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Rafique SA, Steeves JKE. Modulating intrinsic functional connectivity with visual cortex using low-frequency repetitive transcranial magnetic stimulation. Brain Behav 2022; 12:e2491. [PMID: 35049143 PMCID: PMC8865167 DOI: 10.1002/brb3.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Intrinsic network connectivity becomes altered in pathophysiology. Noninvasive brain stimulation can modulate pathological functional networks in an attempt to restore the inherent response. To determine its usefulness for visual-related disorders, we developed procedures investigating repetitive transcranial magnetic stimulation (rTMS) protocols targeting the visual cortex on modulating connectivity associated with the visual network and default mode network (DMN). METHODS We compared two low-frequency (1 Hz) rTMS protocols to the visual cortex (V1)-a single 20 min session and five successive 20 min sessions (accelerated/within-session rTMS)-using multi-echo resting-state functional magnetic resonance whole-brain imaging and resting-state functional connectivity (rsFC). We also explored the relationship between rsFC and rTMS-induced changes in key inhibitory and excitatory neurotransmitters, γ-aminobutyric acid (GABA) and glutamate. GABA (GABA+) and glutamate (Glx) concentrations were measured in vivo using magnetic resonance spectroscopy. RESULTS Acute disruption with a single rTMS session caused widespread connectivity reconfiguration with nodes of interest. Changes were not evident immediately post-rTMS but were observed at 1 h post-rTMS. Accelerated sessions resulted in weak alterations in connectivity, producing a relatively homeostatic response. Changes in GABA+ and Glx concentrations with network connectivity were dependent on the rTMS protocol. CONCLUSIONS This proof-of-concept study offers new perspectives to assess stimulation-induced neural processes involved in intrinsic functional connectivity and the potential for rTMS to modulate nodes interconnected with the visual cortex. The differential effects of single-session and accelerated rTMS on physiological markers are crucial for furthering the advancement of treatment modalities in visual cortex related disorders.
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Affiliation(s)
- Sara A Rafique
- Department of Psychology and Centre for Vision Research, York University, Toronto, Canada
| | - Jennifer K E Steeves
- Department of Psychology and Centre for Vision Research, York University, Toronto, Canada
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Schoorl J, Barbu MC, Shen X, Harris MR, Adams MJ, Whalley HC, Lawrie SM. Grey and white matter associations of psychotic-like experiences in a general population sample (UK Biobank). Transl Psychiatry 2021; 11:21. [PMID: 33414383 PMCID: PMC7791107 DOI: 10.1038/s41398-020-01131-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023] Open
Abstract
There has been a substantial amount of research reporting the neuroanatomical associations of psychotic symptoms in people with schizophrenia. Comparatively little attention has been paid to the neuroimaging correlates of subclinical psychotic symptoms, so-called "psychotic-like experiences" (PLEs), within large healthy populations. PLEs are relatively common in the general population (7-13%), can be distressing and negatively affect health. This study therefore examined gray and white matter associations of four different PLEs (auditory or visual PLEs, and delusional ideas about conspiracies or communications) in subjects of the UK Biobank study with neuroimaging data (N = 21,390, mean age = 63 years). We tested for associations between any PLE (N = 768) and individual PLEs with gray and white matter brain structures, controlling for sex, age, intracranial volume, scanning site, and position in the scanner. Individuals that reported having experienced auditory hallucinations (N = 272) were found to have smaller volumes of the caudate, putamen, and accumbens (β = -0.115-0.134, pcorrected = 0.048-0.036), and reduced temporal lobe volume (β = -0.017, pcorrected = 0.047) compared to those that did not. People who indicated that they had ever believed in unreal conspiracies (N = 111) had a larger volume of the left amygdala (β = 0.023, pcorrected = 0.038). Individuals that reported a history of visual PLEs (N = 435) were found to have reduced white matter microstructure of the forceps major (β = -0.029, pcorrected = 0.009), an effect that was more marked in participants who reported PLEs as distressing. These associations were not accounted for by diagnoses of psychotic or depressive illness, nor the known risk factors for psychotic symptoms of childhood adversity or cannabis use. These findings suggest altered regional gray matter volumes and white matter microstructure in association with PLEs in the general population. They further suggest that these alterations may appear more frequently with the presentation of different psychotic symptoms in the absence of clinically diagnosed psychotic disorders.
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Affiliation(s)
- Julie Schoorl
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Miruna C Barbu
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Xueyi Shen
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mat R Harris
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mark J Adams
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Heather C Whalley
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK.
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Lenka A, Ingalhalikar M, Shah A, Saini J, Arumugham SS, Hegde S, George L, Yadav R, Pal PK. Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis. Neurology 2020; 94:e1876-e1884. [PMID: 32317347 DOI: 10.1212/wnl.0000000000009363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The objective of the current study was to compare the microstructural integrity of the white matter (WM) tracts in patients having Parkinson disease (PD) with and without psychosis (PD-P and PD-NP) through diffusion tensor imaging (DTI). METHODS This cross-sectional study involved 48 PD-NP and 42 PD-P who were matched for age, sex, and education. Tract-based spatial statistics (TBSS) was used to compare several DTI metrics from the diffusion-weighted MRIs obtained through a 3-Tesla scanner. A set of neuropsychological tests was used for the cognitive evaluation of all patients. RESULTS The severity and stage of PD were not statistically different between the groups. The PD-P group performed poorly in all the neuropsychological domains compared with the PD-NP group. TBSS analysis revealed widespread patterns of abnormality in the fractional anisotropy (FA) in the PD-P group, which also correlated with some of the cognitive scores. These tracts include inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, right parieto-occipital WM, body of the corpus callosum, and corticospinal tract. CONCLUSION This study provides novel insights into the putative role of WM tract abnormalities in the pathogenesis of PD-P by demonstrating significant alterations in several WM tracts. Additional longitudinal studies are warranted to confirm the findings of our research.
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Affiliation(s)
- Abhishek Lenka
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Madhura Ingalhalikar
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Apurva Shah
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Jitender Saini
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shyam Sundar Arumugham
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Shantala Hegde
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Lija George
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Ravi Yadav
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC
| | - Pramod Kumar Pal
- From the Department of Clinical Neurosciences (A.L.); Department of Neurology (A.L., L.G., R.Y., P.K.P.); Department of Neuroimaging and Interventional Radiology (J.S.); Department of Psychiatry (S.S.A.); Department of Clinical Psychology (S.H.), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Symbiosis Center for Medical Image Analysis (M.I., A.S.), Symbiosis Institute of Technology (M.I.), Symbiosis International (Deemed University), Lavale, India; and Department of Neurology (A.L.), MedStar Georgetown University Hospital, Washington, DC.
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Rafique SA, Richards JR, Steeves JKE. Altered white matter connectivity associated with visual hallucinations following occipital stroke. Brain Behav 2018; 8:e01010. [PMID: 29781583 PMCID: PMC5991596 DOI: 10.1002/brb3.1010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/11/2018] [Accepted: 04/20/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Visual hallucinations that arise following vision loss stem from aberrant functional activity in visual cortices and an imbalance of activity across associated cortical and subcortical networks subsequent to visual pathway damage. We sought to determine if structural changes in white matter connectivity play a role in cases of chronic visual hallucinations associated with visual cortical damage. METHODS We performed diffusion tensor imaging (DTI) and probabilistic fiber tractography to assess white matter connectivity in a patient suffering from continuous and disruptive phosphene (simple) visual hallucinations for more than 2 years following right occipital stroke. We compared these data to that of healthy age-matched controls. RESULTS Probabilistic tractography to reconstruct white matter tracts suggests regeneration of terminal fibers of the ipsilesional optic radiations in the patient. However, arrangement of the converse reconstruction of these tracts, which were seeded from the ipsilesional visual cortex to the intrahemispheric lateral geniculate body, remained disrupted. We further observed compromised structural characteristics, and changes in diffusion (measured using diffusion tensor indices) of white matter tracts in the patient connecting the visual cortex with frontal and temporal regions, and also in interhemispheric connectivity between visual cortices. CONCLUSIONS Cortical remapping and the disruption of communication between visual cortices and remote regions are consistent with our previous functional magnetic resonance imaging (fMRI) data showing imbalanced functional activity of the same regions in this patient (Rafique et al, 2016, Neurology, 87, 1493-1500). Long-term adaptive and disruptive changes in white matter connectivity may account for the rare nature of cases presenting with chronic and continuous visual hallucinations.
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Affiliation(s)
- Sara A Rafique
- Department of Psychology, Centre for Vision Research, York University, Toronto, ON, Canada
| | - John R Richards
- Department of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, California
| | - Jennifer K E Steeves
- Department of Psychology, Centre for Vision Research, York University, Toronto, ON, Canada
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