. No significant cognitive side effects related to MST were found, with a better cognitive profile when compared to ECT. CONCLUSION MST was effective in reducing depressive symptoms in mood disorders, with generally less side effects than ECT. No study focused on comparing MST to ECT on bipolar depression specifically.
Collapse
|
98
|
Metwally MK, Han SM, Kim TS. The effect of tissue anisotropy on the radial and tangential components of the electric field in transcranial direct current stimulation. Med Biol Eng Comput 2015; 53:1085-101. [PMID: 25940845 DOI: 10.1007/s11517-015-1301-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Abstract
Transcranial direct current stimulation (tDCS) is considered to be a promising technique for noninvasive brain stimulation and brain disease therapy. Recent studies have investigated the distribution of the electric field (EF) magnitude over gyri and sulci and the effect of tissue homogeneity with isotropic electrical conductivities. However, it is well known that the skull and white matter (WM) are highly anisotropic electrically, requiring investigations of their anisotropic effects on the magnitude and the directional components of the induced EF due to the high dependency between neuromodulation and the EF direction. In this study, we investigated the effects of the skull and WM anisotropy on the radial and tangential components of the EF via gyri-specific high-resolution finite element head models. For tDCS, three configurations were investigated: the conventional rectangular pad electrode, a 4(cathodes) +1(anode) ring configuration, and a bilateral configuration. The results showed that the skull anisotropy has a crucial influence on the distribution of the radial EF component. The affected cortical regions by the radial EF were reduced about 22 % when considering the skull anisotropy in comparison with the regions with the skull isotropy. On the other hand, the WM anisotropy strongly alters the EF directionality, especially within the sulci. The electric current tends to flow radially to the cortical surface with the WM anisotropy. This effect increases the affected cortical areas by the radial EF component within the sulcal regions. Our results suggest that one must examine the distribution of the EF components in tDCS, not just the magnitude of the EF alone.
Collapse
Affiliation(s)
- Mohamed K Metwally
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea
| | - Seung Moo Han
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea
| | - Tae-Seong Kim
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea.
| |
Collapse
|
99
|
Lee WH, Lisanby SH, Laine AF, Peterchev AV. Electric Field Model of Transcranial Electric Stimulation in Nonhuman Primates: Correspondence to Individual Motor Threshold. IEEE Trans Biomed Eng 2015; 62:2095-105. [PMID: 25910001 DOI: 10.1109/tbme.2015.2425406] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop a pipeline for realistic head models of nonhuman primates (NHPs) for simulations of noninvasive brain stimulation, and use these models together with empirical threshold measurements to demonstrate that the models capture individual anatomical variability. METHODS Based on structural MRI data, we created models of the electric field (E-field) induced by right unilateral (RUL) electroconvulsive therapy (ECT) in four rhesus macaques. Individual motor threshold (MT) was measured with transcranial electric stimulation (TES) administered through the RUL electrodes in the same subjects. RESULTS The interindividual anatomical differences resulted in 57% variation in median E-field strength in the brain at fixed stimulus current amplitude. Individualization of the stimulus current by MT reduced the E-field variation in the target motor area by 27%. There was significant correlation between the measured MT and the ratio of simulated electrode current and E-field strength (r(2) = 0.95, p = 0.026). Exploratory analysis revealed significant correlations of this ratio with anatomical parameters including of the superior electrode-to-cortex distance, vertex-to-cortex distance, and brain volume (r(2) > 0.96, p < 0.02). The neural activation threshold was estimated to be 0.45 ±0.07 V/cm for 0.2-ms stimulus pulse width. CONCLUSION These results suggest that our individual-specific NHP E-field models appropriately capture individual anatomical variability relevant to the dosing of TES/ECT. These findings are exploratory due to the small number of subjects. SIGNIFICANCE This study can contribute insight in NHP studies of ECT and other brain stimulation interventions, help link the results to clinical studies, and ultimately lead to more rational brain stimulation dosing paradigms.
Collapse
|
100
|
On the stimulation depth of transcranial magnetic stimulation coils. Clin Neurophysiol 2015; 126:843-4. [DOI: 10.1016/j.clinph.2014.06.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/27/2014] [Indexed: 11/24/2022]
|