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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: 5] [Impact Index Per Article: 5.0] [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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Downar J, Siddiqi SH, Mitra A, Williams N, Liston C. Mechanisms of Action of TMS in the Treatment of Depression. Curr Top Behav Neurosci 2024; 66:233-277. [PMID: 38844713 DOI: 10.1007/7854_2024_483] [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] [Indexed: 07/26/2024]
Abstract
Transcranial magnetic stimulation (TMS) is entering increasingly widespread use in treating depression. The most common stimulation target, in the dorsolateral prefrontal cortex (DLPFC), emerged from early neuroimaging studies in depression. Recently, more rigorous casual methods have revealed whole-brain target networks and anti-networks based on the effects of focal brain lesions and focal brain stimulation on depression symptoms. Symptom improvement during therapeutic DLPFC-TMS appears to involve directional changes in signaling between the DLPFC, subgenual and dorsal anterior cingulate cortex, and salience-network regions. However, different networks may be involved in the therapeutic mechanisms for other TMS targets in depression, such as dorsomedial prefrontal cortex or orbitofrontal cortex. The durability of therapeutic effects for TMS involves synaptic neuroplasticity, and specifically may depend upon dopamine acting at the D1 receptor family, as well as NMDA-receptor-dependent synaptic plasticity mechanisms. Although TMS protocols are classically considered 'excitatory' or 'inhibitory', the actual effects in individuals appear quite variable, and might be better understood at the level of populations of synapses rather than individual synapses. Synaptic meta-plasticity may provide a built-in protective mechanism to avoid runaway facilitation or inhibition during treatment, and may account for the relatively small number of patients who worsen rather than improve with TMS. From an ethological perspective, the antidepressant effects of TMS may involve promoting a whole-brain attractor state associated with foraging/hunting behaviors, centered on the rostrolateral periaqueductal gray and salience network, and suppressing an attractor state associated with passive threat defense, centered on the ventrolateral periaqueductal gray and default-mode network.
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Affiliation(s)
- Jonathan Downar
- Department of Psychiatry, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anish Mitra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Conor Liston
- Department of Psychiatry, Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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Moriyasu S, Shimizu T, Honda M, Ugawa Y, Hanajima R. Motor cortical plasticity and its correlation with motor symptoms in Parkinson's disease. eNeurologicalSci 2022; 29:100422. [PMID: 36097517 PMCID: PMC9463550 DOI: 10.1016/j.ensci.2022.100422] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/06/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background The relationship between abnormal cortical plasticity and parkinsonian symptoms remains unclear in Parkinson's disease (PD). Objective We studied the relationship between their symptoms and degree of Long-term potentiation (LTP)-like effects induced by quadripulse magnetic stimulation (QPS) over the primary motor cortex, which has a small inter-individual variability in humans. Methods Participants were 16 PD patients (drug-naïve or treated with L-DOPA monotherapy) and 13 healthy controls (HC). LTP-like effects by QPS were compared between three conditions (HC、PD with or without L-DOPA). In PD, correlation analyses were performed between clinical scores (MDS-UPDRS, MMSE and MoCA-J) and the degree of LTP-like effects induced by QPS. Results In PD, QPS-induced LTP-like effect was reduced and restored by L-DOPA. The degree of the LTP was negatively correlated with MDS-UPDRS Part I and III scores, but not with MMSE and MoCA-J. In the sub-scores, upper limb bradykinesia and rigidity showed a negative correlation with the LTP-like effect whereas the tremor had no correlation. Conclusions Our results suggest that motor cortical plasticity relate with mechanisms underlying bradykinesia and rigidity in the upper limb muscles. LTP induced by QPS may be used as an objective marker of parkinsonian symptoms. Quadripulse magnetic stimulation (QPS) was applied to early PD patients. L-DOPA restored QPS-induced LTP of the primary motor cortex in early PD patients. The degree of LTP was negatively correlated with the severity of motor symptoms. Upper limb bradykinesia and rigidity had a strong negative correlation with LTP.
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Frick A, Persson J, Bodén R. Habitual caffeine consumption moderates the antidepressant effect of dorsomedial intermittent theta-burst transcranial magnetic stimulation. J Psychopharmacol 2021; 35:1536-1541. [PMID: 34872405 PMCID: PMC8652363 DOI: 10.1177/02698811211058975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Potentiating current antidepressant treatment is much needed. Based on animal studies, caffeine may augment the effects of currently available antidepressants. OBJECTIVE Here, we tested whether habitual caffeine consumption moderates the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) using intermittent theta-burst stimulation (iTBS). METHODS Forty patients with current depressive episodes were randomized to active iTBS (n = 19) or sham treatment (n = 21; shielded side of the coil and weak transcutaneous electrical stimulation) delivered two times per day for 10-15 weekdays. Neuronavigated stimulation was applied to the dorsomedial prefrontal cortex. Symptom improvement was measured using change in self-reported Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Pretreatment habitual caffeine consumption was quantified using self-reports of number of cups of coffee and energy drinks consumed the 2 days before the treatment starts. RESULTS Habitual caffeine consumption was associated with symptom improvement following active iTBS (r = 0.51, 95% confidence interval (CI): 0.08-0.78, p = 0.025) but not following sham treatment (r = -0.02, 95% CI: -0.45 to 0.42, p = 0.938). A multiple regression analysis corroborated the findings by showing a significant caffeine consumption × treatment group interaction (β = 0.62, p = 0.043), but no main effects of treatment group (β = 0.22, p = 0.140) or caffeine consumption (β = -0.01, p = 0.948). No group differences in pretreatment symptom scores or caffeine consumption were detected (p values > 0.86). CONCLUSION Habitual caffeine consumption moderated the antidepressant effect of dorsomedial iTBS, consistent with caffeine improving antidepressant pharmacological treatments in animals. Caffeine is an antagonist of adenosine receptors and may enhance antidepressant effects through downstream dopaminergic targets.
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Affiliation(s)
- Andreas Frick
- The Beijer Laboratory, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Jonas Persson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Tanaka N, Tsutsumi R, Shirota Y, Shimizu T, Ohminami S, Terao Y, Ugawa Y, Tsuji S, Hanajima R. Effects of L-DOPA on quadripulse magnetic stimulation-induced long-term potentiation in older adults. Neurobiol Aging 2019; 84:217-224. [PMID: 31570179 DOI: 10.1016/j.neurobiolaging.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 07/03/2019] [Accepted: 08/06/2019] [Indexed: 11/18/2022]
Abstract
Reduced cortical plasticity has been previously reported in older adult as compared with young adults. However, the effects of dopamine on this plasticity reduction remain unknown. Here, we assessed the effects of high-dose (200 mg) and medium-dose (100 mg) L-3,4-dihydroxyphenylalanine (L-DOPA) intake on the long-term potentiation (LTP)-like effect induced by quadripulse magnetic stimulation (QPS) in older adults (aged ∼65 years). The subjects were 32 (200 mg) and 20 (100 mg) healthy older adult volunteers. This study was designed as a double-blind, crossover and placebo-controlled trial on one dose of L-dopa. Two hours after taking L-DOPA or placebo-drug, QPS was applied over the motor cortex. Motor evoked potentials were recorded to evaluate the motor cortical excitability changes. We found that both doses of L-DOPA enhanced LTP after QPS in older adults as one group. We classified subjects into QPS responders and QPS nonresponders. Both L-DOPA doses produced significant LTP enhancement in QPS nonresponders, whereas either of doses did not produce significant LTP enhancement in QPS responders. Collectively, our findings suggest that the neural plasticity reductions observed in older adults could be partly improved by dopamine.
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Affiliation(s)
- Nobuyuki Tanaka
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Ryosuke Tsutsumi
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yuichiro Shirota
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Shimizu
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shinya Ohminami
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasuo Terao
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Ritsuko Hanajima
- Department of Neurology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
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Effect of caffeine on long-term potentiation-like effects induced by quadripulse transcranial magnetic stimulation. Exp Brain Res 2018; 237:647-651. [DOI: 10.1007/s00221-018-5450-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Chen YH, Kuo TT, Kao JH, Huang EYK, Hsieh TH, Chou YC, Hoffer BJ. Exercise Ameliorates Motor Deficits and Improves Dopaminergic Functions in the Rat Hemi-Parkinson's Model. Sci Rep 2018; 8:3973. [PMID: 29507426 PMCID: PMC5838260 DOI: 10.1038/s41598-018-22462-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 01/08/2023] Open
Abstract
To determine the influences of exercise on motor deficits and dopaminergic transmission in a hemiparkinson animal model, we measured the effects of exercise on the ambulatory system by estimating spatio-temporal parameters during walking, striatal dopamine (DA) release and reuptake and synaptic plasticity in the corticostriatal pathway after unilateral 6-OHDA lesions. 6-OHDA lesioned hemiparkinsonian rats were exercised on a fixed speed treadmill for 30 minutes per day. Controls received the same lesion but no exercise. Animals were subsequently analyzed for behavior including gait analysis, rotarod performance and apomorphine induced rotation. Subsequently, in vitro striatal dopamine release was analyzed by using FSCV and activity-dependent plasticity in the corticostriatal pathway was measured in each group. Our data indicated that exercise could improve motor walking speed and increase the apomorphine-induced rotation threshold. Exercise also ameliorated spatiotemporal impairments in gait in PD animals. Exercise increased the parameters of synaptic plasticity formation in the corticostriatal pathway of PD animals as well as the dynamics of dopamine transmission in PD animals. Fixed speed treadmill training 30 minutes per day could ameliorate spatial-temporal gait impairment, improve walking speed, dopamine transmission as well as corticostriatal synaptic plasticity in the unilateral 6-OHDA lesioned rat model.
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Affiliation(s)
- Yuan-Hao Chen
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C..
| | - Tung-Tai Kuo
- Graduate Institute of Computer and Communication Engineering, National Taipei University of Technology, Taipei, Taiwan, R.O.C
| | - Jen-Hsin Kao
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Eagle Yi-Kung Huang
- Department of Pharmacology, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Tsung-Hsun Hsieh
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Barry J Hoffer
- Graduate Program on Neuroregeneration, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Park HJ, Kang HK, Wang M, Jo J, Chung E, Kim S. A pilot study of planar coil based magnetic stimulation using acute hippocampal slice in mice. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1118-1121. [PMID: 29060071 DOI: 10.1109/embc.2017.8037025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Micromagnetic stimulation using small-sized implantable coils has recently been studied. The main advantage of this method is that it can provide sustainable stimulation performance even if a fibrotic encapsulation layer is formed around the implanted coil by inflammation response, because indirectly induced currents are used to induce neural responses. In previous research, we optimized the geometrical and control parameters used in implantable magnetic stimulation. Based on those results, we fabricated the planar coil and studied the LTP effect in the hippocampal slice by two different magnetic stimulation protocols using the quadripulse stimulation (QPS) pattern. We found that direct magnetic stimulation (DMS) induced insignificant LTP effect and priming magnetic stimulation (PMS) occluded LTP effect after tetanic stimulation, when QPS patterned magnetic stimulation with 1 A current pulse was applied to the planar coil.
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Tanaka N, Hanajima R, Tsutsumi R, Shimizu T, Shirota Y, Terao Y, Ugawa Y. Influence of Zonisamide on the LTP-like Effect Induced by Quadripulse Transcranial Magnetic Stimulation (QPS). Brain Stimul 2015; 8:1220-2. [DOI: 10.1016/j.brs.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022] Open
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