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Huang Y, Zelmann R, Hadar P, Dezha-Peralta J, Richardson RM, Williams ZM, Cash SS, Keller CJ, Paulk AC. Theta-burst direct electrical stimulation remodels human brain networks. Nat Commun 2024; 15:6982. [PMID: 39143083 PMCID: PMC11324911 DOI: 10.1038/s41467-024-51443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
Theta-burst stimulation (TBS), a patterned brain stimulation technique that mimics rhythmic bursts of 3-8 Hz endogenous brain rhythms, has emerged as a promising therapeutic approach for treating a wide range of brain disorders, though the neural mechanism of TBS action remains poorly understood. We investigated the neural effects of TBS using intracranial EEG (iEEG) in 10 pre-surgical epilepsy participants undergoing intracranial monitoring. Here we show that individual bursts of direct electrical TBS at 29 frontal and temporal sites evoked strong neural responses spanning broad cortical regions. These responses exhibited dynamic local field potential voltage changes over the course of stimulation presentations, including either increasing or decreasing responses, suggestive of short-term plasticity. Stronger stimulation augmented the mean TBS response amplitude and spread with more recording sites demonstrating short-term plasticity. TBS responses were stimulation site-specific with stronger TBS responses observed in regions with strong baseline stimulation effective (cortico-cortical evoked potentials) and functional (low frequency phase locking) connectivity. Further, we could use these measures to predict stable and varying (e.g. short-term plasticity) TBS response locations. Future work may integrate pre-treatment connectivity alongside other biophysical factors to personalize stimulation parameters, thereby optimizing induction of neuroplasticity within disease-relevant brain networks.
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Affiliation(s)
- Yuhao Huang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Hadar
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaquelin Dezha-Peralta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Yeh CH, Lin PC, Tseng RY, Chao YP, Wu CT, Chou TL, Chen RS, Gau SSF, Ni HC, Lin HY. Lack of effects of eight-week left dorsolateral prefrontal theta burst stimulation on white matter macro/microstructure and connection in autism. Brain Imaging Behav 2024; 18:794-807. [PMID: 38492129 DOI: 10.1007/s11682-024-00874-x] [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] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
Whether brain stimulation could modulate brain structure in autism remains unknown. This study explored the impact of continuous theta burst stimulation (cTBS) over the left dorsolateral prefrontal cortex (DLPFC) on white matter macro/microstructure in intellectually able children and emerging adults with autism. Sixty autistic participants were randomized (30 active) and received active or sham cTBS for eight weeks twice per week, 16 total sessions using a double-blind (participant-, rater-, analyst-blinded) design. All participants received high-angular resolution diffusion MR imaging at baseline and week 8. Twenty-eight participants in the active group and twenty-seven in the sham group with good imaging quality entered the final analysis. With longitudinal fixel-based analysis and network-based statistics, we found no significant difference between the active and sham groups in changes of white matter macro/microstructure and connections following cTBS. In addition, we found no association between baseline white matter macro/microstructure and autistic symptom changes from baseline to week 8 in the active group. In conclusion, we did not find a significant impact of left DLPFC cTBS on white matter macro/microstructure and connections in children and emerging adults with autism. These findings need to be interpreted in the context that the current intellectually able cohort in a single university hospital site limits the generalizability. Future studies are required to investigate if higher stimulation intensities and/or doses, other personal factors, or rTMS parameters might confer significant brain structural changes visible on MRI in ASD.
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Affiliation(s)
- Chun-Hung Yeh
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan
| | - Po-Chun Lin
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan
| | - Rung-Yu Tseng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Deparment of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tai-Li Chou
- Department of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Rou-Shayn Chen
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hsing-Chang Ni
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, No.5 Fusing St. Gueishan, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Speranza BE, Hill AT, Do M, Cerins A, Donaldson PH, Desarkar P, Oberman LM, Das S, Enticott PG, Kirkovski M. The Neurophysiological Effects of Theta Burst Stimulation as Measured by Electroencephalography: A Systematic Review. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00206-4. [PMID: 39084526 DOI: 10.1016/j.bpsc.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
Theta burst stimulation (TBS) is a non-invasive brain stimulation technique that can modulate neural activity. The effect of TBS on regions beyond the motor cortex remains unclear. With increased interest in applying TBS to non-motor regions for research and clinical purposes, these effects must be understood and characterised. We synthesised the electrophysiological effects of a single session of TBS, as indexed by electroencephalography (EEG) and concurrent transcranial magnetic stimulation and EEG (TMS-EEG), in non-clinical participants. We reviewed 79 studies that administered either continuous TBS (cTBS) or intermittent TBS (iTBS) protocols. Broadly, cTBS suppressed and iTBS facilitated evoked response component amplitudes. Response to TBS as measured by spectral power and connectivity was much more variable. Variability increased in the presence of task stimuli. There was a large degree of heterogeneity in the research methodology across studies. Additionally, the effect of individual differences on TBS response is insufficiently investigated. Future research investigating the effects of TBS as measured by EEG must consider methodological and individual factors that may affect TBS outcomes.
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Affiliation(s)
- Bridgette E Speranza
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia.
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Michael Do
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Andris Cerins
- Brain Stimulation Lab, Alfred Psychiatry Research Centre, Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Peter H Donaldson
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lindsay M Oberman
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sushmit Das
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia; Institute for Health and Sport, Victoria University, Melbourne, Australia
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Vergallito A, Gesi C, Torriero S. Intermittent Theta Burst Stimulation Combined with Cognitive Training to Improve Negative Symptoms and Cognitive Impairment in Schizophrenia: A Pilot Study. Brain Sci 2024; 14:683. [PMID: 39061423 PMCID: PMC11274516 DOI: 10.3390/brainsci14070683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Schizophrenia is a chronic psychiatric disorder severely affecting patients' functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms cannot be treated pharmacologically and represent consistent predictors of the illness's prognosis. Cognitive remediation (CR) interventions have been applied to target these symptoms. Brain stimulation also provides promising yet preliminary results in reducing negative symptoms, whereas its effect on cognitive impairment remains heterogeneous. Here, we combined intermittent theta burst stimulation (iTBS) with CR to improve negative symptoms and cognitive impairment in schizophrenia spectrum patients. One hundred eligible patients were invited, and twenty-one participated. We randomized them into four groups, manipulating the stimulation condition (real vs. sham) and CR (no training vs. training). We delivered fifteen iTBS sessions over the left dorsolateral prefrontal cortex for three weeks, followed (or not) by 50 min of training. Consensus-based clinical and cognitive assessment was administered at baseline and after the treatment, plus at three follow-ups occurring one, three, and six months after the intervention. Mixed-model analyses were run on cognitive and negative symptom scores. The preliminary findings highlighted a marginal modulation of iTBS on negative symptoms, whereas CR improved isolated cognitive functions. We herein discuss the limitations and strengths of the methodological approach.
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Affiliation(s)
- Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milan, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
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Walther S, Alexaki D, Weiss F, Baumann-Gama D, Kyrou A, Nuoffer MG, Wüthrich F, Lefebvre S, Nadesalingam N. Psychomotor Slowing in Psychosis and Inhibitory Repetitive Transcranial Magnetic Stimulation: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:563-571. [PMID: 38416468 PMCID: PMC10902782 DOI: 10.1001/jamapsychiatry.2024.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024]
Abstract
Importance Psychomotor slowing is a frequent symptom of psychosis, impairing gross and fine motor behavior. It is associated with poor outcomes and functioning, and no treatment is available. Objective To investigate whether 15 sessions of inhibitory repetitive transcranial magnetic stimulation (rTMS) may reduce psychomotor slowing. Design, Setting, and Participants This was a 4-arm, double-blind, randomized, sham-controlled trial at a university hospital in Switzerland. Enrollment took place from March 2019 to August 2022. Adults aged 18 to 60 years with schizophrenia spectrum disorders and severe psychomotor slowing were eligible. All patients continued existing medications, including antipsychotics and benzodiazepines. Those with substance misuse (other than nicotine), conditions associated with impaired or aberrant movement, convulsions, history of hearing problems, other conditions typically excluded from magnetic resonance imaging or TMS, any TMS treatment in the past 3 months, or those who were pregnant or breastfeeding were excluded. Of 615 patients screened for eligibility, 103 were randomized and 88 received at least 1 session of rTMS: 22 were assigned to 1-Hz rTMS, 22 to iTBS, 22 to sham, and 22 to the waiting group. Follow-up was conducted at 6 weeks and 24 weeks following the week 3 assessments including clinical, functional, and motor measures. Interventions Fifteen sessions of rTMS in 3 weeks over the supplementary motor area: 1-Hz rTMS, iTBS, sham, or no treatment (waiting). After 3 weeks, the waiting group received 15 sessions of 1-Hz rTMS over the supplementary motor area. Main Outcomes and Measures The main outcome was the proportion of responders at week 3 in the Salpêtrière Retardation Rating Scale (SRRS) defined as a 30% or greater reduction from baseline (last-observation-carried-forward). The SRRS has 15 items and a maximum total score of 60. Results Of the 88 participants analyzed, 45 were men and 43 were women. The mean (SD) age was 36.3 (12.4) years and the mean (SD) SRRS score was 24.0 (5.9). A total of 69 participants completed the study. At week 3, response rates differed between groups: 15 of 22 (68%) in the 1-Hz rTMS group, 8 of 22 (36%) in the iTBS group, 7 of 22 (32%) in the sham group, and 4 of 22 (18%) in the waiting group (χ23 = 12.1; P = .007). The 1-Hz rTMS group had more responders than sham (odds ratio [OR], 0.13; 95% CI, 0.02-0.65; P = .03), iTBS (OR, 0.12; 95% CI, 0.02-0.61; P = .02), and waiting (OR, 0.04; 95% CI, 0.01-0.22; P = .003). In the waiting group, 10 of 16 participants (63%) responded after receiving 15 sessions of 1-Hz rTMS. No serious adverse events occurred. Conclusions and Relevance In this study, inhibitory add-on rTMS safely alleviated psychomotor slowing in psychosis compared with iTBS, sham, and no treatment. The treatment was also effective with delayed onset. Future studies need to explore the neural changes associated with supplementary motor area rTMS in psychosis. Trial Registration ClinicalTrials.gov Identifier: NCT03921450.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Florian Weiss
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel Baumann-Gama
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Kyrou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Melanie G. Nuoffer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Florian Wüthrich
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Stephanie Lefebvre
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Taylor SF, Gu P, Simmonite M, Lasagna C, Tso IF, Lee TG, Vesia M, Hernandez-Garcia L. Lateral Prefrontal Stimulation of Active Cortex With Theta Burst Transcranial Magnetic Stimulation Affects Subsequent Engagement of the Frontoparietal Network. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:235-244. [PMID: 37918508 PMCID: PMC10922157 DOI: 10.1016/j.bpsc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND A critical unanswered question about therapeutic transcranial magnetic stimulation is what patients should do during treatment to optimize its effectiveness. Here, we address this lack of knowledge in healthy participants, testing the hypotheses that stimulating the left dorsolateral prefrontal cortex (dlPFC) while participants perform a working memory task will provide stronger effects on subsequent activation, perfusion, connectivity, and performance than stimulating resting dlPFC. METHODS After a baseline functional magnetic resonance imaging session to localize dlPFC activation and the associated frontoparietal network (FPN) engaged by an n-back task, healthy participants (N = 40, 67.5% female) underwent 3 counterbalanced sessions, separated by several weeks, during which they received intermittent theta burst stimulation (iTBS) followed by magnetic resonance imaging scans as follows: 1) iTBS to the dlPFC while resting passively (passive), 2) iTBS to the dlPFC while performing the n-back task (active), and 3) iTBS to a vertex site, while not engaged in the n-back task and resting passively (control). RESULTS We found no difference in n-back performance between the 3 conditions. However, FPN activation was reduced while performing the n-back task in the active condition relative to the passive and control conditions. There was no differential activity in the FPN on comparing passive with control conditions, i.e., there was no effect of the site of stimulation. We found no effects of state or site of stimulation on perfusion or connectivity with the dlPFC. CONCLUSIONS In this study, the state of the brain while receiving iTBS affected FPN activation, possibly reflecting greater efficiency of FPN network activation when participants were stimulated while engaging the FPN.
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Affiliation(s)
- Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Psychology, University of Michigan, Ann Arbor, Michigan.
| | - Pan Gu
- Department of Neuroscience, University of Texas at Dallas, Richardson, Texas
| | - Molly Simmonite
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Carly Lasagna
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Ivy F Tso
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Taraz G Lee
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Michael Vesia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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Nguyen TXD, Kuo CW, Peng CW, Liu HL, Chang MY, Hsieh TH. Transcranial burst electrical stimulation contributes to neuromodulatory effects in the rat motor cortex. Front Neurosci 2023; 17:1303014. [PMID: 38146544 PMCID: PMC10749301 DOI: 10.3389/fnins.2023.1303014] [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: 09/27/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Background and objective Transcranial Burst Electrical Stimulation (tBES) is an innovative non-invasive brain stimulation technique that combines direct current (DC) and theta burst stimulation (TBS) for brain neuromodulation. It has been suggested that the tBES protocol may efficiently induce neuroplasticity. However, few studies have systematically tested neuromodulatory effects and underlying neurophysiological mechanisms by manipulating the polarity of DC and TBS patterns. This study aimed to develop the platform and assess neuromodulatory effects and neuronal activity changes following tBES. Methods Five groups of rats were exposed to anodal DC combined with intermittent TBS (tBES+), cathodal DC combined with continuous TBS (tBES-), anodal and cathodal transcranial direct current stimulation (tDCS+ and tDCS-), and sham groups. The neuromodulatory effects of each stimulation on motor cortical excitability were analyzed by motor-evoked potentials (MEPs) changes. We also investigated the effects of tBES on both excitatory and inhibitory neural biomarkers. We specifically examined c-Fos and glutamic acid decarboxylase (GAD-65) using immunohistochemistry staining techniques. Additionally, we evaluated the safety of tBES by analyzing glial fibrillary acidic protein (GFAP) expression. Results Our findings demonstrated significant impacts of tBES on motor cortical excitability up to 30 min post-stimulation. Specifically, MEPs significantly increased after tBES (+) compared to pre-stimulation (p = 0.026) and sham condition (p = 0.025). Conversely, tBES (-) led to a notable decrease in MEPs relative to baseline (p = 0.04) and sham condition (p = 0.048). Although tBES showed a more favorable neuromodulatory effect than tDCS, statistical analysis revealed no significant differences between these two groups (p > 0.05). Additionally, tBES (+) exhibited a significant activation of excitatory neurons, indicated by increased c-Fos expression (p < 0.05), and a reduction in GAD-65 density (p < 0.05). tBES (-) promoted GAD-65 expression (p < 0.05) while inhibiting c-Fos activation (p < 0.05), suggesting the involvement of cortical inhibition with tBES (-). The expression of GFAP showed no significant difference between tBES and sham conditions (p > 0.05), indicating that tBES did not induce neural injury in the stimulated regions. Conclusion Our study indicates that tBES effectively modulates motor cortical excitability. This research significantly contributes to a better understanding of the neuromodulatory effects of tBES, and could provide valuable evidence for its potential clinical applications in treating neurological disorders.
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Affiliation(s)
- Thi Xuan Dieu Nguyen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Wei Kuo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hao-Li Liu
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ming-Yuan Chang
- Division of Neurosurgery, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Upton S, Brown AA, Ithman M, Newman-Norlund R, Sahlem G, Prisciandaro JJ, McClure EA, Froeliger B. Effects of Hyperdirect Pathway Theta Burst Transcranial Magnetic Stimulation on Inhibitory Control, Craving, and Smoking in Adults With Nicotine Dependence: A Double-Blind, Randomized Crossover Trial. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1156-1165. [PMID: 37567363 PMCID: PMC10840958 DOI: 10.1016/j.bpsc.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Nicotine dependence is associated with dysregulated hyperdirect pathway (HDP)-mediated inhibitory control (IC). However, there are currently no evidence-based treatments that have been shown to target the HDP to improve IC and reduce cigarette cravings and smoking. METHODS Following a baseline nonstimulation control session, this study (N = 37; female: n = 17) used a double-blind, randomized crossover design to examine the behavioral and neural effects of intermittent theta burst stimulation (iTBS) and continuous TBS (cTBS) to the right inferior frontal gyrus (rIFG)-a key cortical node of the HDP. Associations between treatment effects were also explored. RESULTS At baseline, HDP IC task-state functional connectivity was positively associated with IC task performance, which confirmed the association between HDP circuit function and IC. Compared with iTBS, rIFG cTBS improved IC task performance. Compared with the baseline nonstimulation control session, both TBS conditions reduced cigarette craving and smoking; however, although craving and smoking were lower for cTBS, no differences were found between the two active conditions. In addition, although HDP IC task-state functional connectivity was greater following cTBS than iTBS, there was no significant difference between conditions. Finally, cTBS-induced improvement in IC task performance was associated with reduced craving, and cTBS-induced reduction in craving was associated with reduced smoking. CONCLUSIONS These findings warrant further investigation into the effects of rIFG cTBS for increasing IC and reducing craving and smoking among individuals with nicotine dependence. Future sham-controlled cTBS studies may help further elucidate the mechanisms by which rIFG cTBS mediates IC and smoking behavior.
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Affiliation(s)
- Spencer Upton
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Alexander A Brown
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Muaid Ithman
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Roger Newman-Norlund
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Greg Sahlem
- Department of Psychiatry, Stanford University Medical Center, Palo Alto, California
| | - Jim J Prisciandaro
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Erin A McClure
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Brett Froeliger
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri; Department of Psychiatry, University of Missouri, Columbia, Missouri; Cognitive Neuroscience Systems Core Facility, University of Missouri, Columbia, Missouri.
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Rashid-López R, Macías-García P, Sánchez-Fernández FL, Cano-Cano F, Sarrias-Arrabal E, Sanmartino F, Méndez-Bértolo C, Lozano-Soto E, Gutiérrez-Cortés R, González-Moraleda Á, Forero L, López-Sosa F, Zuazo A, Gómez-Molinero R, Gómez-Ramírez J, Paz-Expósito J, Rubio-Esteban G, Espinosa-Rosso R, Cruz-Gómez ÁJ, González-Rosa JJ. Neuroimaging and serum biomarkers of neurodegeneration and neuroplasticity in Parkinson's disease patients treated by intermittent theta-burst stimulation over the bilateral primary motor area: a randomized, double-blind, sham-controlled, crossover trial study. Front Aging Neurosci 2023; 15:1258315. [PMID: 37869372 PMCID: PMC10585115 DOI: 10.3389/fnagi.2023.1258315] [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: 07/13/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background and objectives Intermittent theta-burst stimulation (iTBS) is a patterned form of excitatory transcranial magnetic stimulation that has yielded encouraging results as an adjunctive therapeutic option to alleviate the emergence of clinical deficits in Parkinson's disease (PD) patients. Although it has been demonstrated that iTBS influences dopamine-dependent corticostriatal plasticity, little research has examined the neurobiological mechanisms underlying iTBS-induced clinical enhancement. Here, our primary goal is to verify whether iTBS bilaterally delivered over the primary motor cortex (M1) is effective as an add-on treatment at reducing scores for both motor functional impairment and nonmotor symptoms in PD. We hypothesize that these clinical improvements following bilateral M1-iTBS could be driven by endogenous dopamine release, which may rebalance cortical excitability and restore compensatory striatal volume changes, resulting in increased striato-cortico-cerebellar functional connectivity and positively impacting neuroglia and neuroplasticity. Methods A total of 24 PD patients will be assessed in a randomized, double-blind, sham-controlled crossover study involving the application of iTBS over the bilateral M1 (M1 iTBS). Patients on medication will be randomly assigned to receive real iTBS or control (sham) stimulation and will undergo 5 consecutive sessions (5 days) of iTBS over the bilateral M1 separated by a 3-month washout period. Motor evaluation will be performed at different follow-up visits along with a comprehensive neurocognitive assessment; evaluation of M1 excitability; combined structural magnetic resonance imaging (MRI), resting-state electroencephalography and functional MRI; and serum biomarker quantification of neuroaxonal damage, astrocytic reactivity, and neural plasticity prior to and after iTBS. Discussion The findings of this study will help to clarify the efficiency of M1 iTBS for the treatment of PD and further provide specific neurobiological insights into improvements in motor and nonmotor symptoms in these patients. This novel project aims to yield more detailed structural and functional brain evaluations than previous studies while using a noninvasive approach, with the potential to identify prognostic neuroprotective biomarkers and elucidate the structural and functional mechanisms of M1 iTBS-induced plasticity in the cortico-basal ganglia circuitry. Our approach may significantly optimize neuromodulation paradigms to ensure state-of-the-art and scalable rehabilitative treatment to alleviate motor and nonmotor symptoms of PD.
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Affiliation(s)
- Raúl Rashid-López
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Paloma Macías-García
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - F. Luis Sánchez-Fernández
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Fátima Cano-Cano
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Esteban Sarrias-Arrabal
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Florencia Sanmartino
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Constantino Méndez-Bértolo
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Elena Lozano-Soto
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Remedios Gutiérrez-Cortés
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - Álvaro González-Moraleda
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Lucía Forero
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Fernando López-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Amaya Zuazo
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Jaime Gómez-Ramírez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
| | - José Paz-Expósito
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Raúl Espinosa-Rosso
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Neurology, Jerez de la Frontera University Hospital, Jerez de la Frontera, Spain
| | - Álvaro J. Cruz-Gómez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Javier J. González-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cadiz, Spain
- Department of Psychology, University of Cadiz, Cádiz, Spain
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McNerney MW, Gurkoff GG, Beard C, Berryhill ME. The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies. Brain Sci 2023; 13:1402. [PMID: 37891771 PMCID: PMC10605899 DOI: 10.3390/brainsci13101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.
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Affiliation(s)
- M. Windy McNerney
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gene G. Gurkoff
- Department of Neurological Surgery, and Center for Neuroscience, University of California, Davis, Sacramento, CA 95817, USA;
- Department of Veterans Affairs, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Charlotte Beard
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Program in Neuroscience and Behavioral Biology, Emory University, Atlanta, GA 30322, USA
| | - Marian E. Berryhill
- Programs in Cognitive and Brain Sciences, and Integrative Neuroscience, Department of Psychology, University of Nevada, Reno, NV 89557, USA
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Kuo PH, Chen AYC, Rodriguez RJ, Stuehm C, Chalasani P, Chen NK, Chou YH. Transcranial Magnetic Stimulation for the Treatment of Chemo Brain. SENSORS (BASEL, SWITZERLAND) 2023; 23:8017. [PMID: 37836847 PMCID: PMC10575384 DOI: 10.3390/s23198017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/04/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
This pilot feasibility study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) on chemotherapy-related cognitive impairment (CRCI), and we report here on the first patient. BACKGROUND Deleterious cognitive changes due to chemotherapy or CRCI are commonly referred to as "chemo brain". With the increasing survival of cancer patients, this poorly understood and inadequately treated condition will likewise have an increasing toll on individuals and society. Since there is no approved treatment for chemo brain, we have initiated a therapeutic trial using transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique approved in many countries for the treatment of neurologic and psychiatric conditions like migraine and depression. CASE PRESENTATION A 58-year-old woman, diagnosed 7 years prior with left breast cancer, underwent partial mastectomy with sentinel lymph node biopsy. She then received four cycles of adjuvant chemotherapy followed by radiation therapy. Afterwards, she was on tamoxifen for 4 years and then switched to aromatase inhibitors. The patient's CRCI started during chemotherapy and severely impaired her quality of life for an additional two years. In the third year after chemotherapy, the CRCI partially cleared to stabilize to the level at the time of presentation for this trial. The patient continues to have memory difficulties and decreased concentration, which makes multi-tasking very difficult to impossible. She is reliant on memory aids at work and at home. The participant underwent 10 consecutive sessions of TMS during weekdays for 2 weeks. Stimulation was directed to the left dorsolateral prefrontal cortex. After TMS, the participant significantly improved in memory function on neuropsychological testing. While she reported no subjective differences in concentration or memory, she did report an improvement in her sleep. Functional magnetic resonance imaging of the brain before and after TMS showed increased resting-state functional connectivity between the stimulation site and several brain regions. Remarkably, after 6 years of chemo brain and remaining in the same position at work due to her inability to concentrate and multi-task, she applied for and received a promotion 5-6 months after her TMS treatments. CONCLUSIONS This first patient in the phase 1 clinical trial testing of TMS for the treatment of "chemo brain" provided important lessons for feasibility and insights into mechanisms of potential benefit.
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Affiliation(s)
- Phillip H. Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Allison Yu-Chin Chen
- Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | | | - Carol Stuehm
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA;
| | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington Cancer Center, Washington, DC 20037, USA;
| | - Nan-Kuei Chen
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA;
| | - Ying-Hui Chou
- Brain Imaging and TMS Laboratory, Department of Psychology, Evelyn F McKnight Brain Institute, Arizona Center on Aging, BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA;
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Upton S, Brown AA, Golzy M, Garland EL, Froeliger B. Right inferior frontal gyrus theta-burst stimulation reduces smoking behaviors and strengthens fronto-striatal-limbic resting-state functional connectivity: a randomized crossover trial. Front Psychiatry 2023; 14:1166912. [PMID: 37457779 PMCID: PMC10338839 DOI: 10.3389/fpsyt.2023.1166912] [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: 02/15/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Functional and anatomical irregularities in the right inferior frontal gyrus (rIFG), a ventrolateral prefrontal region that mediates top-down inhibitory control over prepotent behavioral responding, are implicated in the ongoing maintenance of nicotine dependence (ND). However, there is little research on the effects of neuromodulation of the rIFG on smoking behavior, inhibitory control, and resting-state functional connectivity (rsFC) among individuals with ND. Methods In this double-blind, crossover, theta-burst stimulation (TBS) study, adults with ND (N = 31; female: n = 15) completed a baseline session and were then randomized to two counterbalanced sessions of functionally neuronavigated TBS to the rIFG: continuous TBS (cTBS) on 1 day and intermittent TBS (iTBS) on another. Differences in cigarette cravings, smoking, and fronto-striatal-limbic rsFC were assessed. Results Relative to baseline, cTBS significantly reduced appetitive and withdrawal cravings immediately after treatment. The effects of cTBS on withdrawal craving persisted for 24 h, as well as produced a reduction in smoking. Furthermore, cTBS significantly strengthened rsFC between the rIFG pars opercularis and subcallosal cingulate (fronto-striatal circuit), and between the rIFG pars opercularis and the right posterior parahippocampal gyrus (fronto-limbic circuit). At post-24 h, cTBS-induced increase in fronto-striatal rsFC was significantly associated with less appetitive craving, while the increase in fronto-limbic rsFC was significantly associated with less withdrawal craving and smoking. Discussion These findings warrant further investigation into the potential value of rIFG cTBS to attenuate smoking behavior among individuals with ND.
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Affiliation(s)
- Spencer Upton
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Alexander A. Brown
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
- Department of Psychiatry, School of Medicine, University of Missouri, Columbia, MO, United States
- Cognitive Neuroscience Systems Core Facility, University of Missouri, Columbia, MO, United States
| | - Mojgan Golzy
- Biostatistics Unit, Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, United States
| | - Brett Froeliger
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
- Department of Psychiatry, School of Medicine, University of Missouri, Columbia, MO, United States
- Cognitive Neuroscience Systems Core Facility, University of Missouri, Columbia, MO, United States
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