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Kinjo M, Honda S, Wada M, Nakajima S, Koike S, Noda Y. A comparative study of the dorsolateral prefrontal cortex targeting approaches for transcranial magnetic stimulation treatment: Insights from the healthy control data. Brain Res 2024; 1838:148989. [PMID: 38723740 DOI: 10.1016/j.brainres.2024.148989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) is an established treatment for medication-resistant depression. Several targeting methods for the left DLPFC have been proposed including identification with resting-state functional magnetic resonance imaging (rs-fMRI) neuronavigation, stimulus coordinates based on structural MRI, or electroencephalography (EEG) F3 site by Beam F3 method. To date, neuroanatomical and neurofunctional differences among those approaches have not been investigated on healthy subjects, which are structurally and functionally unaffected by psychiatric disorders. This study aimed to compare the mean location, its dispersion, and its functional connectivity with the subgenual cingulate cortex (SGC), which is known to be associated with the therapeutic outcome in depression, of various approaches to target the DLPFC in healthy subjects. Fifty-seven healthy subjects underwent MRI scans to identify the stimulation site based on their resting-state functional connectivity and were measured their head size for targeting with Beam F3 method. In addition, we included two fixed stimulus coordinates over the DLPFC in the analysis, as recommended in previous studies. From the results, the rs-fMRI method had, as expected, more dispersed target sites across subjects and the greatest anticorrelation with the SGC, reflecting the known fact that personalized neuronavigation yields the greatest antidepressant effect. In contrast, the targets located by the other methods were relatively close together with less dispersion, and did not differ in anticorrelation with the SGC, implying their limitation of the therapeutic efficacy and possible interchangeability of them.
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Affiliation(s)
- Megumi Kinjo
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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2
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Zhao T, Guo H, Yang J, Cai A, Liu J, Zheng J, Xiao Y, Zhao P, Li Y, Luo X, Zhang X, Zhu R, Wang J, Wang F. Repetitive Transcranial Magnetic Stimulation Reversing Abnormal Brain Function in Mood Disorders with Early Life Stress: from preclinical models to clinical applications. Asian J Psychiatr 2024; 97:104092. [PMID: 38823081 DOI: 10.1016/j.ajp.2024.104092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Early life stress (ELS) significantly increases the risk of mood disorders and affects the neurodevelopment of the primary cortex. HYPOTHESIS Modulating the primary cortex through neural intervention can ameliorate the impact of ELS on brain development and consequently alleviate its effects on mood disorders. METHOD We induced the chronic unpredictable mild stress (CUMS) model in adolescent rats, followed by applying repetitive transcranial magnetic stimulation (rTMS) to their primary cortex in early adulthood. To assess the applicability of primary cortex rTMS in humans, we recruited individuals aged 17-25 with mood disorders who had experienced ELS and performed primary cortex rTMS on them. Functional magnetic resonance imaging (fMRI) and depression-related behavioral and clinical symptoms were conducted in both rats and human subjects before and after the rTMS. RESULTS In animals, fMRI analysis revealed increased activation in the primary cortex of CUMS rats and decrease subcortical activation. Following the intervention of primary cortex rTMS, the abnormal functional activity was reversed. Similarly, in mood disorders patients with ELS, increased activation in the primary cortex and decreased activation in the frontal cortex were observed. During rTMS intervention, similar neuroimaging improvements were noted, particularly decreased activation in the primary cortex. This suggests that targeted rTMS in the primary cortex can reverse the abnormal neuroimaging. CONCLUSION This cross-species translational study has identified the primary cortex as a key region in mood disorders patients with ELS. Targeting the primary cortex with rTMS can correct abnormal functional activity while improving symptoms. Our study provides translational evidence for therapeutics targeting the ELS factor of mood disorders patients.
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Affiliation(s)
- Tongtong Zhao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Huiling Guo
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China; School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, PR China
| | - Jingyu Yang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Aoling Cai
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, PR China; Changzhou Medical Center, Changzhou No.2 People's Hospital, Nanjing Medical University, Changzhou, PR China
| | - Juan Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Yao Xiao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Pengfei Zhao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Yifan Li
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, Jiangsu 210096, China
| | - Xiongjian Luo
- Department of Psychosomatics and Psychiatry, Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Nanjing, Jiangsu 210096, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, PR China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China
| | - Jie Wang
- Academy of Integrative Medicine, College of Integrative Medicine, Afffliated Third People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China; Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Xiangyang, Hubei, PR China; Institute of Neuroscience and Brain Diseases, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, PR China
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China; Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, PR China; Department of Mental Health, School of Public Health, Nanjing Medical University, Nanjing, PR China.
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3
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Zhao H, Jiang C, Zhao M, Ye Y, Yu L, Li Y, Luan H, Zhang S, Xu P, Chen X, Pan F, Shang D, Hu X, Jin K, Chen J, Mou T, Hu S, Fitzgibbon BM, Fitzgerald PB, Cash RFH, Che X, Huang M. Comparisons of Accelerated Continuous and Intermittent Theta Burst Stimulation for Treatment-Resistant Depression and Suicidal Ideation. Biol Psychiatry 2024; 96:26-33. [PMID: 38142717 DOI: 10.1016/j.biopsych.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Suicidal ideation is a substantial clinical challenge in treatment-resistant depression (TRD). Recent work demonstrated promising antidepressant effects in TRD patients with no or mild suicidal ideation using a specific protocol termed intermittent theta burst stimulation (iTBS). Here, we examined the clinical effects of accelerated schedules of iTBS and continuous TBS (cTBS) in patients with moderate to severe suicidal ideation. METHODS Patients with TRD and moderate to severe suicidal ideation (n = 44) were randomly assigned to receive accelerated iTBS or cTBS treatment. Treatments were delivered in 10 daily TBS sessions (1800 pulses/session) for 5 consecutive days (total of 90,000 pulses). Neuronavigation was employed to target accelerated iTBS and cTBS to the left and right dorsolateral prefrontal cortex (DLPFC), respectively. Clinical outcomes were evaluated in a 4-week follow-up period. RESULTS Accelerated cTBS was superior to iTBS in the management of suicidal ideation (pweek 1 = .027) and anxiety symptoms (pweek 1 = .01). Accelerated iTBS and cTBS were comparable in antidepressant effects (p < .001; accelerated cTBS: mean change at weeks 1, 3, 5 = 49.55%, 54.99%, 53.11%; accelerated iTBS: mean change at weeks 1, 3, 5 = 44.52%, 48.04%, 51.74%). No serious adverse events occurred during the trial. One patient withdrew due to hypomania. The most common adverse event was discomfort at the treatment site (22.73% in both groups). CONCLUSIONS These findings provide the first evidence that accelerated schedules of left DLPFC iTBS and right DLPFC cTBS are comparably effective in managing antidepressant symptoms and indicate that right DLPFC cTBS is potentially superior in reducing suicidal ideation and anxiety symptoms.
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Affiliation(s)
- Haoyang Zhao
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Chaonan Jiang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Miaomiao Zhao
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Yang Ye
- Centre for Cognition and Brain Disorders, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; TMS Centre, Deqing Hospital of Hangzhou Normal University, Hangzhou, China
| | - Liang Yu
- Department of Anesthesiology and Pain, Hang Zhou First People's Hospital, Hangzhou, China
| | - Ying Li
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Honglin Luan
- Department of Psychiatry, Wen Zhou Seventh People's Hospital, Wenzhou, China
| | - Shiyi Zhang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Pengfeng Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Xuanqiang Chen
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Fen Pan
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Desheng Shang
- Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohan Hu
- Department of Psychiatry, Wen Zhou Seventh People's Hospital, Wenzhou, China
| | - Kangyu Jin
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Jingkai Chen
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Tingting Mou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Bernadette M Fitzgibbon
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robin F H Cash
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia; Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xianwei Che
- Centre for Cognition and Brain Disorders, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; TMS Centre, Deqing Hospital of Hangzhou Normal University, Hangzhou, China.
| | - Manli Huang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China.
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Brown JC, Kweon J, Sharma P, Siddiqi SH, Isserles M, Ressler KJ. Critically Assessing the Unanswered Questions of How, Where, and When to Induce Plasticity in the Posttraumatic Stress Disorder Network with Transcranial Magnetic Stimulation. Biol Psychiatry 2024:S0006-3223(24)01390-8. [PMID: 38909668 DOI: 10.1016/j.biopsych.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
Extinction of traumatic memory, a primary treatment approach (termed exposure therapy) in post-traumatic stress disorder (PTSD), occurs through relearning and may be subserved at the molecular level by long-term potentiation (LTP) of relevant circuits. In parallel, repetitive transcranial magnetic stimulation (rTMS) is thought to work through LTP-like mechanisms and may provide a novel, safe, and effective treatment for PTSD. Our recent failed randomized controlled trial (1) emphasizes the necessity of correctly identifying cortical targets, directionality of TMS protocol, and role of memory activation. Here we provide a systematic review of TMS for PTSD to further identify how, where, and when TMS treatment should be delivered to alleviate PTSD symptoms. We conducted a systematic review of the literature searching for rTMS clinical trials involving PTSD patients and outcomes. We searched MEDLINE through October 25th, 2023 for "TMS and PTSD" and "transcranial magnetic stimulation and posttraumatic stress disorder." Thirty-one publications met our inclusion criteria (k=17 randomized controlled trials (RCTs), k=14 open label). RCT protocols were varied in TMS protocols, cortical TMS targets, and memory activation protocols. There was no clear superiority across protocols of low-frequency (k=5) vs. high-frequency protocols (k=6), or by stimulation location. Memory provocation or exposure protocols (k=7) appear to enhance response. Overall, TMS appears to be effective in treating PTSD symptoms across a variety of TMS frequencies, hemispheric target differences, and exposure protocols. Disparate protocols may be conceptually harmonized when viewed as potentiating proposed anxiolytic networks or suppressing anxiogenic networks.
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Affiliation(s)
- Joshua C Brown
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jamie Kweon
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Prayushi Sharma
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Shan H Siddiqi
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Moshe Isserles
- The Jerusalem Center for Mental Health, Jerusalem, Israel
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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5
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Lv T, Chen Y, Hou X, Qin R, Yang Z, Hu Z, Bai F. Anterior-temporal hippocampal network mechanisms of left angular gyrus-navigated rTMS for memory improvement in aMCI: A sham-controlled study. Behav Brain Res 2024; 471:115117. [PMID: 38908485 DOI: 10.1016/j.bbr.2024.115117] [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: 01/09/2024] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Neuro-navigated repetitive transcranial magnetic stimulation (rTMS) of the left angular gyrus has been broadly investigated for the treatment of amnestic mild cognitive impairment (aMCI). Although abnormalities in two hippocampal networks, the anterior-temporal (AT) and posterior-medial (PM) networks, are consistent with aMCI and are potential therapeutic targets for rTMS, the underlying mechanisms of the therapeutic effects of rTMS on hippocampal network connections remain unknown. Here, we assessed the impact of left angular gyrus rTMS on activity in these networks and explored whether the treatment response was due to the distance between the clinically applied target (the group average optimal site) and the personalized target in patients with aMCI. METHODS Sixty subjects clinically diagnosed with aMCI participated in this study after 20 sessions of sham-controlled rTMS targeting the left angular gyrus. Resting-state functional magnetic resonance imaging and neuropsychological assessments were performed before and after rTMS. Functional connectivity alterations in the PM and AT networks were assessed using seed-based functional connectivity analysis and two-factor repeated measures analysis of variance (ANOVA). We then computed the correlations between the functional connectivity changes and clinical rating scales. Finally, we examined whether the Euclidean distance between the clinically applied and personalized targets predicted the subsequent treatment response. RESULTS Compared with the sham group, the active rTMS group showed rTMS-induced deactivation of functional connectivity within the medial temporal lobe-AT network, with a negative correlation with episodic memory score changes. Moreover, the active rTMS lowers the interdependency of changes in the PM and AT networks. Finally, the Euclidean distance between the clinically applied and personalized target distances could predict subsequent network lever responses in the active rTMS group. CONCLUSIONS Neuro-navigated rTMS selectively modulates widespread functional connectivity abnormalities in the PM and AT hippocampal networks in aMCI patients, and the modulation of hippocampal-AT network connectivity can efficiently reverse memory deficits. The results also highlight the necessity of personalized targets for fMRI.
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Affiliation(s)
- Tingyu Lv
- Geriatric Medicine Center, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, China; Institute of Geriatric Medicine, Medical School of Nanjing University, Nanjing 210046, China; Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ya Chen
- Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinle Hou
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Ruomeng Qin
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Zhiyuan Yang
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Zheqi Hu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China
| | - Feng Bai
- Geriatric Medicine Center, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, China; Institute of Geriatric Medicine, Medical School of Nanjing University, Nanjing 210046, China; Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China; Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
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Briley PM, Webster L, Boutry C, Oh H, Auer DP, Liddle PF, Morriss R. Magnetic resonance imaging connectivity features associated with response to transcranial magnetic stimulation in major depressive disorder. Psychiatry Res Neuroimaging 2024; 342:111846. [PMID: 38908353 DOI: 10.1016/j.pscychresns.2024.111846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
Transcranial magnetic stimulation (TMS) is an FDA-approved neuromodulation treatment for major depressive disorder (MDD), thought to work by altering dysfunctional brain connectivity pathways, or by indirectly modulating the activity of subcortical brain regions. Clinical response to TMS remains highly variable, highlighting the need for baseline predictors of response and for understanding brain changes associated with response. This systematic review examined brain connectivity features, and changes in connectivity features, associated with clinical improvement following TMS in MDD. Forty-one studies met inclusion criteria, including 1097 people with MDD. Most studies delivered one of two types of TMS to left dorsolateral prefrontal cortex and measured connectivity using resting-state functional MRI. The subgenual anterior cingulate cortex was the most well-studied brain region, particularly its connectivity with the TMS target or with the "executive control network" of brain regions. There was marked heterogeneity in findings. There is a need for greater understanding of how cortical TMS modulates connectivity with, and the activity of, subcortical regions, and how these effects change within and across treatment sessions.
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Affiliation(s)
- P M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.
| | - L Webster
- Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - C Boutry
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - H Oh
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - D P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - P F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - R Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom; NIHR Mental Health (MindTech) Health Technology Collaboration, University of Nottingham, Nottingham, United Kingdom
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7
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Sun L, Zhao T, Liang X, Xia M, Li Q, Liao X, Gong G, Wang Q, Pang C, Yu Q, Bi Y, Chen P, Chen R, Chen Y, Chen T, Cheng J, Cheng Y, Cui Z, Dai Z, Deng Y, Ding Y, Dong Q, Duan D, Gao JH, Gong Q, Han Y, Han Z, Huang CC, Huang R, Huo R, Li L, Lin CP, Lin Q, Liu B, Liu C, Liu N, Liu Y, Liu Y, Lu J, Ma L, Men W, Qin S, Qiu J, Qiu S, Si T, Tan S, Tang Y, Tao S, Wang D, Wang F, Wang J, Wang P, Wang X, Wang Y, Wei D, Wu Y, Xie P, Xu X, Xu Y, Xu Z, Yang L, Yuan H, Zeng Z, Zhang H, Zhang X, Zhao G, Zheng Y, Zhong S, He Y. Functional connectome through the human life span. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.12.557193. [PMID: 37745373 PMCID: PMC10515818 DOI: 10.1101/2023.09.12.557193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
The lifespan growth of the functional connectome remains unknown. Here, we assemble task-free functional and structural magnetic resonance imaging data from 33,250 individuals aged 32 postmenstrual weeks to 80 years from 132 global sites. We report critical inflection points in the nonlinear growth curves of the global mean and variance of the connectome, peaking in the late fourth and late third decades of life, respectively. After constructing a fine-grained, lifespan-wide suite of system-level brain atlases, we show distinct maturation timelines for functional segregation within different systems. Lifespan growth of regional connectivity is organized along a primary-to-association cortical axis. These connectome-based normative models reveal substantial individual heterogeneities in functional brain networks in patients with autism spectrum disorder, major depressive disorder, and Alzheimer's disease. These findings elucidate the lifespan evolution of the functional connectome and can serve as a normative reference for quantifying individual variation in development, aging, and neuropsychiatric disorders.
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Affiliation(s)
- Lianglong Sun
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Tengda Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xinyuan Liang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Qiongling Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xuhong Liao
- School of Systems Science, Beijing Normal University, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Qian Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Chenxuan Pang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Qian Yu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yanchao Bi
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Pindong Chen
- Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Rui Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yuan Chen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Taolin Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zaixu Cui
- Chinese Institute for Brain Research, Beijing, China
| | - Zhengjia Dai
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yao Deng
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yuyin Ding
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Qi Dong
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Dingna Duan
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying Han
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Chu-Chung Huang
- Key Laboratory of Brain Functional Genomics (Ministry of Education), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Ruiwang Huang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ran Huo
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Lingjiang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Ching-Po Lin
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, China
- Department of Education and Research, Taipei City Hospital, Taipei, China
| | - Qixiang Lin
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Bangshan Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, China
| | - Chao Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ningyu Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Yong Liu
- Center for Artificial Intelligence in Medical Imaging, School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Jing Lu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Leilei Ma
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Weiwei Men
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Shaozheng Qin
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China
- Department of Psychology, Southwest University, Chongqing, China
| | - Shijun Qiu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Shuping Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Sha Tao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Ji’nan, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jiali Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Pan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
| | - Xiaoqin Wang
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China
- Department of Psychology, Southwest University, Chongqing, China
| | - Yanpei Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Dongtao Wei
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China
- Department of Psychology, Southwest University, Chongqing, China
| | - Yankun Wu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Peng Xie
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuehua Xu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zhilei Xu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Liyuan Yang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Zilong Zeng
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Haibo Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xi Zhang
- Department of Neurology, the Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Gai Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yanting Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Suyu Zhong
- Center for Artificial Intelligence in Medical Imaging, School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | | | | | | | | | | | | | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
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8
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Kim T, Lee SW, Lho SK, Moon SY, Kim M, Kwon JS. Neurocomputational model of compulsivity: deviating from an uncertain goal-directed system. Brain 2024; 147:2230-2244. [PMID: 38584499 PMCID: PMC11146420 DOI: 10.1093/brain/awae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Despite a theory that an imbalance in goal-directed versus habitual systems serve as building blocks of compulsions, research has yet to delineate how this occurs during arbitration between the two systems in obsessive-compulsive disorder. Inspired by a brain model in which the inferior frontal cortex selectively gates the putamen to guide goal-directed or habitual actions, this study aimed to examine whether disruptions in the arbitration process via the fronto-striatal circuit would underlie imbalanced decision-making and compulsions in patients. Thirty patients with obsessive-compulsive disorder [mean (standard deviation) age = 26.93 (6.23) years, 12 females (40%)] and 30 healthy controls [mean (standard deviation) age = 24.97 (4.72) years, 17 females (57%)] underwent functional MRI scans while performing the two-step Markov decision task, which was designed to dissociate goal-directed behaviour from habitual behaviour. We employed a neurocomputational model to account for an uncertainty-based arbitration process, in which a prefrontal arbitrator (i.e. inferior frontal gyrus) allocates behavioural control to a more reliable strategy by selectively gating the putamen. We analysed group differences in the neural estimates of uncertainty of each strategy. We also compared the psychophysiological interaction effects of system preference (goal-directed versus habitual) on fronto-striatal coupling between groups. We examined the correlation between compulsivity score and the neural activity and connectivity involved in the arbitration process. The computational model captured the subjects' preferences between the strategies. Compared with healthy controls, patients had a stronger preference for the habitual system (t = -2.88, P = 0.006), which was attributed to a more uncertain goal-directed system (t = 2.72, P = 0.009). Before the allocation of controls, patients exhibited hypoactivity in the inferior frontal gyrus compared with healthy controls when this region tracked the inverse of uncertainty (i.e. reliability) of goal-directed behaviour (P = 0.001, family-wise error rate corrected). When reorienting behaviours to reach specific goals, patients exhibited weaker right ipsilateral ventrolateral prefronto-putamen coupling than healthy controls (P = 0.001, family-wise error rate corrected). This hypoconnectivity was correlated with more severe compulsivity (r = -0.57, P = 0.002). Our findings suggest that the attenuated top-down control of the putamen by the prefrontal arbitrator underlies compulsivity in obsessive-compulsive disorder. Enhancing fronto-striatal connectivity may be a potential neurotherapeutic approach for compulsivity and adaptive decision-making.
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Affiliation(s)
- Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul 08826, Republic of Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Center for Neuroscience-inspired Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Sang Wan Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Center for Neuroscience-inspired Artificial Intelligence, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
- Kim Jaechul Graduate School of AI, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul 08826, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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9
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Yang J, Guo H, Cai A, Zheng J, Liu J, Xiao Y, Ren S, Sun D, Duan J, Zhao T, Tang J, Zhang X, Zhu R, Wang J, Wang F. Aberrant Hippocampal Development in Early-onset Mental Disorders and Promising Interventions: Evidence from a Translational Study. Neurosci Bull 2024; 40:683-694. [PMID: 38141109 PMCID: PMC11178726 DOI: 10.1007/s12264-023-01162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/01/2023] [Indexed: 12/24/2023] Open
Abstract
Early-onset mental disorders are associated with disrupted neurodevelopmental processes during adolescence. The methylazoxymethanol acetate (MAM) animal model, in which disruption in neurodevelopmental processes is induced, mimics the abnormal neurodevelopment associated with early-onset mental disorders from an etiological perspective. We conducted longitudinal structural magnetic resonance imaging (MRI) scans during childhood, adolescence, and adulthood in MAM rats to identify specific brain regions and critical windows for intervention. Then, the effect of repetitive transcranial magnetic stimulation (rTMS) intervention on the target brain region during the critical window was investigated. In addition, the efficacy of this intervention paradigm was tested in a group of adolescent patients with early-onset mental disorders (diagnosed with major depressive disorder or bipolar disorder) to evaluate its clinical translational potential. The results demonstrated that, compared to the control group, the MAM rats exhibited significantly lower striatal volume from childhood to adulthood (all P <0.001). In contrast, the volume of the hippocampus did not show significant differences during childhood (P >0.05) but was significantly lower than the control group from adolescence to adulthood (both P <0.001). Subsequently, rTMS was applied to the occipital cortex, which is anatomically connected to the hippocampus, in the MAM models during adolescence. The MAM-rTMS group showed a significant increase in hippocampal volume compared to the MAM-sham group (P <0.01), while the volume of the striatum remained unchanged (P >0.05). In the clinical trial, adolescents with early-onset mental disorders showed a significant increase in hippocampal volume after rTMS treatment compared to baseline (P <0.01), and these volumetric changes were associated with improvement in depressive symptoms (r = - 0.524, P = 0.018). These findings highlight the potential of targeting aberrant hippocampal development during adolescence as a viable intervention for early-onset mental disorders with neurodevelopmental etiology as well as the promise of rTMS as a therapeutic approach for mitigating aberrant neurodevelopmental processes and alleviating clinical symptoms.
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Affiliation(s)
- Jingyu Yang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Huiling Guo
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
- School of Biomedical Engineering and Informatics, Nanjing, Medical University, Nanjing, 211166, China
| | - Aoling Cai
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
- School of Biomedical Engineering and Informatics, Nanjing, Medical University, Nanjing, 211166, China
- The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Juan Liu
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Yao Xiao
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Sihua Ren
- Department of Radiology, First Hospital of China Medical University, Shenyang, 110002, China
| | - Dandan Sun
- Department of Cardiac Function, The People's Hospital of China Medical University and the People's Hospital of Liaoning Province, Shenyang, 110067, China
| | - Jia Duan
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Tongtong Zhao
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Jingwei Tang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing, Medical University, Nanjing, 211166, China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430064, China.
- Institute of Neuroscience and Brain Diseases; Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China.
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029, China.
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10
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Ge Q, Lock M, Yang X, Ding Y, Yue J, Zhao N, Hu YS, Zhang Y, Yao M, Zang YF. Utilizing fMRI to Guide TMS Targets: the Reliability and Sensitivity of fMRI Metrics at 3 T and 1.5 T. Neuroinformatics 2024:10.1007/s12021-024-09667-5. [PMID: 38780699 DOI: 10.1007/s12021-024-09667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
US Food and Drug Administration (FDA) cleared a Transcranial Magnetic Stimulation (TMS) system with functional Magnetic Resonance Imaging-guided (fMRI) individualized treatment protocol for major depressive disorder, which employs resting state-fMRI (RS-fMRI) functional connectivity (FC) to pinpoint the target individually to increase the accuracy and effeteness of the stimulation. Furthermore, task activation-guided TMS, as well as the use of RS-fMRI local metrics for targeted the specific abnormal brain regions, are considered a precise scheme for TMS targeting. Since 1.5 T MRI is more available in hospitals, systematic evaluation of the test-retest reliability and sensitivity of fMRI metrics on 1.5 T and 3 T MRI may provide reference for the application of fMRI-guided individualized-precise TMS stimulation. Twenty participants underwent three RS-fMRI scans and one scan of finger-tapping task fMRI with self-initiated (SI) and visual-guided (VG) conditions at both 3 T and 1.5 T. Then the location reliability derived by FC (with three seed regions) and peak activation were assessed by intra-individual distance. The test-retest reliability and sensitivity of five RS-fMRI local metrics were evaluated using intra-class correlation and effect size, separately. The intra-individual distance of peak activation location between 1.5 T and 3 T was 15.8 mm and 19 mm for two conditions, respectively. The intra-individual distance for the FC derived targets at 1.5 T was 9.6-31.2 mm, compared to that of 3 T (7.6-31.1 mm). The test-retest reliability and sensitivity of RS-fMRI local metrics showed similar trends on 1.5 T and 3 T. These findings hasten the application of fMRI-guided individualized TMS treatment in clinical practice.
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Affiliation(s)
- Qiu Ge
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Matthew Lock
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Xue Yang
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Yuejiao Ding
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Juan Yue
- Hangzhou Normal University Affiliated Deqing Hospital, TMS Center, Zhejiang Province, Hangzhou, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China
- Institute of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Yun-Song Hu
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China
| | | | - Minliang Yao
- Hangzhou Normal University Affiliated Deqing Hospital, TMS Center, Zhejiang Province, Hangzhou, China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Zhejiang, Hangzhou, China.
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Zhejiang, Hangzhou, China.
- Institute of Psychological Sciences, Hangzhou Normal University, Zhejiang, Hangzhou, China.
- Hangzhou Normal University Affiliated Deqing Hospital, TMS Center, Zhejiang Province, Hangzhou, China.
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11
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Cerins A, Thomas EHX, Barbour T, Taylor JJ, Siddiqi SH, Trapp N, McGirr A, Caulfield KA, Brown JC, Chen L. A new angle on transcranial magnetic stimulation coil orientation: A targeted narrative review. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00120-4. [PMID: 38729243 DOI: 10.1016/j.bpsc.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
Transcranial magnetic stimulation (TMS) is used to treat several neuropsychiatric disorders including depression, where it is effective in approximately half of patients for whom pharmacological approaches have failed. Treatment response is related to stimulation parameters such as the stimulation frequency, pattern, intensity, location, total number of pulses and sessions applied, as well as target brain network engagement. One critical but underexplored component of the stimulation procedure is the orientation or yaw angle of the commonly used figure-of-eight TMS coil, which is known to impact neuronal response to TMS. However, coil orientation has remained largely unchanged since TMS was first used to treat depression and continues to be based on motor cortex anatomy which may not be optimal for the dorsolateral prefrontal cortex treatment site. This targeted narrative review evaluates experimental, clinical, and computational evidence indicating that optimizing coil orientation may potentially improve TMS treatment outcomes. The properties of the electric field induced by TMS, the changes to this field caused by the differing conductivities of head tissues, and the interaction between coil orientation and the underlying cortical anatomy are summarized. We describe evidence that the magnitude and site of cortical activation, surrogate markers of TMS dosing and brain network targeting considered central in clinical response to TMS, are influenced by coil orientation. We suggest that coil orientation should be considered when applying therapeutic TMS and propose several approaches to optimizing this potentially important treatment parameter.
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Affiliation(s)
- Andris Cerins
- Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Elizabeth H X Thomas
- Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tracy Barbour
- Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph J Taylor
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Trapp
- University of Iowa Department of Psychiatry, Carver College of Medicine, Iowa City, Iowa, USA; Iowa Neuroscience Institute, Iowa City, Iowa, USA
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kevin A Caulfield
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua C Brown
- Brain Stimulation Mechanisms Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo Chen
- Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
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12
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Ganesan S, Misaki M, Zalesky A, Tsuchiyagaito A. Functional brain network dynamics of brooding in depression: insights from real-time fMRI neurofeedback. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.05.24306889. [PMID: 38766116 PMCID: PMC11100839 DOI: 10.1101/2024.05.05.24306889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Brooding is a critical symptom and prognostic factor of major depressive disorder (MDD), which involves passively dwelling on self-referential dysphoria and related abstractions. The neurobiology of brooding remains under characterized. We aimed to elucidate neural dynamics underlying brooding, and explore their responses to neurofeedback intervention in MDD. Methods We investigated functional MRI (fMRI) dynamic functional network connectivity (dFNC) in 36 MDD subjects and 26 healthy controls (HCs) during rest and brooding. Rest was measured before and after fMRI neurofeedback (MDD-active/sham: n=18/18, HC-active/sham: n=13/13). Baseline brooding severity was recorded using Ruminative Response Scale - Brooding subscale (RRS-B). Results Four recurrent dFNC states were identified. Measures of time spent were not significantly different between MDD and HC for any of these states during brooding or rest. RRS-B scores in MDD showed significant negative correlation with measures of time spent in dFNC state 3 during brooding (r=-0.5, p= 1.7E-3, FDR-significant). This state comprises strong connections spanning several brain systems involved in sensory, attentional and cognitive processing. Time spent in this anti-brooding dFNC state significantly increased following neurofeedback only in the MDD active group (z=-2.09, p=0.037). Limitations The sample size was small and imbalanced between groups. Brooding condition was not examined post-neurofeedback. Conclusion We identified a densely connected anti-brooding dFNC brain state in MDD. MDD subjects spent significantly longer time in this state after active neurofeedback intervention, highlighting neurofeedback's potential for modulating dysfunctional brain dynamics to treat MDD.
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Affiliation(s)
- Saampras Ganesan
- Department of Psychiatry, Melbourne Medical School, Carlton, Victoria 3053, Australia
- Department of Biomedical Engineering, The University of Melbourne, Carlton, Victoria 3053, Australia
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health and Natural Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Medical School, Carlton, Victoria 3053, Australia
- Department of Biomedical Engineering, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health and Natural Sciences, The University of Tulsa, Tulsa, OK, USA
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
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13
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Mehta DD, Siddiqui S, Ward HB, Steele VR, Pearlson GD, George TP. Functional and structural effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations in schizophrenia: A systematic review. Schizophr Res 2024; 267:86-98. [PMID: 38531161 DOI: 10.1016/j.schres.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) are a disabling symptom for people with schizophrenia (SCZ), and do not always respond to antipsychotics. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for medication-refractory AVH, though the underlying neural mechanisms by which rTMS produces these effects remain unclear. This systematic review evaluated the structural and functional impact of rTMS for AVH in SCZ, and its association with clinical outcomes. METHODS A systematic search was conducted in Medline, PsychINFO, and PubMed using terms for four key concepts: AVH, SCZ, rTMS, neuroimaging. Using PRISMA guidelines, 18 studies were identified that collected neuroimaging data of an rTMS intervention for AVH in SCZ. Risk of bias assessments was conducted. RESULTS Low frequency (<5 Hz) rTMS targeting left hemispheric language processing regions may normalize brain abnormalities in AVH patients at structural, functional, electrophysiological, and topological levels, with concurrent symptom improvement. Amelioration of aberrant neural activity in frontotemporal networks associated with speech and auditory processing was commonly observed, as well as in cerebellar and emotion regulation regions. Neuroimaging analyses identified neural substrates with direct correlations to post-rTMS AVH severity, propounding their use as therapeutic targets. DISCUSSION Combined rTMS-neuroimaging highlights the multidimensional alterations of rTMS on brain activity and structure in treatment-resistant AVH, which may be used to develop more efficacious therapies. Larger randomized, sham-controlled studies are needed. Future studies should explore alternate stimulation targets, investigate the neural effects of high-frequency rTMS and evaluate long-term neuroimaging outcomes.
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Affiliation(s)
- Dhvani D Mehta
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Salsabil Siddiqui
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Heather B Ward
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Vaughn R Steele
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Godfrey D Pearlson
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Tony P George
- Institute of Medical Sciences, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Vanderbilt University, Nashville, TN, USA; Hartford Hospital and Department of Psychiatry and Behavioural Sciences, Yale University, New Haven, CT, USA; Department of Psychiatry, University of Toronto, Canada; Addictions Division and Institute for Mental Health Policy and Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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14
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Hermosillo RJM, Moore LA, Feczko E, Miranda-Domínguez Ó, Pines A, Dworetsky A, Conan G, Mooney MA, Randolph A, Graham A, Adeyemo B, Earl E, Perrone A, Carrasco CM, Uriarte-Lopez J, Snider K, Doyle O, Cordova M, Koirala S, Grimsrud GJ, Byington N, Nelson SM, Gratton C, Petersen S, Feldstein Ewing SW, Nagel BJ, Dosenbach NUF, Satterthwaite TD, Fair DA. A precision functional atlas of personalized network topography and probabilities. Nat Neurosci 2024; 27:1000-1013. [PMID: 38532024 PMCID: PMC11089006 DOI: 10.1038/s41593-024-01596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
Although the general location of functional neural networks is similar across individuals, there is vast person-to-person topographic variability. To capture this, we implemented precision brain mapping functional magnetic resonance imaging methods to establish an open-source, method-flexible set of precision functional network atlases-the Masonic Institute for the Developing Brain (MIDB) Precision Brain Atlas. This atlas is an evolving resource comprising 53,273 individual-specific network maps, from more than 9,900 individuals, across ages and cohorts, including the Adolescent Brain Cognitive Development study, the Developmental Human Connectome Project and others. We also generated probabilistic network maps across multiple ages and integration zones (using a new overlapping mapping technique, Overlapping MultiNetwork Imaging). Using regions of high network invariance improved the reproducibility of executive function statistical maps in brain-wide associations compared to group average-based parcellations. Finally, we provide a potential use case for probabilistic maps for targeted neuromodulation. The atlas is expandable to alternative datasets with an online interface encouraging the scientific community to explore and contribute to understanding the human brain function more precisely.
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Affiliation(s)
- Robert J M Hermosillo
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Lucille A Moore
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Óscar Miranda-Domínguez
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Adam Pines
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA, USA
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ally Dworetsky
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Gregory Conan
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Michael A Mooney
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
- Center for Mental Health Innovation, Oregon Health and Science University, Portland, OR, USA
| | - Anita Randolph
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Babatunde Adeyemo
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Earl
- Data Science and Sharing Team, National Institute of Mental Health, Bethesda, MD, USA
| | - Anders Perrone
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Cristian Morales Carrasco
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Kathy Snider
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Olivia Doyle
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Michaela Cordova
- Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, University of California San Diego, San Diego, CA, USA
| | - Sanju Koirala
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Gracie J Grimsrud
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Nora Byington
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Steven M Nelson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Caterina Gratton
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychology, Florida State University, Tallahassee, FL, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven Petersen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Nico U F Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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15
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Siddiqi SH, Klingbeil J, Webler R, Kratter IH, Blumberger DM, Fox MD, George MS, Grafman JH, Pascual-Leone A, Pines AR, Richardson RM, Talati P, Vila-Rodriguez F, Downar J, Hershey T, Black KJ. Causal network localization of brain stimulation targets for trait anxiety. RESEARCH SQUARE 2024:rs.3.rs-4221074. [PMID: 38659844 PMCID: PMC11042390 DOI: 10.21203/rs.3.rs-4221074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) can treat some neuropsychiatric disorders, but there is no consensus approach for identifying new targets. We localized causal circuit-based targets for anxiety that converged across multiple natural experiments. Lesions (n=451) and TMS sites (n=111) that modify anxiety mapped to a common normative brain circuit (r=0.68, p=0.01). In an independent dataset (n=300), individualized TMS site connectivity to this circuit predicted anxiety change (p=0.02). Subthalamic DBS sites overlapping the circuit caused more anxiety (n=74, p=0.006), thus demonstrating a network-level effect, as the circuit was derived without any subthalamic sites. The circuit was specific to trait versus state anxiety in datasets that measured both (p=0.003). Broadly, this illustrates a pathway for discovering novel circuit-based targets across neuropsychiatric disorders.
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Affiliation(s)
- Shan H. Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | | | - Ryan Webler
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Hospital
| | - Jordan H. Grafman
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Andrew R. Pines
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Pratik Talati
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry and School of Biomedical Engineering, University of British Columbia
| | | | - Tamara Hershey
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
| | - Kevin J. Black
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
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16
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Ngoy A, Tang VM, Xiao K, Blumberger DM, George TP, Gowin JL, Le Foll B, Sloan ME. Neuromodulation for Cannabis Use: A Scoping Review. Brain Sci 2024; 14:356. [PMID: 38672008 PMCID: PMC11048669 DOI: 10.3390/brainsci14040356] [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: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
This scoping review explores the use of neuromodulation techniques in individuals with cannabis use. Our goal was to determine whether cannabis use alters cortical excitation and inhibition in the context of neuromodulation and to determine whether neuromodulation affects craving and cannabis use patterns. A systematic search was conducted using PubMed, OVID Medline, and PsycINFO from inception to 20 December 2022. Our review identified ten relevant studies, eight of which used Transcranial Magnetic Stimulation (TMS), while two employed Transcranial Direct Current Stimulation (tDCS). Findings from TMS studies suggest that cannabis users exhibit altered cortical inhibition, with decreased short interval intracortical inhibition (SICI) compared to non-users. Single sessions of rTMS did not have any impact on cannabis craving. By contrast, two studies found that multiple sessions of rTMS reduced cannabis use, but these changes did not meet the threshold for statistical significance and both studies were limited by small sample sizes. The two included tDCS studies found contradictory results, with one showing reduced cannabis craving with active treatment and another showing no effect of active treatment on craving compared to sham. Future studies should further explore the effects of multiple treatment sessions and different neuromodulation modalities.
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Affiliation(s)
- Anthony Ngoy
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Victor M. Tang
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Kebin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Joshua L. Gowin
- Departments of Radiology and Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON M1C 1A4, Canada
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17
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Muratore AF, Foerde K, Lloyd EC, Touzeau C, Uniacke B, Aw N, Semanek D, Wang Y, Walsh BT, Attia E, Posner J, Steinglass JE. Reduced dorsal fronto-striatal connectivity at rest in anorexia nervosa. Psychol Med 2024:1-10. [PMID: 38497102 DOI: 10.1017/s003329172400031x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric illness that remains difficult to treat. Elucidating the neural mechanisms of AN is necessary to identify novel treatment targets and improve outcomes. A growing body of literature points to a role for dorsal fronto-striatal circuitry in the pathophysiology of AN, with increasing evidence of abnormal task-based fMRI activation within this network among patients with AN. Whether these abnormalities are present at rest and reflect fundamental differences in brain organization is unclear. METHODS The current study combined resting-state fMRI data from patients with AN (n = 89) and healthy controls (HC; n = 92) across four studies, removing site effects using ComBat harmonization. First, the a priori hypothesis that dorsal fronto-striatal connectivity strength - specifically between the anterior caudate and dlPFC - differed between patients and HC was tested using seed-based functional connectivity analysis with small-volume correction. To assess specificity of effects, exploratory analyses examined anterior caudate whole-brain connectivity, amplitude of low-frequency fluctuations (ALFF), and node centrality. RESULTS Compared to HC, patients showed significantly reduced right, but not left, anterior caudate-dlPFC connectivity (p = 0.002) in small-volume corrected analyses. Whole-brain analyses also identified reduced connectivity between the right anterior caudate and left superior frontal and middle frontal gyri (p = 0.028) and increased connectivity between the right anterior caudate and right occipital cortex (p = 0.038). No group differences were found in analyses of anterior caudate ALFF and node centrality. CONCLUSIONS Decreased coupling of dorsal fronto-striatal regions indicates that circuit-based abnormalities persist at rest and suggests this network may be a potential treatment target.
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Affiliation(s)
- Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Karin Foerde
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - E Caitlin Lloyd
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Touzeau
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Natalie Aw
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - David Semanek
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Yun Wang
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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18
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Huang L, Li Q, He D, Cheng Z, Zhang H, Shen W, Zhan L, Zhang J, Hao Z, Ding Q. Modulatory effects of aerobic training on the degree centrality of brain functional activity in subthreshold depression. Brain Res 2024; 1827:148767. [PMID: 38224827 DOI: 10.1016/j.brainres.2024.148767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Aerobic training has been shown to effectively prevent the progression of depressive symptoms from subthreshold depression (StD) to major depressive disorder (MDD), and understanding how aerobic training promotes changes in neuroplasticity is essential to comprehending its antidepressant effects. Few studies, however, have quantified the alterations in spontaneous brain activity before and after aerobic training for StD. METHODS Participants included 44 individuals with StD and 34 healthy controls (HCs). Both groups underwent moderate aerobic training for eight weeks, and resting state functional magnetic resonance imaging (rs-fMRI) data were collected before and after training. The degree centrality (DC) changes between the two groups and the DC changes in each group before and after training were quantified. RESULTS The rs-fMRI results showed that compared with the HCs, the DC values of the StD group in the orbital region of the left inferior frontal gyrus significantly depreciated at baseline. After aerobic training, the results of the follow-up examination revealed no significant difference in the DC values between the two groups. In addition, compared with baseline, the StD group exhibited an significant decrease in the DC values of the left dorsolateral superior frontal gyrus; while the HCs group exhibited an significant decrease in the DC values of the left thalamus. No statistically significant connection was seen between changes in DC values and psychological scale scores in the StD group. CONCLUSIONS Our findings suggest that regular aerobic training can enhance brain plasticity in StD. In addition, we demonstrated that DC is a relevant and accessible method for evaluating the functional plasticity of the brain induced by aerobic training in StD.
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Affiliation(s)
- Lina Huang
- Department of Radiology, Changshu Hospital Affiliated to Nantong University, Jiangsu, China
| | - Qin Li
- Department of Radiology, Changshu Hospital Affiliated to Nantong University, Jiangsu, China
| | - Di He
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Zhixiang Cheng
- School of Information Science and Engineering, Dalian Polytechnic University, Dalian 116030, Liaoning, China
| | - Hongqiang Zhang
- Department of Radiology, Changshu Hospital Affiliated to Nantong University, Jiangsu, China
| | - Wenbin Shen
- Department of Radiology, Changshu Hospital Affiliated to Nantong University, Jiangsu, China
| | - Linlin Zhan
- School of Western Studies, Heilongjiang University, Harbin, China
| | - Jun Zhang
- Department of Psychiatry, Changshu Third People's Hospital, Changshu, Jiangsu, China
| | - Zeqi Hao
- School of Psychology, Zhejiang Normal University, Jinhua, China.
| | - Qingguo Ding
- Department of Radiology, Changshu Hospital Affiliated to Nantong University, Jiangsu, China.
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19
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Cash RFH, Zalesky A. Personalized and Circuit-Based Transcranial Magnetic Stimulation: Evidence, Controversies, and Opportunities. Biol Psychiatry 2024; 95:510-522. [PMID: 38040047 DOI: 10.1016/j.biopsych.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
The development of neuroimaging methodologies to map brain connectivity has transformed our understanding of psychiatric disorders, the distributed effects of brain stimulation, and how transcranial magnetic stimulation can be best employed to target and ameliorate psychiatric symptoms. In parallel, neuroimaging research has revealed that higher-order brain regions such as the prefrontal cortex, which represent the most common therapeutic brain stimulation targets for psychiatric disorders, show some of the highest levels of interindividual variation in brain connectivity. These findings provide the rationale for personalized target site selection based on person-specific brain network architecture. Recent advances have made it possible to determine reproducible personalized targets with millimeter precision in clinically tractable acquisition times. These advances enable the potential advantages of spatially personalized transcranial magnetic stimulation targeting to be evaluated and translated to basic and clinical applications. In this review, we outline the motivation for target site personalization, preliminary support (mostly in depression), convergent evidence from other brain stimulation modalities, and generalizability beyond depression and the prefrontal cortex. We end by detailing methodological recommendations, controversies, and notable alternatives. Overall, while this research area appears highly promising, the value of personalized targeting remains unclear, and dedicated large prospective randomized clinical trials using validated methodology are critical.
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Affiliation(s)
- Robin F H Cash
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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20
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Baldi S, Schuhmann T, Goossens L, Schruers KRJ. Individualized, connectome-based, non-invasive stimulation of OCD deep-brain targets: A proof-of-concept. Neuroimage 2024; 288:120527. [PMID: 38286272 DOI: 10.1016/j.neuroimage.2024.120527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/09/2023] [Accepted: 01/26/2024] [Indexed: 01/31/2024] Open
Abstract
Treatment-resistant obsessive-compulsive disorder (OCD) generally improves with deep-brain stimulation (DBS), thought to modulate neural activity at both the implantation site and in connected brain regions. However, its invasive nature, side-effects, and lack of customization, make non-invasive treatments preferable. Harnessing the established remote effects of cortical transcranial magnetic stimulation (TMS), connectivity-based approaches have emerged for depression that aim at influencing distant regions connected to the stimulation site. We here investigated whether effective OCD DBS targets (here subthalamic nucleus [STN] and nucleus accumbens [NAc]) could be modulated non-invasively with TMS. In a proof-of-concept study with nine healthy individuals, we used 7T magnetic resonance imaging (MRI) and probabilistic tractography to reconstruct the fiber tracts traversing manually segmented STN/NAc. Two TMS targets were individually selected based on the strength of their structural connectivity to either the STN, or both the STN and NAc. In a sham-controlled, within-subject cross-over design, TMS was administered over the personalized targets, located around the precentral and middle frontal gyrus. Resting-state functional 3T MRI was acquired before, and at 5 and 25 min after stimulation to investigate TMS-induced changes in the functional connectivity of the STN and NAc with other regions of the brain. Static and dynamic seed-to-voxel correlation analyses were conducted. TMS over both targets was able to modulate the functional connectivity of the STN and NAc, engaging both overlapping and distinct regions, and unfolding following different temporal dynamics. Given the relevance of the engaged connected regions to OCD pathology, we argue that a personalized, connectivity-based procedure is worth investigating as potential treatment for refractory OCD.
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Affiliation(s)
- Samantha Baldi
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Teresa Schuhmann
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Maastricht Brain Imaging Centre, Maastricht, the Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Koen R J Schruers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
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21
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Mehta DD, Praecht A, Ward HB, Sanches M, Sorkhou M, Tang VM, Steele VR, Hanlon CA, George TP. A systematic review and meta-analysis of neuromodulation therapies for substance use disorders. Neuropsychopharmacology 2024; 49:649-680. [PMID: 38086901 PMCID: PMC10876556 DOI: 10.1038/s41386-023-01776-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.
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Affiliation(s)
- Dhvani D Mehta
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Angela Praecht
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Heather B Ward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Maryam Sorkhou
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victor M Tang
- Addictions Division, CAMH, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vaughn R Steele
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Tony P George
- Addictions Division, CAMH, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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22
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Zhang Y, Tang N, Lei L, Lv R, Zhang Y, Liu N, Chen H, Cai M, Wang H. Efficacy of functional magnetic resonance imaging-guided personalized repetitive transcranial magnetic stimulation (fMRI-rTMS) in depressive patients with emotional blunting: study protocol for a randomized controlled trial. Trials 2024; 25:134. [PMID: 38383418 PMCID: PMC10880253 DOI: 10.1186/s13063-024-07976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Emotional blunting is a symptom that has always been present in depressed patients. Repetitive transcranial magnetic stimulation (rTMS) is a safe and effective supplementary therapy for treating depression. However, the effectiveness and brain imaging processes of functional magnetic resonance imaging-guided personalized rTMS (fMRI-rTMS) in the treatment of depression with emotional blunting have not been observed in randomized controlled trials. METHODS This study is a randomized, controlled, double-blind, and single-center clinical trial in which 80 eligible depressed patients with emotional blunting will be randomly assigned to two groups: a functional magnetic resonance imaging-guided personalized rTMS (fMRI-rTMS) group and a control group. Individuals in the fMRI-rTMS group (n = 40) will receive high-frequency rTMS (10 Hz, 120% MT). The main target of stimulation will be the area most relevant to the functional connectivity of the right medial prefrontal cortex (mPFC) and amygdala. The control group (n = 40) will receive sham stimulation, with a coil flipped to 90 degrees relative to the vertical scalp. All patients will receive 15 consecutive days of treatment, with each session lasting half an hour per day, followed by 8 weeks of follow-up. The primary outcome is the comparison of Oxford Depression Questionnaire (ODQ) scores between these two groups at different time points. The secondary outcomes include evaluating other clinical scales and assessing the differences in brain imaging changes between the two groups before and after treatment. DISCUSSION This trial aims to examine the effects of functional magnetic resonance imaging-guided personalized rTMS (fMRI-rTMS) intervention on depressed patients experiencing emotional blunting and to elucidate the potential mechanism behind it. The results will provide new evidence for using fMRI-rTMS in treating depression with emotional blunting in the future. TRIAL REGISTRATION ClinicalTrials.gov INCT05555940. Registered on 13 September 2022 at http://clinicaltrials.gov .
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Affiliation(s)
- Yuyu Zhang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of Psychiatry, the 907th Hospital of the PLA Joint Logistics Support Force, Nanping, Fujian, China
| | - Lei Lei
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Runxin Lv
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yaochi Zhang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Nian Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Haixia Chen
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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23
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Cheng J, Hu H, Ju Y, Liu J, Wang M, Liu B, Zhang Y. Gut microbiota-derived short-chain fatty acids and depression: deep insight into biological mechanisms and potential applications. Gen Psychiatr 2024; 37:e101374. [PMID: 38390241 PMCID: PMC10882305 DOI: 10.1136/gpsych-2023-101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/25/2023] [Indexed: 02/24/2024] Open
Abstract
The gut microbiota is a complex and dynamic ecosystem known as the 'second brain'. Composing the microbiota-gut-brain axis, the gut microbiota and its metabolites regulate the central nervous system through neural, endocrine and immune pathways to ensure the normal functioning of the organism, tuning individuals' health and disease status. Short-chain fatty acids (SCFAs), the main bioactive metabolites of the gut microbiota, are involved in several neuropsychiatric disorders, including depression. SCFAs have essential effects on each component of the microbiota-gut-brain axis in depression. In the present review, the roles of major SCFAs (acetate, propionate and butyrate) in the pathophysiology of depression are summarised with respect to chronic cerebral hypoperfusion, neuroinflammation, host epigenome and neuroendocrine alterations. Concluding remarks on the biological mechanisms related to gut microbiota will hopefully address the clinical value of microbiota-related treatments for depression.
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Affiliation(s)
- Junzhe Cheng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hongkun Hu
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yumeng Ju
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Jin Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Mi Wang
- Department of Mental Health Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Bangshan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Yan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
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24
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Cao Z, Xiao X, Xie C, Wei L, Yang Y, Zhu C. Personalized connectivity-based network targeting model of transcranial magnetic stimulation for treatment of psychiatric disorders: computational feasibility and reproducibility. Front Psychiatry 2024; 15:1341908. [PMID: 38419897 PMCID: PMC10899497 DOI: 10.3389/fpsyt.2024.1341908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating psychiatric disorders; however, the variability in treatment efficacy among individuals underscores the need for further improvement. Growing evidence has shown that TMS induces a broad network modulatory effect, and its effectiveness may rely on accurate modulation of the pathological network specific to each disorder. Therefore, determining the optimal TMS coil setting that will engage the functional pathway delivering the stimulation is crucial. Compared to group-averaged functional connectivity (FC), individual FC provides specific information about a person's brain functional architecture, offering the potential for more accurate network targeting for personalized TMS. However, the low signal-to-noise ratio (SNR) of FC poses a challenge when utilizing individual resting-state FC. To overcome this challenge, the proposed solutions include increasing the scan duration and employing the cluster method to enhance the stability of FC. This study aimed to evaluate the stability of a personalized FC-based network targeting model in individuals with major depressive disorder or schizophrenia with auditory verbal hallucinations. Using resting-state functional magnetic resonance imaging data from the Human Connectome Project, we assessed the model's stability. We employed longer scan durations and cluster methodologies to improve the precision in identifying optimal individual sites. Our findings demonstrate that a scan duration of 28 minutes and the utilization of the cluster method achieved stable identification of individual sites, as evidenced by the intraindividual distance falling below the ~1cm spatial resolution of TMS. The current model provides a feasible approach to obtaining stable personalized TMS targets from the scalp, offering a more accurate method of TMS targeting in clinical applications.
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Affiliation(s)
- Zhengcao Cao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- School of Arts and Communication, Beijing Normal University, Beijing, China
| | - Xiang Xiao
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Cong Xie
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Lijiang Wei
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Chaozhe Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China
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25
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Morriss R, Briley PM, Webster L, Abdelghani M, Barber S, Bates P, Brookes C, Hall B, Ingram L, Kurkar M, Lankappa S, Liddle PF, McAllister-Williams RH, O'Neil-Kerr A, Pszczolkowski S, Suazo Di Paola A, Walters Y, Auer DP. Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nat Med 2024; 30:403-413. [PMID: 38228914 PMCID: PMC10878976 DOI: 10.1038/s41591-023-02764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
Disruption in reciprocal connectivity between the right anterior insula and the left dorsolateral prefrontal cortex is associated with depression and may be a target for neuromodulation. In a five-center, parallel, double-blind, randomized controlled trial we personalized resting-state functional magnetic resonance imaging neuronavigated connectivity-guided intermittent theta burst stimulation (cgiTBS) at a site based on effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. We tested its efficacy in reducing the primary outcome depression symptoms measured by the GRID Hamilton Depression Rating Scale 17-item over 8, 16 and 26 weeks, compared with structural magnetic resonance imaging (MRI) neuronavigated repetitive transcranial magnetic stimulation (rTMS) delivered at the standard stimulation site (F3) in patients with 'treatment-resistant depression'. Participants were randomly assigned to 20 sessions over 4-6 weeks of either cgiTBS (n = 128) or rTMS (n = 127) with resting-state functional MRI at baseline and 16 weeks. Persistent decreases in depressive symptoms were seen over 26 weeks, with no differences between arms on the primary outcome GRID Hamilton Depression Rating Scale 17-item score (intention-to-treat adjusted mean, -0.31, 95% confidence interval (CI) -1.87, 1.24, P = 0.689). Two serious adverse events were possibly related to TMS (mania and psychosis). MRI-neuronavigated cgiTBS and rTMS were equally effective in patients with treatment-resistant depression over 26 weeks (trial registration no. ISRCTN19674644).
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Affiliation(s)
- Richard Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Paul M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Webster
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mohamed Abdelghani
- Clinical Neuromodulation Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Peter Bates
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Cassandra Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Beth Hall
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Luke Ingram
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Micheal Kurkar
- Pennine Care TMS Service, Pennine Care NHS Foundation Trust, Oldham, UK
| | - Sudheer Lankappa
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Peter F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander O'Neil-Kerr
- Centre for Neuromodulation, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Stefan Pszczolkowski
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Yvette Walters
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Dorothee P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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26
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Liu J, Guan J, Xiong J, Wang F. Effects of Transcranial Magnetic Stimulation Combined with Sertraline on Cognitive Level, Inflammatory Response and Neurological Function in Depressive Disorder Patients with Non-suicidal Self-injury Behavior. ACTAS ESPANOLAS DE PSIQUIATRIA 2024; 52:28-36. [PMID: 38454900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Depressive disorder is a chronic mental illness characterized by persistent low mood as its primary clinical symptom. Currently, psychotherapy and drug therapy stand as the primary treatment modalities in clinical practice, offering a certain degree of relief from negative emotions for patients. Nevertheless, sole reliance on drug therapy exhibits a delayed impact on neurotransmitters, and long-term usage often results in adverse side effects such as nausea, drowsiness, and constipation, significantly impeding medication adherence. This study aims to investigate the impact of combining transcranial magnetic stimulation with sertraline on the cognitive level, inflammatory response, and neurological function in patients with depressive disorder who engage in non-suicidal self-injury (NSSI) behavior. METHODS A total of 130 depressive patients NSSI behavior, who were admitted to our hospital from December 2020 to February 2023, were selected as the subjects for this research. The single-group (65 cases) received treatment with oral sertraline hydrochloride tablets, while the combination group (65 cases) underwent repetitive transcranial magnetic stimulation (rTMS) in conjunction with sertraline. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was utilized to assess the depression status and cognitive function levels of both groups. Additionally, the enzyme-linked immunosorbent assay (ELISA) was employed to measure serum levels of inflammatory factors, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6). Furthermore, serum levels of neurotransmitters (norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT)) and neuro-cytokines (brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glial fibrillary acidic protein (GFAP)) were assessed. The clinical effects of the interventions on both groups were then evaluated. RESULTS Following the treatment, the combination group exhibited significantly higher levels of immediate memory, delayed memory, attention, visual function, and language function compared to the single group, with statistically significant differences (p < 0.05). Additionally, the serum levels of TNF-α, IL-1β, IL-6, and GFAP in the combination group were lower than those in the single group, while the levels of BDNF and NGF were higher in the combination group compared to the single group. These differences were also statistically significant (p < 0.05). Simultaneously, the total clinical effective rate in the combination group reached 95.38%, surpassing the 84.61% observed in the single group, and the disparity between the two groups was statistically significant (p < 0.05). CONCLUSIONS The combined use of rTMS and sertraline in treating patients with depressive disorder exhibiting NSSI behavior has proven to be effective in enhancing cognitive function, mitigating inflammatory responses, and elevating levels of neurotransmitters and nerve cytokines in the patients.
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Affiliation(s)
- Jun Liu
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Juan Guan
- Early Intervention Ward 1, Wuhan Mental Health Centre, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Jie Xiong
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
| | - Fang Wang
- Psychosomatic Ward, Wuhan Mental Health Center, Wuhan Hospital for Psychotherapy, 430000 Wuhan, Hubei, China
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27
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Soleimani G, Joutsa J, Moussawi K, Siddiqi SH, Kuplicki R, Bikson M, Paulus MP, Fox MD, Hanlon CA, Ekhtiari H. Converging Evidence for Frontopolar Cortex as a Target for Neuromodulation in Addiction Treatment. Am J Psychiatry 2024; 181:100-114. [PMID: 38018143 DOI: 10.1176/appi.ajp.20221022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Noninvasive brain stimulation technologies such as transcranial electrical and magnetic stimulation (tES and TMS) are emerging neuromodulation therapies that are being used to target the neural substrates of substance use disorders. By the end of 2022, 205 trials of tES or TMS in the treatment of substance use disorders had been published, with heterogeneous results, and there is still no consensus on the optimal target brain region. Recent work may help clarify where and how to apply stimulation, owing to expanding databases of neuroimaging studies, new systematic reviews, and improved methods for causal brain mapping. Whereas most previous clinical trials targeted the dorsolateral prefrontal cortex, accumulating data highlight the frontopolar cortex as a promising therapeutic target for transcranial brain stimulation in substance use disorders. This approach is supported by converging multimodal evidence, including lesion-based maps, functional MRI-based maps, tES studies, TMS studies, and dose-response relationships. This review highlights the importance of targeting the frontopolar area and tailoring the treatment according to interindividual variations in brain state and trait and electric field distribution patterns. This converging evidence supports the potential for treatment optimization through context, target, dose, and timing dimensions to improve clinical outcomes of transcranial brain stimulation in people with substance use disorders in future clinical trials.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Juho Joutsa
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Khaled Moussawi
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Shan H Siddiqi
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Rayus Kuplicki
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Marom Bikson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Martin P Paulus
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Michael D Fox
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Colleen A Hanlon
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
| | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Soleimani, Ekhtiari); Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, and Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland (Joutsa); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Moussawi); Center for Brain Circuit Therapeutics and Departments of Neurology, Psychiatry, Neurosurgery, and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston (Siddiqi, Fox); Laureate Institute for Brain Research, Tulsa, Okla. (Kuplicki, Paulus, Ekhtiari); Department of Biomedical Engineering, City College of New York, New York (Bikson); Department Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hanlon)
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Zeng Y, Ye Z, Zheng W, Wang J. Efficacy of Cerebellar Transcranial Magnetic Stimulation for Post-stroke Balance and Limb Motor Function Impairments: Meta-analyses of Random Controlled Trials and Resting-State fMRI Studies. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01660-7. [PMID: 38280142 DOI: 10.1007/s12311-024-01660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
This study aimed to investigate the potential therapeutic effects of cerebellar transcranial magnetic stimulation (TMS) on balance and limb motor impairments in stroke patients. A meta-analysis of randomized controlled trials was conducted to assess the effects of cerebellar TMS on balance and motor impairments in stroke patients. Additionally, an activation likelihood estimation (ALE) meta-analysis was performed on resting-state functional magnetic resonance imaging (fMRI) studies to compare spontaneous neural activity differences between stroke patients and healthy controls using measures including the amplitude of low frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo). The analysis included 10 cerebellar TMS studies and 18 fMRI studies. Cerebellar TMS treatment demonstrated significant improvements in the Berg Balance Scale score (p < 0.0001) and the Fugl-Meyer Assessment lower extremity score (p < 0.0001) compared to the control group in stroke patients. Additionally, spontaneous neural activity alterations were identified in motor-related regions after stroke, including the precentral gyrus, putamen, thalamus, and paracentral lobule. Cerebellar TMS shows promise as a therapeutic intervention to enhance balance and lower limb motor function in stroke patients. It is easy for clinical application and addresses the limitations of insufficient direct stimulation depth on the leg area of the cortex. However, further research combining neuroimaging outcomes with clinical measurements is necessary to validate these findings.
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Affiliation(s)
- Yuheng Zeng
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China.
| | - Zujuan Ye
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Wanxin Zheng
- Department of Genome Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, 156-8506, Japan
| | - Jue Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
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Patel D, Shetty S, Acha C, Pantoja IEM, Zhao A, George D, Gracias DH. Microinstrumentation for Brain Organoids. Adv Healthc Mater 2024:e2302456. [PMID: 38217546 DOI: 10.1002/adhm.202302456] [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: 07/30/2023] [Revised: 12/10/2023] [Indexed: 01/15/2024]
Abstract
Brain organoids are three-dimensional aggregates of self-organized differentiated stem cells that mimic the structure and function of human brain regions. Organoids bridge the gaps between conventional drug screening models such as planar mammalian cell culture, animal studies, and clinical trials. They can revolutionize the fields of developmental biology, neuroscience, toxicology, and computer engineering. Conventional microinstrumentation for conventional cellular engineering, such as planar microfluidic chips; microelectrode arrays (MEAs); and optical, magnetic, and acoustic techniques, has limitations when applied to three-dimensional (3D) organoids, primarily due to their limits with inherently two-dimensional geometry and interfacing. Hence, there is an urgent need to develop new instrumentation compatible with live cell culture techniques and with scalable 3D formats relevant to organoids. This review discusses conventional planar approaches and emerging 3D microinstrumentation necessary for advanced organoid-machine interfaces. Specifically, this article surveys recently developed microinstrumentation, including 3D printed and curved microfluidics, 3D and fast-scan optical techniques, buckling and self-folding MEAs, 3D interfaces for electrochemical measurements, and 3D spatially controllable magnetic and acoustic technologies relevant to two-way information transfer with brain organoids. This article highlights key challenges that must be addressed for robust organoid culture and reliable 3D spatiotemporal information transfer.
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Affiliation(s)
- Devan Patel
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Saniya Shetty
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Chris Acha
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Itzy E Morales Pantoja
- Center for Alternatives to Animal Testing (CAAT), Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Alice Zhao
- Department of Biology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Derosh George
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - David H Gracias
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Chemistry, Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD, 21218, USA
- Sidney Kimmel Comprehensive Cancer Center (SKCCC), Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
- Center for MicroPhysiological Systems (MPS), Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
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30
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Li B, Zhao N, Tang N, Friston KJ, Zhai W, Wu D, Liu J, Chen Y, Min Y, Qiao Y, Liu W, Shu W, Liu M, Zhou P, Guo L, Qi S, Cui LB, Wang H. Targeting suicidal ideation in major depressive disorder with MRI-navigated Stanford accelerated intelligent neuromodulation therapy. Transl Psychiatry 2024; 14:21. [PMID: 38199983 PMCID: PMC10781692 DOI: 10.1038/s41398-023-02707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/16/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024] Open
Abstract
High suicide risk represents a serious problem in patients with major depressive disorder (MDD), yet treatment options that could safely and rapidly ameliorate suicidal ideation remain elusive. Here, we tested the feasibility and preliminary efficacy of the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) in reducing suicidal ideation in patients with MDD. Thirty-two MDD patients with moderate to severe suicidal ideation participated in the current study. Suicidal ideation and depression symptoms were assessed before and after 5 days of open-label SAINT. The neural pathways supporting rapid-acting antidepressant and suicide prevention effects were identified with dynamic causal modelling based on resting-state functional magnetic resonance imaging. We found that 5 days of SAINT effectively alleviated suicidal ideation in patients with MDD with a high response rate of 65.63%. Moreover, the response rates achieved 78.13% and 90.63% with 2 weeks and 4 weeks after SAINT, respectively. In addition, we found that the suicide prevention effects of SAINT were associated with the effective connectivity involving the insula and hippocampus, while the antidepressant effects were related to connections of the subgenual anterior cingulate cortex (sgACC). These results show that SAINT is a rapid-acting and effective way to reduce suicidal ideation. Our findings further suggest that distinct neural mechanisms may contribute to the rapid-acting effects on the relief of suicidal ideation and depression, respectively.
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Affiliation(s)
- Baojuan Li
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Na Zhao
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, 310015, Hangzhou, Zhejiang, China
- Institute of Psychological Sciences, Hangzhou Normal University, 311121, Hangzhou, Zhejiang, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, 310015, Hangzhou, Zhejiang, China
| | - Nailong Tang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
- Department of Psychiatry, 907 Hospital of Joint Logistics Team, 353000, Nanping, Fujian, China
| | - Karl J Friston
- The Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, WC1N 3AR, UK
| | - Wensheng Zhai
- School of Biomedical Engineering, Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Di Wu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Junchang Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yihuan Chen
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yan Min
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Yuting Qiao
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wenming Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Wanqing Shu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Min Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Ping Zhou
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Li Guo
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China
| | - Shun Qi
- Brain Modulation and Scientific Research Center, 710043, Xi'an, China
- Neuromodulation Lab of Brain Science and Humanoid Intelligence Research Center, Xi'an Jiaotong University, 710049, Xi'an, China
| | - Long-Biao Cui
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, 710032, Xi'an, China.
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, 100856, Beijing, China.
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
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Galimberti A, Tik M, Pellegrino G, Schuler AL. Effectiveness of rTMS and tDCS treatment for chronic TBI symptoms: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110863. [PMID: 37709126 DOI: 10.1016/j.pnpbp.2023.110863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of long-term disability with conventional treatments frequently falling short to restore a good quality-of-life. Non-invasive brain stimulation (NIBS) techniques have shown potential as therapeutic options for neuropsychiatric conditions, including TBI sequelae. This study aims at providing a systematic review and meta-analysis on the effectiveness of repetitive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) on post-TBI symptoms. METHODS Fifteen randomized controlled trials (RCTs) on adult TBI patients that examined the effects of multiple treatment sessions of NIBS techniques were selected from five databases. Symptoms were clustered into four categories: depression, anxiety, headache and cognitive dysfunctions. Meta-analysis was performed using correlated and hierarchical effects models. RESULTS There were only few and heterogeneous studies with generally small sample sizes. Most studies targeted the dorsolateral prefrontal cortex (dlPFC). Overall, the effects of NIBS were small. However, there was a significant effect for overall symptoms (0.404, p = 0.031). Moreover, subgroup analyses revealed significant overall effects for anxiety (0.195, p = 0.020) and headache (0.354, p = 0.040). CONCLUSIONS To date, there is limited evidence supporting the effectiveness of NIBS concerning treatment for TBI sequelae. The observed effect sizes were modest, suggesting subtle improvements rather than drastic changes. While NIBS techniques remain promising for treating neuropsychiatric conditions, larger RCT studies with longer follow-ups, optimized stimulation parameters and standardized methodology are required to establish their efficacy in addressing TBI sequelae.
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Affiliation(s)
| | - Martin Tik
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Giovanni Pellegrino
- Epilepsy Program, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Anna-Lisa Schuler
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; IRCCS San Camillo Hospital, Venice, Italy.
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Siddiqi SH, Khosravani S, Rolston JD, Fox MD. The future of brain circuit-targeted therapeutics. Neuropsychopharmacology 2024; 49:179-188. [PMID: 37524752 PMCID: PMC10700386 DOI: 10.1038/s41386-023-01670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
The principle of targeting brain circuits has drawn increasing attention with the growth of brain stimulation treatments such as transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and focused ultrasound (FUS). Each of these techniques can effectively treat different neuropsychiatric disorders, but treating any given disorder depends on choosing the right treatment target. Here, we propose a three-phase framework for identifying and modulating these targets. There are multiple approaches to identifying a target, including correlative neuroimaging, retrospective optimization based on existing stimulation sites, and lesion localization. These techniques can then be optimized using personalized neuroimaging, physiological monitoring, and engagement of a specific brain state using pharmacological or psychological interventions. Finally, a specific stimulation modality or combination of modalities can be chosen after considering the advantages and tradeoffs of each. While there is preliminary literature to support different components of this framework, there are still many unanswered questions. This presents an opportunity for the future growth of research and clinical care in brain circuit therapeutics.
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Affiliation(s)
- Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sanaz Khosravani
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - John D Rolston
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurosurgery, Harvard Medical School, Boston, MA, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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33
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Wang Y, Tan B, Shi S, Ye Y, Che X. Dopamine D2 receptor antagonist modulates rTMS-induced pain experiences and corticospinal excitability dependent on stimulation targets. Int J Clin Health Psychol 2024; 24:100413. [PMID: 37954401 PMCID: PMC10632113 DOI: 10.1016/j.ijchp.2023.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
Both the primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) rTMS have the potential to reduce certain chronic pain conditions. However, the analgesic mechanisms remain unclear, in which M1- and DLPFC-rTMS may have different impact on the release of dopamine receptor D2 neurotransmissions (DRD2). Using a double-blind, randomised, sham- and placebo-controlled design, this study investigated the influence of DRD2 antagonist on rTMS-induced analgesia and corticospinal excitability across the M1 and DLPFC. Healthy participants in each group (M1, DLPFC, or Sham) received an oral dose of chlorpromazine or placebo before the delivery of rTMS in two separate sessions. Heat pain and cortical excitability were assessed before drug administration and after rTMS intervention. DRD2 antagonist selectively abolished the increased heat pain threshold induced by DLPFC stimulation and increased pain unpleasantness. The absence of analgesic effects in DLPFC stimulation was not accompanied by plastic changes in the corticospinal pathway. In contrast, DRD2 antagonist increased corticospinal excitability and rebalanced excitation-inhibition relationship following motor cortex stimulation, although there were no clear changes in pain experiences. These novel findings together highlight the influence of dopaminergic neurotransmission on rTMS-induced analgesia and corticospinal excitability dependent on stimulation targets.
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Affiliation(s)
- Ying Wang
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Bolin Tan
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Shuyan Shi
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yang Ye
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xianwei Che
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- TMS Centre, Deqing Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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34
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Huang S, Wen X, Liu Z, Li C, He Y, Liang J, Huang W. Distinguishing functional and structural MRI abnormalities between bipolar and unipolar depression. Front Psychiatry 2023; 14:1343195. [PMID: 38169701 PMCID: PMC10758430 DOI: 10.3389/fpsyt.2023.1343195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Background This study aims to investigate the underlying characteristics of spontaneous brain activity by analyzing the volumes of the hippocampus and parahippocampal gyrus, as well as the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), in order to differentiate between bipolar disorder (BD) and unipolar depressive disorder. Methods A total of 46 healthy controls, 58 patients with major depressive disorder (MDD), and 61 patients with BD participated in the study and underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans. The researchers calculated the differences in volume, fALFF, and ReHo values among the three groups. Additionally, they conducted correlation analyses to examine the relationships between clinical variables and the aforementioned brain measures. Results The results showed that the BD group exhibited increased fALFF in the hippocampus compared to the healthy control (HC) and MDD groups. Furthermore, the ReHo values in the hippocampus and parahippocampal gyrus were significantly higher in the BD group compared to the HC group. The findings from the person correlation analysis indicated a positive relationship between ReHo values in the hippocampus and both HAMD and HAMA scores. Moreover, there was no correlation between the volumes, fALFF, and ReHo values in the hippocampus and parahippocampal gyrus, and cognitive function levels (RBANS). Conclusion Taken together, these aberrant patterns of intrinsic brain activity in the hippocampus and parahippocampal gyrus may serve as quantitative indicators for distinguishing between BD and unipolar depression.
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Affiliation(s)
| | | | | | | | | | - Jiaquan Liang
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Wei Huang
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, Guangdong, China
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35
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Wang S, Kong G, Wu G, Cui H, Qian Z, Xu L, Wei Y, Wang J, Huang J, Wang J, Li H, Tang Y. Comparing the efficacies of transcranial magnetic stimulation treatments using different targeting methods in major depressive disorder: protocol for a network meta-analysis. BMJ Open 2023; 13:e075525. [PMID: 38086594 PMCID: PMC10729247 DOI: 10.1136/bmjopen-2023-075525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (lDLPFC) has been widely used as a treatment for major depressive disorder (MDD) in the past two decades. Different methods for localising the lDLPFC target include the '5 cm' method, the F3 method and the neuro-navigational method. However, whether TMS efficacies differ between the three targeting methods remains unclear. We present a protocol for a systematic review and network meta-analysis (NMA) to compare the efficacies of TMS treatments using these three targeting methods in MDD. METHODS AND ANALYSIS Relevant studies reported in English or Chinese and published up to May 2023 will be identified from searches of the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, China National Knowledge Infrastructure, Wan Fang Database, Chinese BioMedical Literature Database, and China Science and Technology Journal Database. We will include all randomised controlled trials assessing the efficacy of an active TMS treatment using any one of the three targeting methods compared with sham TMS treatment or comparing efficacies between active TMS treatments using different targeting methods. Interventions must include a minimum of 10 sessions of high-frequency TMS over the lDLPFC. The primary outcome is the reduction score of the 17-item Hamilton Depression Rating Scale, 24-item Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale. The dropout rate is a secondary outcome representing the TMS treatment's acceptability. Pairwise meta-analyses and a random-effects NMA will be conducted using Stata. We will use the surface under the cumulative ranking curve to rank the different targeting methods in terms of efficacy and acceptability. ETHICS AND DISSEMINATION This systematic review and NMA does not require ethics approval. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023410273.
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Affiliation(s)
- Sirui Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gai Kong
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guanfu Wu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenying Qian
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yumei Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Wang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Jingjing Huang
- 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
- CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Soleimani G, Kuplicki R, Camchong J, Opitz A, Paulus MP, Lim KO, Ekhtiari H. Are we really targeting and stimulating DLPFC by placing transcranial electrical stimulation (tES) electrodes over F3/F4? Hum Brain Mapp 2023; 44:6275-6287. [PMID: 37750607 PMCID: PMC10619406 DOI: 10.1002/hbm.26492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
In many clinical trials involving transcranial electrical stimulation (tES), target electrodes are typically placed over DLPFC with the assumption that this will primarily stimulate the underlying brain region. However, our study aimed to evaluate the electric fields (EF) that are actually delivered and identify prefrontal regions that may be inadvertently targeted in DLPFC tES. Head models were generated from the Human Connectome Project database's T1 + T2-weighted MRIs of 80 healthy adults. Two common DLPFC montages were simulated; symmetric-F4/F3, and asymmetric-F4/Fp1. Averaged EF was extracted from (1) the center of the target electrode (F4), and (2) the top 1% of voxels showing the strongest EF in individualized EF maps. Interindividual variabilities were quantified with the standard deviation of EF peak location/value. Similar steps were repeated with 66 participants with methamphetamine use disorder (MUDs) as an independent clinical population. In healthy adults, the group-level location of EF peaks was situated in the medial-frontopolar, and the individualized EF peaks were positioned in a cube with a volume of 29 cm3 /46 cm3 (symmetric/asymmetric montages). EFs in the frontopolar area were significantly higher than EF "under" the target electrode in both symmetric (peak: 0.41 ± 0.06, F4:0.22 ± 0.04) and asymmetric (peak: 0.38 ± 0.04, F4:0.2 ± 0.04) montages (Heges'g > 0.7). Similar results with slight between-group differences were found in MUDs. We highlighted that in common DLPFC tES montages, in addition to interindividual/intergroup variability, the frontopolar received the highest EFs rather than DLPFC as the main target. We specifically recommended considering the potential involvement of the frontopolar area as a mechanism underlying the effectiveness of DLPFC tES protocols.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research (LIBR)TulsaOklahomaUSA
| | - Jazmin Camchong
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Alexander Opitz
- Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Kelvin O. Lim
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Hamed Ekhtiari
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
- Laureate Institute for Brain Research (LIBR)TulsaOklahomaUSA
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Zanao TA, Luethi MS, Goerigk S, Suen P, Diaz AP, Soares JC, Brunoni AR. White matter predicts tDCS antidepressant effects in a sham-controlled clinical trial study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1421-1431. [PMID: 36336757 DOI: 10.1007/s00406-022-01504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been used as treatment for depression, but its effects are heterogeneous. We investigated, in a subsample of the clinical trial Escitalopram versus Electrical Direct Current Therapy for Depression Study (ELECTTDCS), whether white matter areas associated with depression disorder were associated with tDCS response. Baseline diffusion tensor imaging data were analyzed from 49 patients (34 females, mean age 41.9) randomized to escitalopram 20 mg/day, tDCS (2 mA, 30 min, 22 sessions), or placebo. Antidepressant outcomes were assessed by Hamilton Depression Rating Scale-17 (HDRS) after 10-week treatment. We used whole-brain tractography for extracting white matter measures for anterior corpus callosum, and bilaterally for cingulum bundle, striato-frontal, inferior occipito-frontal fasciculus and uncinate. For the rostral body, tDCS group showed higher MD associated with antidepressant effects (estimate = -5.13 ± 1.64, p = 0.002), and tDCS significantly differed from the placebo and the escitalopram group. The left striato-frontal tract showed higher FA associated with antidepressant effects (estimate = -2.14 ± 0.72, p = 0.003), and tDCS differed only from the placebo group. For the right uncinate, the tDCS group lower AD values were associated with higher HDRS decrease (estimate = -1.45 ± 0.67, p = 0.031). Abnormalities in white matter MDD-related areas are associated with tDCS antidepressant effects. Suggested better white matter microstructure of the left prefrontal cortex was associated with tDCS antidepressant effects. Future studies should investigate whether these findings are driven by electric field diffusion and density in these areas.
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Affiliation(s)
- Tamires A Zanao
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Matthias S Luethi
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stephan Goerigk
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Laboratory of Neurosciences LIM-27), São Paulo, Brazil
- Department of Psychological Methodology and Assessment, LMU Munich, Munich, Germany
| | - Paulo Suen
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre P Diaz
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Jair C Soares
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
- Hospital Universitário, Departamento de Clínica Médica, Faculdade de Medicina da USP, São Paulo, Brazil.
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38
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Wu GR, Baeken C. Precision targeting in prediction for rTMS clinical outcome in depression: what about sgACC lateralization, metabolic connectivity, and the potential role of the cerebellum? Eur Arch Psychiatry Clin Neurosci 2023; 273:1443-1450. [PMID: 37329365 DOI: 10.1007/s00406-023-01637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/03/2023] [Indexed: 06/19/2023]
Abstract
Predicting clinical response to repetitive transcranial magnetic stimulation (rTMS) in medication-resistant depression (MRD) has gained great importance in recent years. Mainly, the right subgenual anterior cingulate cortex (sgACC) functional connectivity has been put forward as biomarker in relation to rTMS clinical outcome. Even though the left and right sgACC may have different neurobiological functions, little is known about the possible lateralized predictive role of the sgACC in rTMS clinical outcome. In 43 right-handed antidepressant-free MRD patients, we applied a searchlight-based interregional covariance connectivity approach using the baseline 18FDG-PET scan-collected from two previous high-frequency (HF)-rTMS treatment studies delivering stimulation to the left dorsolateral prefrontal cortex (DLPFC)-and investigated whether unilateral or bilateral sgACC glucose metabolism at baseline would result in different predictive metabolic connectivity patterns. Regardless of sgACC lateralization, the weaker the sgACC seed-based baseline metabolic functional connections with the (left anterior) cerebellar areas, the significantly better the clinical outcome. However, the seed diameter seems to be crucial. Similar significant findings on sgACC metabolic connectivity with the left anterior cerebellum, also unrelated to sgACC lateralization, in relation to clinical outcome were observed when using the HCPex atlas. Although we could not substantiate that specifically right sgACC metabolic connectivity would predict HF-rTMS clinical outcome, our findings suggest considering the entire sgACC in functional connectivity predictions. Given that the interregional covariance connectivity results were significant only when using the Beck Depression Inventory (BDI-II) and not with the Hamilton Depression Rating Scale (HDRS), our sgACC metabolic connectivity observations also suggest the possible involvement of the (left) anterior cerebellum involved in higher-order cognitive processing as part of this predictive value.
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Affiliation(s)
- Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China.
- School of Psychology, Jiangxi Normal University, Nanchang, China.
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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39
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Trapp NT, Pace BD, Neisewander B, Ten Eyck P, Boes AD. A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness. Brain Stimul 2023; 16:1392-1400. [PMID: 37714408 PMCID: PMC11095825 DOI: 10.1016/j.brs.2023.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The Beam F3 and 5.5 cm methods are the two most common targeting strategies for localizing the left dorsolateral prefrontal cortex (DLPFC) treatment site in repetitive transcranial magnetic stimulation (rTMS) protocols. This prospective, randomized, double-blind comparative effectiveness trial assesses the clinical outcomes for these two methods in a naturalistic sample of patients with major depressive disorder (MDD) undergoing clinical rTMS treatment. METHODS 105 adult patients with MDD (mean age = 43.2; range = 18-73; 66% female) were randomized to receive rTMS to the Beam F3 (n = 58) or 5.5 cm (n = 47) target. Between group differences from pre-to post-treatment were evaluated with the Patient Health Questionnaire-9 (PHQ-9) [primary outcome measure], Generalized Anxiety Disorder-7 (GAD-7), and clinician-administered Montgomery-Åsberg Depression Scale (MADRS). Primary treatment endpoint was completion of daily treatment series. RESULTS Per-protocol analyses showed no statistically significant differences on any measure between the 5.5 cm and F3 groups (all p ≥ 0.50), including percent improvement (PHQ-9: 39% vs. 39%; GAD-7: 34% vs. 27%; MADRS: 40% vs. 38%), response rate (PHQ-9: 37% vs. 43%; GAD-7: 27% vs. 30%; MADRS: 43% vs. 43%), and remission rate (PHQ-9: 22% vs. 21%; MADRS: 20% vs. 19%). Post hoc analysis of anxiety symptom change while controlling for depression severity suggested more favorable anxiolytic effects with 5.5 cm targeting (p = 0.03). CONCLUSIONS Similar antidepressant effects were observed with DLFPC rTMS using either the Beam F3 or 5.5 cm targeting method, supporting clinical equipoise in MDD patients with head circumference ≤ 60 cm. Comparison to MRI-based targeting and differential effects on anxiety symptoms require further investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03378570.
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Affiliation(s)
- Nicholas T Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States.
| | - Benjamin D Pace
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
| | - Aaron D Boes
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States; Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States; Department of Neurology, University of Iowa, Iowa City, IA, United States; Department of Pediatrics, University of Iowa, Iowa City, IA, United States
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40
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Ren J, Ren W, Zhou Y, Dahmani L, Duan X, Fu X, Wang Y, Pan R, Zhao J, Zhang P, Wang B, Yu W, Chen Z, Zhang X, Sun J, Ding M, Huang J, Xu L, Li S, Wang W, Xie W, Zhang H, Liu H. Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: A randomized sham-controlled trial. Brain Stimul 2023; 16:1313-1321. [PMID: 37652135 DOI: 10.1016/j.brs.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery. OBJECTIVE We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery. METHODS This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment. RESULTS Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group. CONCLUSION The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.
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Affiliation(s)
- Jianxun Ren
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Weijing Ren
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China
| | - Ying Zhou
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Louisa Dahmani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Xinyu Duan
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Xiaoxuan Fu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Yezhe Wang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Ruiqi Pan
- Neural Galaxy Inc., Beijing, 102206, China
| | - Jingdu Zhao
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China
| | - Ping Zhang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Bo Wang
- Department of Hearing and Language Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Weiyong Yu
- Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhenbo Chen
- Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Xin Zhang
- Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China
| | - Jian Sun
- Neural Galaxy Inc., Beijing, 102206, China
| | | | - Jianting Huang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China
| | - Liu Xu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Shiyi Li
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | | | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, 100191, China
| | - Hao Zhang
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250100, China.
| | - Hesheng Liu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China.
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41
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Chai Y, Sheline YI, Oathes DJ, Balderston NL, Rao H, Yu M. Functional connectomics in depression: insights into therapies. Trends Cogn Sci 2023; 27:814-832. [PMID: 37286432 PMCID: PMC10476530 DOI: 10.1016/j.tics.2023.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
Depression is a common mental disorder characterized by heterogeneous cognitive and behavioral symptoms. The emerging research paradigm of functional connectomics has provided a quantitative theoretical framework and analytic tools for parsing variations in the organization and function of brain networks in depression. In this review, we first discuss recent progress in depression-associated functional connectome variations. We then discuss treatment-specific brain network outcomes in depression and propose a hypothetical model highlighting the advantages and uniqueness of each treatment in relation to the modulation of specific brain network connectivity and symptoms of depression. Finally, we look to the future promise of combining multiple treatment types in clinical practice, using multisite datasets and multimodal neuroimaging approaches, and identifying biological depression subtypes.
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Affiliation(s)
- Ya Chai
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Penn Brain Science, Translation, Innovation and Modulation Center (brainSTIM), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Nicholas L Balderston
- Center for Neuromodulation in Depression and Stress (CNDS), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hengyi Rao
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China; Center for Functional Neuroimaging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Meichen Yu
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Network Science Institute, Bloomington, IN, USA.
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Sun W, Wu Q, Gao L, Zheng Z, Xiang H, Yang K, Yu B, Yao J. Advancements in Transcranial Magnetic Stimulation Research and the Path to Precision. Neuropsychiatr Dis Treat 2023; 19:1841-1851. [PMID: 37641588 PMCID: PMC10460597 DOI: 10.2147/ndt.s414782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has become increasingly popular in clinical practice in recent years, and there have been significant advances in the principles and stimulation modes of TMS. With the development of multi-mode and precise stimulation technology, it is crucial to have a comprehensive understanding of TMS. The neuroregulatory effects of TMS can vary depending on the specific mode of stimulation, highlighting the importance of exploring these effects through multimodal application. Additionally, the use of precise TMS therapy can help enhance our understanding of the neural mechanisms underlying these effects, providing us with a more comprehensive perspective. This article aims to review the mechanism of action, stimulation mode, multimodal application, and precision of TMS.
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Affiliation(s)
- Wei Sun
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Qiao Wu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Li Gao
- Department of Neurology, The Third People’s Hospital of Chengdu, Chengdu Institute of Neurological Diseases, Chengdu City, Sichuan Province, People’s Republic of China
| | - Zhong Zheng
- Neurobiological Detection Center, West China Hospital Affiliated to Sichuan University, Chengdu City, Sichuan Province, People’s Republic of China
| | - Hu Xiang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Kun Yang
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Bo Yu
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
| | - Jing Yao
- Department of Psychiatry, the Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang City, Sichuan Province, People’s Republic of China
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Deng ZD, Robins PL, Dannhauer M, Haugen LM, Port JD, Croarkin PE. Optimizing TMS Coil Placement Approaches for Targeting the Dorsolateral Prefrontal Cortex in Depressed Adolescents: An Electric Field Modeling Study. Biomedicines 2023; 11:2320. [PMID: 37626817 PMCID: PMC10452519 DOI: 10.3390/biomedicines11082320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023] Open
Abstract
High-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) shows promise as a treatment for treatment-resistant depression in adolescents. Conventional rTMS coil placement strategies include the 5 cm, the Beam F3, and the magnetic resonance imaging (MRI) neuronavigation methods. The purpose of this study was to use electric field (E-field) models to compare the three targeting approaches to a computational E-field optimization coil placement method in depressed adolescents. Ten depressed adolescents (4 females, age: 15.9±1.1) participated in an open-label rTMS treatment study and were offered MRI-guided rTMS five times per week over 6-8 weeks. Head models were generated based on individual MRI images, and E-fields were simulated for the four targeting approaches. Results showed a significant difference in the induced E-fields at the L-DLPFC between the four targeting methods (χ2=24.7, p<0.001). Post hoc pairwise comparisons showed that there was a significant difference between any two of the targeting methods (Holm adjusted p<0.05), with the 5 cm rule producing the weakest E-field (46.0±17.4V/m), followed by the F3 method (87.4±35.4V/m), followed by MRI-guided (112.1±14.6V/m), and followed by the computational approach (130.1±18.1V/m). Variance analysis showed that there was a significant difference in sample variance between the groups (K2=8.0, p<0.05), with F3 having the largest variance. Participants who completed the full course of treatment had median E-fields correlated with depression symptom improvement (r=-0.77, p<0.05). E-field models revealed limitations of scalp-based methods compared to MRI guidance, suggesting computational optimization could enhance dose delivery to the target.
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Affiliation(s)
- Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Pei L. Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Laura M. Haugen
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - John D. Port
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA;
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Paul E. Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
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Soleimani G, Nitsche MA, Bergmann TO, Towhidkhah F, Violante IR, Lorenz R, Kuplicki R, Tsuchiyagaito A, Mulyana B, Mayeli A, Ghobadi-Azbari P, Mosayebi-Samani M, Zilverstand A, Paulus MP, Bikson M, Ekhtiari H. Closing the loop between brain and electrical stimulation: towards precision neuromodulation treatments. Transl Psychiatry 2023; 13:279. [PMID: 37582922 PMCID: PMC10427701 DOI: 10.1038/s41398-023-02565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
One of the most critical challenges in using noninvasive brain stimulation (NIBS) techniques for the treatment of psychiatric and neurologic disorders is inter- and intra-individual variability in response to NIBS. Response variations in previous findings suggest that the one-size-fits-all approach does not seem the most appropriate option for enhancing stimulation outcomes. While there is a growing body of evidence for the feasibility and effectiveness of individualized NIBS approaches, the optimal way to achieve this is yet to be determined. Transcranial electrical stimulation (tES) is one of the NIBS techniques showing promising results in modulating treatment outcomes in several psychiatric and neurologic disorders, but it faces the same challenge for individual optimization. With new computational and methodological advances, tES can be integrated with real-time functional magnetic resonance imaging (rtfMRI) to establish closed-loop tES-fMRI for individually optimized neuromodulation. Closed-loop tES-fMRI systems aim to optimize stimulation parameters based on minimizing differences between the model of the current brain state and the desired value to maximize the expected clinical outcome. The methodological space to optimize closed-loop tES fMRI for clinical applications includes (1) stimulation vs. data acquisition timing, (2) fMRI context (task-based or resting-state), (3) inherent brain oscillations, (4) dose-response function, (5) brain target trait and state and (6) optimization algorithm. Closed-loop tES-fMRI technology has several advantages over non-individualized or open-loop systems to reshape the future of neuromodulation with objective optimization in a clinically relevant context such as drug cue reactivity for substance use disorder considering both inter and intra-individual variations. Using multi-level brain and behavior measures as input and desired outcomes to individualize stimulation parameters provides a framework for designing personalized tES protocols in precision psychiatry.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neuroscience, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
- Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Til Ole Bergmann
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ines R Violante
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, UK
| | - Romy Lorenz
- Department of Psychology, Stanford University, Stanford, CA, USA
- MRC CBU, University of Cambridge, Cambridge, UK
- Department of Neurophysics, MPI, Leipzig, Germany
| | | | | | - Beni Mulyana
- Laureate Institute for Brain Research, Tulsa, OK, USA
- School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK, USA
| | - Ahmad Mayeli
- University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - Peyman Ghobadi-Azbari
- Department of Biomedical Engineering, Shahed University, Tehran, Iran
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Mosayebi-Samani
- Department of Psychology and Neuroscience, Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany
| | - Anna Zilverstand
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Hamed Ekhtiari
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
- Laureate Institute for Brain Research, Tulsa, OK, USA.
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Voineskos D, Blumberger DM. Transcranial direct current stimulation as a treatment for major depressive disorder. Lancet 2023; 402:506-507. [PMID: 37414063 DOI: 10.1016/s0140-6736(23)00822-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Zhang W, Liu N, Zhao Y, Yao C, Yang D, Yang C, Sun H, Wei X, Sweeney JA, Liang H, Zhang M, Gong Q, Lui S. The acute effects of repetitive transcranial magnetic stimulation on laminar diffusion anisotropy of neocortical gray matter. MedComm (Beijing) 2023; 4:e335. [PMID: 37560755 PMCID: PMC10407029 DOI: 10.1002/mco2.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is increasingly used to treat neuropsychiatric disorders. Inhibitory and excitatory regimens have been both adopted but the exact mechanism of action remains unclear, and investigating their differential effects on laminar diffusion profiles of neocortex may add important evidence. Twenty healthy participants were randomly assigned to receive a low-frequency/inhibitory or high-frequency/excitatory rTMS targeting the left dorsolateral prefrontal cortex (DLPFC). With the brand-new submillimeter diffusion tensor imaging of whole brain and specialized surface-based laminar analysis, fractional anisotropy (FA) and mean diffusion (MD) profiles of cortical layers at different cortical depths were characterized before/after rTMS. Inhibitory and excitatory rTMS both showed impacts on diffusion metrics of somatosensory, limbic, and sensory regions, but different patterns of changes were observed-increased FA with inhibitory rTMS, whereas decreased FA with excitatory rTMS. More importantly, laminar analysis indicated laminar specificity of changes in somatosensory regions during different rTMS patterns-inhibitory rTMS affected the superficial layers contralateral to the DLPFC, while excitatory rTMS led to changes in the intermediate/deep layers bilateral to the DLPFC. These findings provide novel insights into acute neurobiological effects on diffusion profiles of rTMS that may add critical evidence relevant to different protocols of rTMS on neocortex.
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Affiliation(s)
- Wenjing Zhang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Naici Liu
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Youjin Zhao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Chenyang Yao
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Dan Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
| | - Chengmin Yang
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Hui Sun
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - Xia Wei
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
| | - John A. Sweeney
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | | | | | - Qiyong Gong
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
- Department of RadiologyWest China Xiamen Hospital of Sichuan UniversityXiamenFujianChina
| | - Su Lui
- Department of Radiologyand Functional and Molecular Imaging Key Laboratory of Sichuan ProvinceWest China Hospital of Sichuan UniversityChengduChina
- Huaxi MR Research Center (HMRRC)West China Hospital of Sichuan UniversityChengduChina
- Research Unit of PsychoradiologyChinese Academy of Medical SciencesChengduChina
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Dalhuisen I, Schutte C, Bramson B, Roelofs K, van Eijndhoven P, Tendolkar I. Studying additive effects of combining rTMS with cognitive control training: a pilot investigation. Front Hum Neurosci 2023; 17:1201344. [PMID: 37584029 PMCID: PMC10423931 DOI: 10.3389/fnhum.2023.1201344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) on the dorsolateral prefrontal cortex (DLPFC) is an effective treatment for depression that has been proposed to work via the enhancement of cognitive control. Cognitive control training (CCT) can also alleviate depression by relying on DLPFC activation. As the additive effects of rTMS and CCT are unclear, we set out to conduct a within-subject pilot study in healthy controls. Methods Seventeen participants received two sessions of individualized resting-state connectivity-guided high-frequency rTMS, while randomly performing CCT or a control task. After each session, a negative mood was induced. Results We found effects on mood and cognitive control after rTMS + CCT as well as rTMS + control, which were indiscriminative between conditions. Based on the statistical evidence for the absence of an additive effect of CCT, we did not perform a full study. Conclusion Our results demonstrate no differential effects of single sessions combining rTMS and CCT in a healthy population, even with the methodological improvement of individualized neuronavigation. The improvement in cognitive control seen in both conditions could indicate that a simple cognitive task is sufficient when studying additive rTMS effects. Future studies should focus on augmenting the effects of various cognitive tasks and compare the present interventions with rTMS or cognitive tasks alone.
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Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Céline Schutte
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bob Bramson
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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Tan V, Jeyachandra J, Ge R, Dickie EW, Gregory E, Vanderwal T, Vila-Rodriguez F, Hawco C. Subgenual cingulate connectivity as a treatment predictor during low-frequency right dorsolateral prefrontal rTMS: A concurrent TMS-fMRI study. Brain Stimul 2023; 16:1165-1172. [PMID: 37543171 DOI: 10.1016/j.brs.2023.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) is effective in alleviating treatment-resistant depression (TRD). It has been proposed that regions within the left DLPFC that are anti-correlated with the right subgenual anterior cingulate cortex (sgACC) may represent optimal individualized target sites for high-frequency left rTMS (HFL). OBJECTIVE/HYPOTHESIS This study aimed to explore the effects of low-frequency right rTMS (LFR) on left sgACC connectivity during concurrent TMS-fMRI. METHODS 34 TRD patients underwent an imaging session that included both a resting-state fMRI run (rs-fMRI0) and a run during which LFR was applied to the right DLPFC (TMS-fMRI). Participants subsequently completed four weeks of LFR treatment. The left sgACC functional connectivity was compared between the rs-fMRI0 run and TMS-fMRI run. Personalized e-fields and a region-of-interest approach were used to calculate overlap of left sgACC functional connectivity at the TMS target and to assess for a relationship with treatment effects. RESULTS TMS-fMRI increased left sgACC functional connectivity to parietal regions within the ventral attention network; differences were not significantly associated with clinical improvements. Personalized e-fields were not significant in predicting treatment outcomes (p = 0.18). CONCLUSION This was the first study to examine left sgACC anti-correlation with the right DLPFC during an LFR rTMS protocol. In contrast to studies that targeted the left DLPFC, we did not find that higher anti-correlation was associated with clinical outcomes. Our results suggest that the antidepressant mechanism of action of LFR to the right DLPFC may be different than for HFL.
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Affiliation(s)
- Vinh Tan
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jerrold Jeyachandra
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Ruiyang Ge
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Erin W Dickie
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Elizabeth Gregory
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Vanderwal
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Colin Hawco
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
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Sheng R, Chen C, Chen H, Yu P. Repetitive transcranial magnetic stimulation for stroke rehabilitation: insights into the molecular and cellular mechanisms of neuroinflammation. Front Immunol 2023; 14:1197422. [PMID: 37283739 PMCID: PMC10239808 DOI: 10.3389/fimmu.2023.1197422] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023] Open
Abstract
Stroke is a leading cause of mortality and disability worldwide, with most survivors reporting dysfunctions of motor, sensation, deglutition, cognition, emotion, and speech, etc. Repetitive transcranial magnetic stimulation (rTMS), one of noninvasive brain stimulation (NIBS) techniques, is able to modulate neural excitability of brain regions and has been utilized in neurological and psychiatric diseases. Moreover, a large number of studies have shown that the rTMS presents positive effects on function recovery of stroke patients. In this review, we would like to summarized the clinical benefits of rTMS for stroke rehabilitation, including improvements of motor impairment, dysphagia, depression, cognitive function, and central post-stroke pain. In addition, this review will also discuss the molecular and cellular mechanisms underlying rTMS-mediated stroke rehabilitation, especially immune regulatory mechanisms, such as regulation of immune cells and inflammatory cytokines. Moreover, the neuroimaging technique as an important tool in rTMS-mediated stroke rehabilitation has been discussed, to better understanding the mechanisms underlying the effects of rTMS. Finally, the current challenges and future prospects of rTMS-mediated stroke rehabilitation are also elucidated with the intention to accelerate its widespread clinical application.
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Affiliation(s)
- Rongjun Sheng
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Changchun Chen
- Department of Radiology, The People’s Hospital of Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Huan Chen
- Department of Radiology, The People’s Hospital of Longyou, Quzhou, China
| | - Peipei Yu
- Department of Radiology, Sanmen People’s Hospital, Taizhou, China
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Wang H, Hu Y, Deng J, Ye Y, Huang M, Che X, Yu L. A randomised sham-controlled study evaluating rTMS analgesic efficacy for postherpetic neuralgia. Front Neurosci 2023; 17:1158737. [PMID: 37250417 PMCID: PMC10213647 DOI: 10.3389/fnins.2023.1158737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Context Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition in which new treatment options are being developed. Repetitive transcranial magnetic stimulation (rTMS) may have the potential to reduce pain sensations in patients with postherpetic neuralgia. Objectives This study investigated the efficacy on postherpetic neuralgia by stimulating two potential targets, the motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC). Methods This is a double-blind, randomised, sham-controlled study. Potential participants were recruited from Hangzhou First People's Hospital. Patients were randomly assigned to either the M1, DLPFC or Sham group. Patients received ten daily sessions of 10-Hz rTMS in 2 consecutive weeks. The primary outcome measure was visual analogue scale (VAS) assessed at baseline, first week of treatment (week 1), post-treatment (week 2), 1-week (week 4), 1-month (week 6) and 3-month (week 14) follow-up. Results Of sixty patients enrolled, 51 received treatment and completed all outcome assessments. M1 stimulation resulted in a larger analgesia during and after treatment compared to the Sham (week 2 - week 14, p < 0.005), as well as to the DLPFC stimulation (week 1 - week 14, p < 0.05). In addition to pain, sleep disturbance was significantly improved and relieved by targeting either the M1 or the DLPFC (M1: week 4 - week 14, p < 0.01; DLPFC: week 4 - week 14, p < 0.01). Moreover, pain sensations following M1 stimulation uniquely predicted improvement in sleep quality. Conclusion M1 rTMS is superior to DLPFC stimulation in treating PHN with excellent pain response and long-term analgesia. Meanwhile, M1 and DLPFC stimulation were equally effective in improving sleep quality in PHN. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2100051963.
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Affiliation(s)
- Huan Wang
- Zhejiang Chinese Medicine University, Hangzhou, China
- Department of Anesthesiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuzhong Hu
- Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jiayi Deng
- Zhejiang Chinese Medicine University, Hangzhou, China
| | - Yang Ye
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Manli Huang
- Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The Key Laboratory of Mental Disorder Management of Zhejiang Province, Hangzhou, China
| | - Xianwei Che
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- TMS Center, Deqing Hospital of Hangzhou Normal University, Deqing, China
| | - Liang Yu
- Zhejiang Chinese Medicine University, Hangzhou, China
- Department of Pain, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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