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Gonsalves MA, Beck QM, Fukuda AM, Tirrell E, Kokdere F, Kronenberg EF, Iadarola ND, Hagberg S, Carpenter LL, Barredo J. Mechanical Affective Touch Therapy for Anxiety Disorders: Effects on Resting State Functional Connectivity. Neuromodulation 2022; 25:1431-1442. [PMID: 35088729 PMCID: PMC9256848 DOI: 10.1016/j.neurom.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Mechanical Affective Touch Therapy (MATT) is a safe, novel form of noninvasive peripheral nerve stimulation. Although mechanical stimulation activates nerves, we know little about its impact on psychiatric symptoms and their underlying cortical mechanisms. We examined the effects of open-label MATT on resting state functional connectivity (RSFC) and its relationship with anxiety and affective symptomatology (clinical results in separate report). MATERIALS AND METHODS A total of 22 adults with an Axis I anxiety disorder were recruited from the community. After two initial sessions assisted by research staff, participants self-administered 20-minute sessions of MATT at home at least twice daily for four weeks. Self-report measures of mood and anxiety severity were collected at baseline, two weeks, and four weeks. Resting state functional magnetic resonance imaging was collected before the initial MATT session (n = 20), immediately after the first session (n = 18), and following four weeks of MATT (n = 14). Seed-based whole-brain functional connectivity analyses identified brain connectivity patterns correlated with responsiveness to MATT. Seeds were based on Neurosynth meta-analytic maps for "anxiety" and "pain" given MATT's hypothesized role in anxiety symptom amelioration and potential mechanism of action through C-tactile afferents, which play an important role in detecting pain and its affective components. Connectivity results were corrected for multiple comparisons (voxel p < 0.005, cluster p-FDR < 0.05). RESULTS Baseline RSFC is predictive of symptom improvement with chronic MATT. Acute increases in insula connectivity were observed between mid-cingulate cortex and postcentral motor regions following the first MATT session. Chronic MATT was associated with increased connectivity between pain and anxiety regions of interest (ROIs) and posterior default mode network (DMN) regions involved in memory and self-reflection; the connectivity changes correlated with decreases in stress and depression symptoms. CONCLUSIONS MATT is associated with alterations in RSFC in the DMN of anxiety disorder patients both acutely and after long-term administration, and baseline RSFC is predictive of post-treatment symptom improvement.
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Affiliation(s)
- Meghan A Gonsalves
- Neuroscience Graduate Program, Department of Neuroscience, Brown University, Providence, RI, USA; Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA.
| | - Quincy M Beck
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Andrew M Fukuda
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Eric Tirrell
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Fatih Kokdere
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Eugenia F Kronenberg
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA
| | - Nicolas D Iadarola
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
| | - Sean Hagberg
- AffectNeuro, Inc, Brooklyn, NY, USA; Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Linda L Carpenter
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Barredo
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
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Feusner JD, Madsen S, Moody TD, Bohon C, Hembacher E, Bookheimer SY, Bystritsky A. Effects of cranial electrotherapy stimulation on resting state brain activity. Brain Behav 2012; 2:211-20. [PMID: 22741094 PMCID: PMC3381625 DOI: 10.1002/brb3.45] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/10/2012] [Indexed: 11/11/2022] Open
Abstract
Cranial electrotherapy stimulation (CES) is a U.S. Food and Drug Administration (FDA)-approved treatment for insomnia, depression, and anxiety consisting of pulsed, low-intensity current applied to the earlobes or scalp. Despite empirical evidence of clinical efficacy, its mechanism of action is largely unknown. The goal was to characterize the acute effects of CES on resting state brain activity. Our primary hypothesis was that CES would result in deactivation in cortical and subcortical regions. Eleven healthy controls were administered CES applied to the earlobes at subsensory thresholds while being scanned with functional magnetic resonance imaging in the resting state. We tested 0.5- and 100-Hz stimulation, using blocks of 22 sec "on" alternating with 22 sec of baseline (device was "off"). The primary outcome measure was differences in blood oxygen level dependent data associated with the device being on versus baseline. The secondary outcome measures were the effects of stimulation on connectivity within the default mode, sensorimotor, and fronto-parietal networks. Both 0.5- and 100-Hz stimulation resulted in significant deactivation in midline frontal and parietal regions. 100-Hz stimulation was associated with both increases and decreases in connectivity within the default mode network (DMN). Results suggest that CES causes cortical brain deactivation, with a similar pattern for high- and low-frequency stimulation, and alters connectivity in the DMN. These effects may result from interference from high- or low-frequency noise. Small perturbations of brain oscillations may therefore have significant effects on normal resting state brain activity. These results provide insight into the mechanism of action of CES, and may assist in the future development of optimal parameters for effective treatment.
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Affiliation(s)
- Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sarah Madsen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Teena D. Moody
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Cara Bohon
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Emily Hembacher
- Department of Psychology, University of California, Davis, California
| | - Susan Y. Bookheimer
- Center for Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
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Bracciano AG, Chang WP, Kokesh S, Martinez A, Meier M, Moore K. Cranial Electrotherapy Stimulation in the Treatment of Posttraumatic Stress Disorder: A Pilot Study of Two Military Veterans. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/10874208.2012.650100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Volkow ND, Tomasi D, Wang GJ, Fowler JS, Telang F, Wang R, Alexoff D, Logan J, Wong C, Pradhan K, Caparelli EC, Ma Y, Jayne M. Effects of low-field magnetic stimulation on brain glucose metabolism. Neuroimage 2010; 51:623-8. [PMID: 20156571 DOI: 10.1016/j.neuroimage.2010.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 01/19/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022] Open
Abstract
Echo planar imaging (EPI), the gold standard technique for functional MRI (fMRI), is based on fast magnetic field gradient switching. These time-varying magnetic fields induce electric (E) fields in the brain that could influence neuronal activity; but this has not been tested. Here we assessed the effects of EPI on brain glucose metabolism (marker of brain function) using PET and 18F 2-fluoro-2-deoxy-D-glucose ((18)FDG). Fifteen healthy subjects were in a 4 T magnet during the (18)FDG uptake period twice: with (ON) and without (OFF) EPI gradients pulses along the z-axis (G(z): 23 mT/m; 250 mus rise-time; 920 Hz). The E-field from these EPI pulses is non-homogeneous, increasing linearly from the gradient's isocenter (radial and z directions), which allowed us to assess the correlation between local strength of the E-field and the regional metabolic differences between ON and OFF sessions. Metabolic images were normalized to metabolic activity in the plane positioned at the gradient's isocenter where E=0 for both ON and OFF conditions. Statistical parametric analyses used to identify regions that differed between ON versus OFF (p<0.05, corrected) showed that the relative metabolism was lower in areas at the poles of the brain (inferior occipital and frontal and superior parietal cortices) for ON than for OFF, which was also documented with individual region of interest analysis. Moreover the magnitude of the metabolic decrements was significantly correlated with the estimated strength of E (r=0.68, p<0.0001); the stronger the E-field the larger the decreases. However, we did not detect differences between ON versus OFF conditions on mood ratings nor on absolute whole brain metabolism. This data provides preliminary evidence that EPI sequences may affect neuronal activity and merits further investigation.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, Bethesda, MD 20892, USA.
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Shealy CN, Thomlinson P. Safe Effective Nondrug Treatment of Chronic Depression: A Review of Research on Low-Voltage Cranial Electrical Stimulation and Other Adjunctive Therapies. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/1533210108317232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although clinical practice guidelines tend to emphasize pharmacological treatments for chronic depression, safe and effective nondrug treatments are available. This article reviews three decades of research at the Shealy Institute on nonpharmacological treatments for chronic depression in chronic pain patients via low-voltage electrical stimulation and other adjunctive therapies. More than 30,000 chronically depressed patients have been treated with cranial electrical stimulation at 1 to 2 mA at 15,000 Hz, modulated at 500 and 15 Hz. Approximately half of patients treated with this approach experienced marked clinical improvement. When combined with photostimulation at 1 to 7 Hz, 85% of patients improved adequately without use of antidepressant drugs and without complications. Magnesium replacement and nutrition education are useful adjuncts. This program is cost effective and can be carried out by a nurse practitioner and an assistant. Further controlled clinical research and research on mechanisms of action would strengthen the validity of these findings and increase the application of these therapeutic approaches.
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