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Mellon N, Robbins B, van Bruggen R, Zhang Y. A systematic review and meta-analysis of the preclinical and clinical results of low-field magnetic stimulation in cognitive disorders. Rev Neurosci 2024; 35:619-625. [PMID: 38671560 PMCID: PMC11297417 DOI: 10.1515/revneuro-2024-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
Cognitive disorders such as major depressive disorder and bipolar disorder severely compromise brain function and neuronal activity. Treatments to restore cognitive abilities can have severe side effects due to their intense and excitatory nature, in addition to the fact that they are expensive and invasive. Low-field magnetic stimulation (LFMS) is a novel non-invasive proposed treatment for cognitive disorders. It repairs issues in the brain by altering deep cortical areas with treatments of low-intensity magnetic stimulation. This paper aims to summarize the current literature on the effects and results of LFMS in cognitive disorders. We developed a search strategy to identify relevant studies utilizing LFMS and systematically searched eight scientific databases. Our review suggests that LFMS could be a viable and effective treatment for multiple cognitive disorders, especially major depressive disorder. Additionally, longer, more frequent, and more personalized LFMS treatments tend to be more efficacious.
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Affiliation(s)
- Nicholas Mellon
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Brett Robbins
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Rebekah van Bruggen
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Yanbo Zhang
- Faculty of Medicine and Dentistry, The University of Alberta, Edmonton, AB, T6G 2E1, Canada
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2
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Siebner HR, Funke K, Aberra AS, Antal A, Bestmann S, Chen R, Classen J, Davare M, Di Lazzaro V, Fox PT, Hallett M, Karabanov AN, Kesselheim J, Beck MM, Koch G, Liebetanz D, Meunier S, Miniussi C, Paulus W, Peterchev AV, Popa T, Ridding MC, Thielscher A, Ziemann U, Rothwell JC, Ugawa Y. Transcranial magnetic stimulation of the brain: What is stimulated? - A consensus and critical position paper. Clin Neurophysiol 2022; 140:59-97. [PMID: 35738037 PMCID: PMC9753778 DOI: 10.1016/j.clinph.2022.04.022] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/14/2022] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
Transcranial (electro)magnetic stimulation (TMS) is currently the method of choice to non-invasively induce neural activity in the human brain. A single transcranial stimulus induces a time-varying electric field in the brain that may evoke action potentials in cortical neurons. The spatial relationship between the locally induced electric field and the stimulated neurons determines axonal depolarization. The induced electric field is influenced by the conductive properties of the tissue compartments and is strongest in the superficial parts of the targeted cortical gyri and underlying white matter. TMS likely targets axons of both excitatory and inhibitory neurons. The propensity of individual axons to fire an action potential in response to TMS depends on their geometry, myelination and spatial relation to the imposed electric field and the physiological state of the neuron. The latter is determined by its transsynaptic dendritic and somatic inputs, intrinsic membrane potential and firing rate. Modeling work suggests that the primary target of TMS is axonal terminals in the crown top and lip regions of cortical gyri. The induced electric field may additionally excite bends of myelinated axons in the juxtacortical white matter below the gyral crown. Neuronal excitation spreads ortho- and antidromically along the stimulated axons and causes secondary excitation of connected neuronal populations within local intracortical microcircuits in the target area. Axonal and transsynaptic spread of excitation also occurs along cortico-cortical and cortico-subcortical connections, impacting on neuronal activity in the targeted network. Both local and remote neural excitation depend critically on the functional state of the stimulated target area and network. TMS also causes substantial direct co-stimulation of the peripheral nervous system. Peripheral co-excitation propagates centrally in auditory and somatosensory networks, but also produces brain responses in other networks subserving multisensory integration, orienting or arousal. The complexity of the response to TMS warrants cautious interpretation of its physiological and behavioural consequences, and a deeper understanding of the mechanistic underpinnings of TMS will be critical for advancing it as a scientific and therapeutic tool.
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Affiliation(s)
- Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Klaus Funke
- Department of Neurophysiology, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - Aman S Aberra
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Robert Chen
- Krembil Brain Institute, University Health Network and Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Marco Davare
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Anke N Karabanov
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Nutrition and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Janine Kesselheim
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mikkel M Beck
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Non-invasive Brain Stimulation Unit, Laboratorio di NeurologiaClinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Sabine Meunier
- Sorbonne Université, Faculté de Médecine, INSERM U 1127, CNRS 4 UMR 7225, Institut du Cerveau, F-75013, Paris, France
| | - Carlo Miniussi
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di DioFatebenefratelli, Brescia, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Göttingen, Germany
| | - Angel V Peterchev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA; Department of Electrical & Computer Engineering, Duke University, Durham, NC, USA; Department of Neurosurgery, School of Medicine, Duke University, Durham, NC, USA
| | - Traian Popa
- Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Michael C Ridding
- University of South Australia, IIMPACT in Health, Adelaide, Australia
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ulf Ziemann
- Department of Neurology & Stroke, University Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Yoshikazu Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Centre, Advanced Clinical Research Centre, Fukushima Medical University, Fukushima, Japan
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3
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van Belkum SM, de Boer MK, Opmeer EM, Kortekaas R, Mulder T, Woonings F, Hoenders HJR, Kamphuis H, Aleman A, Schoevers RA. No antidepressant effects of low intensity transcranial pulsed electromagnetic fields for treatment resistant depression. J Affect Disord 2021; 294:679-685. [PMID: 34333176 DOI: 10.1016/j.jad.2021.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Noninvasive neurostimulation with transcranial Pulsed Electromagnetic Fields (tPEMF) may be a promising method for treatment resistant depression (TRD). Studies shown substantial improvement of depressive symptoms in patients with TRD, but there is no information on long-term antidepressant effects. The aim of this study was to investigate the short- and long-term efficacy of tPEMF in participants with TRD. METHODS Eligible participants with TRD in this sham-controlled double-blind multicenter trial were randomly assigned to five weeks either daily active or sham tPEMF. Severity of depression and anxiety was assessed pre- and directly post-treatment and five and fifteen weeks post-treatment. Primary outcome was change on the 17-item Hamilton depression rating scale directly post-treatment. Secondary outcome was change on the Hamilton-17 during follow-up and change on the Inventory of Depressive Symptomatology Self-Report and the Beck Anxiety Index. RESULTS Of the 55 included participants, 50 completed the treatment protocol. Depressive symptoms improved over time in both groups. The improvement continued until the last follow-up measure. There was no difference in outcome between the active and the sham group on change in depression post-treatment or on any secondary measure. CONCLUSION Treatment with this type of active tPEMF was not superior to sham in patients with TRD. This is in contrast to a previous study using a similar design and power calculation, but a higher magnetic field strength, that reported improvement of depression after treatment with tPEMF compared to sham. An important limitation of our study was the fact that no different dosing regimens were tried.
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Affiliation(s)
- Sjoerd M van Belkum
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands..
| | - Marrit K de Boer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
| | - Esther M Opmeer
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Rudie Kortekaas
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Tim Mulder
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | | | | | - Hans Kamphuis
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands.; GGZ Drenthe, the Netherlands,; Lentis, Center for Integrative Psychiatry, the Netherlands.; PsyQ Groningen, the Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
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4
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Rhythmic low-field magnetic stimulation may improve depression by increasing brain-derived neurotrophic factor. CNS Spectr 2019; 24:313-321. [PMID: 29460712 DOI: 10.1017/s1092852917000670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low-field magnetic stimulation (LFMS) has mood-elevating effect, and the increase of brain-derived neurotrophic factor (BDNF) is associated with antidepressant treatment. We evaluated the effects and association with BDNF of rhythmic LFMS in the treatment of major depressive disorder (MDD). METHODS A total of 22 MDD patients were randomized to rhythmic alpha stimulation (RAS) or rhythmic delta stimulation (RDS), with 5 sessions per week, lasting for 6 weeks. Outcomes assessments included the 17-item Hamilton Depression Rating Scale (HAMD-17), the Hamilton Anxiety Rating Scale (HAMA), and the Clinical Global Impressions-Severity scale (CGI-S) at baseline and at weeks 1, 2, 3, 4, and 6. Serum BDNF level was measured at baseline and at weeks 2, 4, and 6. RESULTS HAMD-17, HAMA, and CGI-S scores were significantly reduced with both RAS and RDS. RAS patients had numerically greater reductions in HAMD-17 scores than RDS patients (8.9 ± 7.4 vs. 6.2 ± 6.2, effect size [ES]=0.40), while RDS patients had greater improvement in HAMA scores (8.2 ± 8.0 vs. 5.3 ± 5.8, ES=0.42). RAS was associated with clinically relevant advantages in response (54.5% vs. 18.2%, number-needed-to-treat [NNT]=3) and remission (36.4% vs. 9.1%, NNT=4). BDNF increased significantly during the 6-week study period (p<0.05), with greater increases in RAS at weeks 4 and 6 (ES=0.66-0.76) and statistical superiority at week 2 (p=0.034, ES=1.23). Baseline BDNF in the 8 responders (24.8±9.0 ng/ml) was lower than in the 14 nonresponders (31.1±7.3 ng/ml, p=0.083, ES=-0.79), and BDNF increased more in responders (8.9±7.8 ng/ml) than in nonresponders (1.8±3.5 ng/ml, p=0.044). The change in BDNF at week 2 was the most strongly predicted response (p=0.016). CONCLUSIONS Rhythmic LFMS was effective for MDD. BDNF may moderate/mediate the efficacy of LFMS.
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Dubin MJ, Ilieva IP, Deng ZD, Thomas J, Cochran A, Kravets K, Brody BD, Christos PJ, Kocsis JH, Liston C, Gunning FM. A double-blind pilot dosing study of low field magnetic stimulation (LFMS) for treatment-resistant depression (TRD). J Affect Disord 2019; 249:286-293. [PMID: 30784726 PMCID: PMC6486658 DOI: 10.1016/j.jad.2019.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low field magnetic stimulation is a potentially rapid-acting treatment for depression with mood-enhancing effects in as little as one 20-min session. The most convincing data for LFMS has come from treating bipolar depression. We examined whether LFMS also has rapid mood-enhancing effects in treatment-resistant major depressive disorder, and whether these effects are dose-dependent. OBJECTIVE/HYPOTHESIS We hypothesized that a single 20-min session of LFMS would reduce depressive symptom severity and that the magnitude of this change would be greater after three 20-min sessions than after a single 20-min session. METHODS In a double-blind randomized controlled trial, 30 participants (age 21-65) with treatment-resistant depression were randomized to three 20-min active or sham LFMS treatments with 48 h between treatments. Response was assessed immediately following LFMS treatment using the 6-item Hamilton Depression Rating Scale (HAMD-6), the Positive and Negative Affect Scale (PANAS) and the Visual Analog Scale. RESULTS Following the 3rd session of LFMS, the effect of LFMS on VAS and HAMD-6 was superior to sham (F (1, 24) = 7.45, p = 0.03, Bonferroni-Holm corrected; F (1, 22) = 6.92, p = 0.03, Bonferroni-Holm corrected, respectively). There were no differences between sham and LFMS following the initial or second session with the effect not becoming significant until after the third session. CONCLUSIONS Three 20-min LFMS sessions were required for active LFMS to have a mood-enhancing effect for individuals with treatment-resistant depression. As this effect may be transient, future work should address dosing schedules of longer treatment courses as well as biomarker-based targeting of LFMS to optimize patient selection and treatment outcomes.
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Affiliation(s)
- Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA.
| | - Irena P Ilieva
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeena Thomas
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashly Cochran
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kamilla Kravets
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Paul J Christos
- Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Negahbani E, Schmidt SL, Mishal N, Fröhlich F. Neuromodulation-dependent effect of gated high-frequency, LFMS-like electric field stimulation in mouse cortical slices. Eur J Neurosci 2018; 49:1288-1297. [PMID: 30450622 DOI: 10.1111/ejn.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/27/2022]
Abstract
Low-field magnetic stimulation (LFMS) is a gated high-frequency non-invasive brain stimulation method (500 Hz gated at 2 Hz) with a proposed antidepressant effect. However, it has remained unknown how such stimulation paradigms modulate neuronal network activity and how the induced changes depend on network state. Here we examined the immediate and outlasting effects of the gated high-frequency electric field associated with LFMS on the cortical activity as a function of neuromodulatory tone that defines network state. We used a sham-controlled study design to investigate effects of stimulation (20 min of 0.5 s trains of 500 Hz charge-balanced pulse stimulation patterned at 0.5 Hz) on neural activity in mouse medial prefrontal cortex in vitro. Bath application of cholinergic and noradrenergic agents enabled us to examine the stimulation effects as a function of neuromodulatory tone. The stimulation attenuated the increase in firing rate of layer V cortical neurons during the post-stimulation period in the presence of cholinergic activation. The same stimulation had no significant immediate or outlasting effect in the absence of exogenous neuromodulators or in the presence of noradrenergic activation. These results provide electrophysiological insights into the neuromodulatory-dependent effects of gated high-frequency stimulation. More broadly, our results are the first to provide a mechanistic demonstration of how behavioral states and arousal levels may modify the effects of non-invasive brain stimulation.
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Affiliation(s)
- Ehsan Negahbani
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Carolina Center for Neurostimulation, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen L Schmidt
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina
| | - Nadia Mishal
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Flavio Fröhlich
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.,Carolina Center for Neurostimulation, University of North Carolina, Chapel Hill, North Carolina.,Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina.,Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina.,Neuroscience Center, University of North Carolina, Chapel Hill, North Carolina.,Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
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7
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Smith JE, Peterchev AV. Electric field measurement of two commercial active/sham coils for transcranial magnetic stimulation. J Neural Eng 2018; 15:054001. [PMID: 29932429 DOI: 10.1088/1741-2552/aace89] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Sham TMS coils isolate the ancillary effects of their active counterparts but typically induce low-strength electric fields (E-fields) in the brain, which could be biologically active. We measured the E-fields induced by two pairs of commonly-used commercial active/sham coils. APPROACH E-field distributions of the active and sham configurations of the Magstim 70 mm AFC and MagVenture Cool-B65 A/P coils were measured over a 7 cm-radius, hemispherical grid approximating the cortical surface. Peak E-field strength was recorded over a range of pulse amplitudes. MAIN RESULTS The Magstim and MagVenture shams induce peak E-fields corresponding to 25.3% and 7.72% of their respective active values. The MagVenture sham has an E-field distribution shaped like its active counterpart. The Magstim sham induces nearly zero E-field under the coil's center, and its peak E-field forms a diffuse oval 3-7 cm from the center. Electrical scalp stimulation paired with the MagVenture sham is estimated to increase the sham E-field in the brain up to 10%. SIGNIFICANCE Different commercial shams induce different E-field strengths and distributions in the brain, which should be considered in interpreting outcomes of sham stimulation.
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Affiliation(s)
- J Evan Smith
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC 27710, United States of America
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8
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Fava M, Freeman MP, Flynn M, Hoeppner BB, Shelton R, Iosifescu DV, Murrough JW, Mischoulon D, Cusin C, Rapaport M, Dunlop BW, Trivedi MH, Jha M, Sanacora G, Hermes G, Papakostas GI. Double-blind, proof-of-concept (POC) trial of Low-Field Magnetic Stimulation (LFMS) augmentation of antidepressant therapy in treatment-resistant depression (TRD). Brain Stimul 2018; 11:75-84. [PMID: 29030111 PMCID: PMC5729080 DOI: 10.1016/j.brs.2017.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Low-Field Magnetic Stimulation (LFMS) is a novel, non-invasive, sub-threshold neuromodulation technique, shown in preliminary studies to have immediate mood elevating effects in both unipolar and bipolar depressed patients. OBJECTIVE We aimed to assess the antidepressant augmentation effects at 48 h of LFMS administered on two consecutive days compared to sham treatment in treatment resistant depression (TRD) subjects, using the Sequential Parallel Comparison Design (SPCD). METHODS Eighty-four eligible subjects with TRD were randomly assigned to double-blind treatment with LFMS 20 min/day for four days, sham treatment 20 min/day for four days, or sham treatment 20 min/day for 2 days followed by LFMS treatment 20 min/day for two days, using the pre-randomization version of the SPCD (randomization 1:1:1). The SPCD analyses used a repeated measures linear modeling approach with maximum likelihood estimation to use all available data, and using a 60-40 weighting of Stage 1 vs. 2 responses, with the primary outcome being measured after 2 and 4 days. RESULTS Both primary and secondary outcome measures consistently showed no differences between LFMS-treated patients and those treated with sham, with the exception of a slight, non-significantly greater improvement than sham in the visual analogue scale (VAS) sad mood on LFMS-treated patients. LFMS treatment was relatively well tolerated. CONCLUSIONS We did not observe a significantly greater, rapid efficacy of LFMS compared to sham therapy. Future studies need to examine the possible therapeutic effects of more intensive forms of LFMS, as other forms of neurostimulation typically require longer duration of exposure.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Manish Jha
- University of Texas Southwestern, United States
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9
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Zhen J, Qian Y, Weng X, Su W, Zhang J, Cai L, Dong L, An H, Su R, Wang J, Zheng Y, Wang X. Gamma rhythm low field magnetic stimulation alleviates neuropathologic changes and rescues memory and cognitive impairments in a mouse model of Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:487-497. [PMID: 29124106 PMCID: PMC5671620 DOI: 10.1016/j.trci.2017.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction The abnormal amyloid β (Aβ) accumulation and Aβ-related neural network dysfunction are considered central to the pathogenesis of Alzheimer's disease (AD) at the early stage. Deep-brain reachable low field magnetic stimulation (DMS), a novel noninvasive approach that was designed to intervene the network activity in brains, has been found to alleviate stress-related cognitive impairments. Methods Amyloid precursor protein/presenilin-1 transgenic mice (5XFAD) were treated with DMS, and cognitive behavior and AD-like pathologic changes in the neurochemical and electrophysiological properties in 5XFAD mice were assessed. Results We demonstrate that DMS treatment enhances cognitive performances, attenuates Aβ load, upregulates postsynaptic density protein 95 level, and promotes hippocampal long-term potentiation in 5XFAD mouse brain. Intriguingly, the gamma burst magnetic stimulation reverses the aberrant gamma oscillations in the transgenic hippocampal network. Discussion This work establishes a solid foundation for the effectiveness of DMS in treating AD and proposes a future study of gamma rhythm stimulation on reorganizing rhythmic neural activity in AD brain.
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Affiliation(s)
- Junli Zhen
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanjing Qian
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Xiechuan Weng
- Department of Neurobiology and State Key Laboratory of Proteomics, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Wenting Su
- Beijing Institute for Brain Disorders, Beijing, China
| | - Jianliang Zhang
- Department of Neurobiology, Capital Medical University, Beijing, China
| | - Lihui Cai
- School of Electrical Engineering and Automation, Tianjin University, Tianjin, China
| | - Lin Dong
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Haiting An
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Ruijun Su
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Jiang Wang
- School of Electrical Engineering and Automation, Tianjin University, Tianjin, China
| | - Yan Zheng
- Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China.,Department of Physiology, Capital Medical University, Beijing, China
| | - Xiaomin Wang
- Department of Neurobiology, Capital Medical University, Beijing, China.,Key Laboratory for Neurodegenerative Disorders of the Ministry of Education, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
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10
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Barnes AK, Smith SB, Datta S. Beyond Emotional and Spatial Processes: Cognitive Dysfunction in a Depressive Phenotype Produced by Long Photoperiod Exposure. PLoS One 2017; 12:e0170032. [PMID: 28060930 PMCID: PMC5218505 DOI: 10.1371/journal.pone.0170032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/27/2016] [Indexed: 01/04/2023] Open
Abstract
Cognitive dysfunction in depression has recently been given more attention and legitimacy as a core symptom of the disorder. However, animal investigations of depression-related cognitive deficits have generally focused on emotional or spatial memory processing. Additionally, the relationship between the cognitive and affective disturbances that are present in depression remains obscure. Interestingly, sleep disruption is one aspect of depression that can be related both to cognition and affect, and may serve as a link between the two. Previous studies have correlated sleep disruption with negative mood and impaired cognition. The present study investigated whether a long photoperiod-induced depressive phenotype showed cognitive deficits, as measured by novel object recognition, and displayed a cognitive vulnerability to an acute period of total sleep deprivation. Adult male Wistar rats were subjected to a long photoperiod (21L:3D) or a normal photoperiod (12L:12D) condition. Our results indicate that our long photoperiod exposed animals showed behaviors in the forced swim test consistent with a depressive phenotype, and showed significant deficits in novel object recognition. Three hours of total sleep deprivation, however, did not significantly change novel object recognition in either group, but the trends suggest that the long photoperiod and normal photoperiod groups had different cognitive responses to total sleep deprivation. Collectively, these results underline the extent of cognitive dysfunction present in depression, and suggest that altered sleep plays a role in generating both the affective and cognitive symptoms of depression.
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Affiliation(s)
- Abigail K. Barnes
- Department of Anesthesiology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, United States of America
- Department of Psychology, College of Arts and Sciences, The University of Tennessee, Knoxville, TN, United States of America
| | - Summer B. Smith
- Department of Psychology, College of Arts and Sciences, The University of Tennessee, Knoxville, TN, United States of America
| | - Subimal Datta
- Department of Anesthesiology, Graduate School of Medicine, The University of Tennessee, Knoxville, TN, United States of America
- Department of Psychology, College of Arts and Sciences, The University of Tennessee, Knoxville, TN, United States of America
- Program in Comparative and Experimental Medicine, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, United States of America
- * E-mail:
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11
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van Belkum SM, Bosker FJ, Kortekaas R, Beersma DGM, Schoevers RA. Treatment of depression with low-strength transcranial pulsed electromagnetic fields: A mechanistic point of view. Prog Neuropsychopharmacol Biol Psychiatry 2016; 71:137-43. [PMID: 27449361 DOI: 10.1016/j.pnpbp.2016.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mood disorders constitute a high burden for both patients and society. Notwithstanding the large arsenal of available treatment options, a considerable group of patients does not remit on current antidepressant treatment. There is an urgent need to develop alternative treatment strategies. Recently, low-strength transcranial pulsed electromagnetic field (tPEMF) stimulation has been purported as a promising strategy for such treatment-resistant depression (TRD). The mode of action of this new technique is however largely unknown. METHODS We searched PubMed for literature reports on the effects of tPEMF and for information regarding its working mechanism and biological substrate. RESULTS Most studies more or less connect with the major hypotheses of depression and concern the effects of tPEMF on brain metabolism, neuronal connectivity, brain plasticity, and the immune system. Relatively few studies paid attention to the possible chronobiologic effects of electromagnetic fields. LIMITATIONS We reviewed the literature of a new and still developing field. Some of the reports involved translational studies, which inevitably limits the reach of the conclusions. CONCLUSION Weak magnetic fields influence divergent neurobiological processes. The antidepressant effect of tPEMF may be specifically attributable to its effects on local brain activity and connectivity.
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Affiliation(s)
- S M van Belkum
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC 30, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - F J Bosker
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC 30, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - R Kortekaas
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC 30, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience, P.O. Box 196, 9700 AD Groningen, The Netherlands
| | - D G M Beersma
- Department Chronobiology, University of Groningen, Nijenborgh 7, 9747 AG Groningen, The Netherlands
| | - R A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, CC 30, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center for Psychopathology and Emotion regulation (ICPE), CC 30, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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12
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Effects of short term and long term Extremely Low Frequency Magnetic Field on depressive disorder in mice: Involvement of nitric oxide pathway. Life Sci 2016; 146:52-7. [DOI: 10.1016/j.lfs.2015.12.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/16/2015] [Accepted: 12/31/2015] [Indexed: 11/23/2022]
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13
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Peterchev AV, Deng ZD, Goetz SM. Advances in Transcranial Magnetic Stimulation Technology. Brain Stimul 2015. [DOI: 10.1002/9781118568323.ch10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Chung SW, Hoy KE, Fitzgerald PB. Theta-burst stimulation: a new form of TMS treatment for depression? Depress Anxiety 2015; 32:182-92. [PMID: 25450537 DOI: 10.1002/da.22335] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/17/2014] [Accepted: 10/21/2014] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a common debilitating condition where only one third of patients achieve remission after the first antidepressant treatment. Inadequate efficacy and adverse effects of current treatment strategies call for more effective and tolerable treatment options. Transcranial magnetic stimulation (TMS) is a noninvasive approach to manipulate brain activity and alter cortical excitability. There has been more than 15 years of research on the use of repetitive form of TMS (rTMS) for the treatment of patients with depression, which has shown it to be an effective antidepressant treatment. Even though rTMS treatment has shown efficacy in treating depression, there is a high degree of interindividual variability in response. A newer form of rTMS protocol, known as theta-burst stimulation (TBS), has been shown to produce similar if not greater effects on brain activity than standard rTMS. TBS protocols have a major advantage over standard rTMS approaches in their reduced administration duration. Conventional rTMS procedures last between 20 and 45 min, as compared to TBS paradigms that require 1 to 3 min of stimulation. Recently, a small number of studies have suggested that TBS has similar or better efficacy in treating depression compared to rTMS. Optimization, identification of response predictors, and clarification of neurobiological mechanisms of TBS is required if it is to be further developed as a less time intensive, safe, and effective treatment for MDD.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
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15
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Deng ZD, McClintock SM, Oey NE, Luber B, Lisanby SH. Neuromodulation for mood and memory: from the engineering bench to the patient bedside. Curr Opin Neurobiol 2014; 30:38-43. [PMID: 25222617 DOI: 10.1016/j.conb.2014.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 08/29/2014] [Accepted: 08/29/2014] [Indexed: 12/28/2022]
Abstract
Brain stimulation, in the form of electroconvulsive therapy (ECT), has long been a gold standard treatment for depression, but today, the field of neuromodulation is rapidly changing with the advent of newer and more precise tools to alter neuroplasticity and to treat brain-based disorders. Now there are new means to induce focal seizures, as with magnetic seizure therapy (MST), or modifications to ECT. There are also surgical approaches to target brain circuits via implanted stimulators placed in the brain or on cranial nerves. Finally, there are noninvasive subconvulsive approaches for the transcranial application of either electric or magnetic fields. Collectively, these tools have transformed the face of neurotherapeutics and informed our understanding of the brain basis of complex neurobehavioral conditions.
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Affiliation(s)
- Zhi-De Deng
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shawn M McClintock
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicodemus E Oey
- Duke-National University of Singapore Graduate Medical School, Singapore
| | - Bruce Luber
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Sarah H Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
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Rohan ML, Yamamoto RT, Ravichandran CT, Cayetano KR, Morales OG, Olson DP, Vitaliano G, Paul SM, Cohen BM. Rapid mood-elevating effects of low field magnetic stimulation in depression. Biol Psychiatry 2014; 76:186-93. [PMID: 24331545 DOI: 10.1016/j.biopsych.2013.10.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/18/2013] [Accepted: 10/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We previously reported rapid mood elevation following an experimental magnetic resonance imaging procedure in depressed patients with bipolar disorder (BPD). This prompted the design, construction, and testing of a portable electromagnetic device that reproduces only the rapidly oscillating (1 kHz, <1 V/m) electromagnetic field of the experimental procedure, called low field magnetic stimulation (LFMS). METHODS We used a randomized, double blind, sham controlled treatment protocol to study the effects of LFMS in a large group of stably medicated, depressed patients with either BPD (n = 41) or major depressive disorder (n = 22). Subjects received a single, 20-minute treatment. Change in mood was assessed immediately afterward using a visual analog scale (VAS), the 17-item Hamilton Depression Rating Scale (HDRS-17), and the Positive and Negative Affect Schedule scales. RESULTS Substantial improvement (>10% of baseline) in mood was observed following LFMS treatment relative to sham treatment for both diagnostic subgroups for our primary outcomes, the VAS and the HDRS-17. These differences were not statistically significant in primary analyses stratifying by diagnosis but were significant in secondary analyses combining data across the two diagnostic groups (p = .01 VAS, p = .02 HDRS-17). Rapid improvement in mood was also observed using the Positive and Negative Affect Schedule scales as secondary measures (positive affect scale p = .02 BPD, p = .002 combined group). A finite element method calculation indicates a broad penetration of the LFMS electric field throughout the cerebral cortex. CONCLUSIONS Low field magnetic stimulation may produce rapid changes in mood using a previously unexplored range of electromagnetic fields.
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Affiliation(s)
- Michael L Rohan
- McLean Hospital and the Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.
| | - Rinah T Yamamoto
- McLean Hospital and the Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
| | - Caitlin T Ravichandran
- Departments of Neuroscience (Mind and Brain Institute), Psychiatry, and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Kenroy R Cayetano
- McLean Hospital and the Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
| | - Oscar G Morales
- Departments of Neuroscience (Mind and Brain Institute), Psychiatry, and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York
| | - David P Olson
- McLean Hospital and the Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
| | - Gordana Vitaliano
- Departments of Neuroscience (Mind and Brain Institute), Psychiatry, and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Steven M Paul
- Departments of Neuroscience (Mind and Brain Institute), Psychiatry, and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Bruce M Cohen
- Departments of Neuroscience (Mind and Brain Institute), Psychiatry, and Pharmacology, Weill Cornell Medical College of Cornell University, New York, New York
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17
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Deng ZD, Lisanby SH, Peterchev AV. Coil design considerations for deep transcranial magnetic stimulation. Clin Neurophysiol 2013; 125:1202-12. [PMID: 24411523 DOI: 10.1016/j.clinph.2013.11.038] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 10/06/2013] [Accepted: 11/09/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore the field characteristics and design tradeoffs of coils for deep transcranial magnetic stimulation (dTMS). METHODS We simulated parametrically two dTMS coil designs on a spherical head model using the finite element method, and compare them with five commercial TMS coils, including two that are FDA approved for the treatment of depression (ferromagnetic-core figure-8 and H1 coil). RESULTS Smaller coils have a focality advantage over larger coils; however, this advantage diminishes with increasing target depth. Smaller coils have the disadvantage of producing stronger field in the superficial cortex and requiring more energy. When the coil dimensions are large relative to the head size, the electric field decay in depth becomes linear, indicating that, at best, the electric field attenuation is directly proportional to the depth of the target. Ferromagnetic cores improve electrical efficiency for targeting superficial brain areas; however magnetic saturation reduces the effectiveness of the core for deeper targets, especially for highly focal coils. Distancing winding segments from the head, as in the H1 coil, increases the required stimulation energy. CONCLUSIONS Among standard commercial coils, the double cone coil offers high energy efficiency and balance between stimulated volume and superficial field strength. Direct TMS of targets at depths of ~4 cm or more results in superficial stimulation strength that exceeds the upper limit in current rTMS safety guidelines. Approaching depths of ~6 cm is almost certainly unsafe considering the excessive superficial stimulation strength and activated brain volume. SIGNIFICANCE Coil design limitations and tradeoffs are important for rational and safe exploration of dTMS.
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Affiliation(s)
- Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Angel V Peterchev
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
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18
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Leuchter AF, Cook IA, Jin Y, Phillips B. The relationship between brain oscillatory activity and therapeutic effectiveness of transcranial magnetic stimulation in the treatment of major depressive disorder. Front Hum Neurosci 2013; 7:37. [PMID: 23550274 PMCID: PMC3581824 DOI: 10.3389/fnhum.2013.00037] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/01/2013] [Indexed: 12/11/2022] Open
Abstract
Major depressive disorder (MDD) is marked by disturbances in brain functional connectivity. This connectivity is modulated by rhythmic oscillations of brain electrical activity, which enable coordinated functions across brain regions. Oscillatory activity plays a central role in regulating thinking and memory, mood, cerebral blood flow, and neurotransmitter levels, and restoration of normal oscillatory patterns is associated with effective treatment of MDD. Repetitive transcranial magnetic stimulation (rTMS) is a robust treatment for MDD, but the mechanism of action (MOA) of its benefits for mood disorders remains incompletely understood. Benefits of rTMS have been tied to enhanced neuroplasticity in specific brain pathways. We summarize here the evidence that rTMS entrains and resets thalamocortical oscillators, normalizes regulation and facilitates reemergence of intrinsic cerebral rhythms, and through this mechanism restores normal brain function. This entrainment and resetting may be a critical step in engendering neuroplastic changes and the antidepressant effects of rTMS. It may be possible to modify the method of rTMS administration to enhance this MOA and achieve better antidepressant effectiveness. We propose that rTMS can be administered: (1) synchronized to a patient's individual alpha frequency (IAF), or synchronized rTMS (sTMS); (2) as a low magnetic field strength sinusoidal waveform; and, (3) broadly to multiple brain areas simultaneously. We present here the theory and evidence indicating that these modifications could enhance the therapeutic effectiveness of rTMS for the treatment of MDD.
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Affiliation(s)
- Andrew F Leuchter
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles Los Angeles, CA, USA
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Paulus W, Peterchev AV, Ridding M. Transcranial electric and magnetic stimulation: technique and paradigms. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:329-42. [PMID: 24112906 DOI: 10.1016/b978-0-444-53497-2.00027-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcranial electrical and magnetic stimulation techniques encompass a broad physical variety of stimuli, ranging from static magnetic fields or direct current stimulation to pulsed magnetic or alternating current stimulation with an almost infinite number of possible stimulus parameters. These techniques are continuously refined by new device developments, including coil or electrode design and flexible control of the stimulus waveforms. They allow us to influence brain function acutely and/or by inducing transient plastic after-effects in a range from minutes to days. Manipulation of stimulus parameters such as pulse shape, intensity, duration, and frequency, and location, size, and orientation of the electrodes or coils enables control of the immediate effects and after-effects. Physiological aspects such as stimulation at rest or during attention or activation may alter effects dramatically, as does neuropharmacological drug co-application. Non-linear relationships between stimulus parameters and physiological effects have to be taken into account.
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Affiliation(s)
- Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Göttingen, Germany.
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20
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Deng ZD, Lisanby SH, Peterchev AV. Electric field depth-focality tradeoff in transcranial magnetic stimulation: simulation comparison of 50 coil designs. Brain Stimul 2012; 6:1-13. [PMID: 22483681 DOI: 10.1016/j.brs.2012.02.005] [Citation(s) in RCA: 531] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Various transcranial magnetic stimulation (TMS) coil designs are available or have been proposed. However, key coil characteristics such as electric field focality and attenuation in depth have not been adequately compared. Knowledge of the coil focality and depth characteristics can help TMS researchers and clinicians with coil selection and interpretation of TMS studies. OBJECTIVE To quantify the electric field focality and depth of penetration of various TMS coils. METHODS The electric field distributions induced by 50 TMS coils were simulated in a spherical human head model using the finite element method. For each coil design, we quantified the electric field penetration by the half-value depth, d(1/2), and focality by the tangential spread, S(1/2), defined as the half-value volume (V(1/2)) divided by the half-value depth, S(1/2) = V(1/2)/d(1/2). RESULTS The 50 TMS coils exhibit a wide range of electric field focality and depth, but all followed a depth-focality tradeoff: coils with larger half-value depth cannot be as focal as more superficial coils. The ranges of achievable d(1/2) are similar between coils producing circular and figure-8 electric field patterns, ranging 1.0-3.5 cm and 0.9-3.4 cm, respectively. However, figure-8 field coils are more focal, having S(1/2) as low as 5 cm(2) compared to 34 cm(2) for circular field coils. CONCLUSIONS For any coil design, the ability to directly stimulate deeper brain structures is obtained at the expense of inducing wider electrical field spread. Novel coil designs should be benchmarked against comparison coils with consistent metrics such as d(1/2) and S(1/2).
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Affiliation(s)
- Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
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Rosa MA, Lisanby SH. Somatic treatments for mood disorders. Neuropsychopharmacology 2012; 37:102-16. [PMID: 21976043 PMCID: PMC3238088 DOI: 10.1038/npp.2011.225] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 12/22/2022]
Abstract
Somatic treatments for mood disorders represent a class of interventions available either as a stand-alone option, or in combination with psychopharmacology and/or psychotherapy. Here, we review the currently available techniques, including those already in clinical use and those still under research. Techniques are grouped into the following categories: (1) seizure therapies, including electroconvulsive therapy and magnetic seizure therapy, (2) noninvasive techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial electric stimulation, (3) surgical approaches, including vagus nerve stimulation, epidural electrical stimulation, and deep brain stimulation, and (4) technologies on the horizon. Additionally, we discuss novel approaches to the optimization of each treatment, and new techniques that are under active investigation.
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Affiliation(s)
- Moacyr A Rosa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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22
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Wong DL, Tai TC, Wong-Faull DC, Claycomb R, Meloni EG, Myers KM, Carlezon WA, Kvetnansky R. Epinephrine: a short- and long-term regulator of stress and development of illness : a potential new role for epinephrine in stress. Cell Mol Neurobiol 2011; 32:737-48. [PMID: 22090159 DOI: 10.1007/s10571-011-9768-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/31/2011] [Indexed: 01/24/2023]
Abstract
Epinephrine (Epi), which initiates short-term responses to cope with stress, is, in part, stress-regulated via genetic control of its biosynthetic enzyme, phenylethanolamine N-methyltransferase (PNMT). In rats, immobilization (IMMO) stress activates the PNMT gene in the adrenal medulla via Egr-1 and Sp1 induction. Yet, elevated Epi induced by acute and chronic stress is associated with stress induced, chronic illnesses of cardiovascular, immune, cancerous, and behavioral etiologies. Major sources of Epi include the adrenal medulla and brainstem. Although catecholamines do not cross the blood-brain barrier, circulating Epi from the adrenal medulla may communicate with the central nervous system and stress circuitry by activating vagal nerve β-adrenergic receptors to release norepinephrine, which could then stimulate release of the same from the nucleus tractus solitarius and locus coeruleus. In turn, the basal lateral amygdala (BLA) may activate to stimulate afferents to the hypothalamus, neocortex, hippocampus, caudate nucleus, and other brain regions sequentially. Recently, we have shown that repeated IMMO or force swim stress may evoke stress resiliency, as suggested by changes in expression and extinction of fear memory in the fear-potentiated startle paradigm. However, concomitant adrenergic changes seem stressor dependent. Present studies aim to identify stressful conditions that elicit stress resiliency versus stress sensitivity, with the goal of developing a model to investigate the potential role of Epi in stress-associated illness. If chronic Epi over expression does elicit illness, possibilities for alternative therapeutics exist through regulating stress-induced Epi expression, adrenergic receptor function and/or corticosteroid effects on Epi, adrenergic receptors and the stress axis.
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Affiliation(s)
- Dona Lee Wong
- Department of Psychiatry, Harvard Medical School, MA, USA.
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Antidepressant effects of magnetic resonance imaging—based stimulation on major depressive disorder: a double-blind randomized clinical trial. Brain Imaging Behav 2011; 6:70-6. [DOI: 10.1007/s11682-011-9143-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE The aim of this study was to review the current state of development and application of a wide range of brain stimulation approaches in the treatment of psychiatric disorders. METHOD The approaches reviewed include forms of minimally invasive magnetic and electrical stimulation, seizure induction, implanted devices and several highly novel approaches in early development. RESULTS An extensive range of brain stimulation approaches are now being widely used in the treatment of patients with psychiatric disorders, or actively investigated for this use. Both vagal nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS) have been introduced into clinical practice in some countries. A small body of research suggests that VNS has some potentially long-lasting antidepressant effects in a minority of patients treated. rTMS has now been extensively investigated for over 15 years, with a large body of research now supporting its antidepressant effects. Further rTMS research needs to focus on defining the most appropriate stimulation methods and exploring its longer term use in maintenance protocols. Very early data suggest that magnetic seizure therapy (MST) has promise in the treatment of patients referred for electroconvulsive therapy: MST appears to have fewer side effects and may have similar efficacy. A number of other approaches including surgical and alternative forms of electrical stimulation appear to alter brain activity in a promising manner, but are in need of evaluation in more substantive patient samples. CONCLUSIONS It appears likely that the range of psychiatric treatments available for patients will grow over the coming years to progressively include a number of novel brain stimulation techniques.
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Affiliation(s)
- Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia. paul.fi
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25
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Brain Stimulation. From the editor-in-chief's desk. Brain Stimul 2010; 3:129-30. [PMID: 20633441 DOI: 10.1016/j.brs.2010.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sobiś J, Jarzab M, Hese RT, Sieroń A, Zyss T, Gorczyca P, Gierlotka Z, Pudlo R, Matysiakiewicz J. Therapeutic efficacy assessment of weak variable magnetic fields with low value of induction in patients with drug-resistant depression. J Affect Disord 2010; 123:321-6. [PMID: 19896204 DOI: 10.1016/j.jad.2009.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this prospective study was to verify whether magnetostimulation with weak variable magnetic fields with low value of induction could enhance the effects of pharmacological therapy in drug-resistant depression. MATERIALS AND METHODS Thirty patients, 26 women and 4 men, with drug-resistant depression were enrolled in the study. The subjects from Group No. I (14 patients) were given fluvoxamine and treated with weak variable magnetic field using the VIOFOR JPS device; the subjects from Group No. II (16 patients) were also given fluvoxamine but they were treated with the VIOFOR JPS device in placebo mode. Changes in depressive symptoms were estimated with the 21-point Hamilton Depression Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS) and Beck Depression Inventory (BDI) questionnaire. RESULTS After 15 days of treatment highly significant differences were revealed between the patients treated with magnetic field and the patients treated with placebo: the final HDRS score was 53% of the initial value for the group receiving combined treatment, and 86% in the placebo group (p<0.001); for MADRS score the values were 51% and 88% (p<0.001), respectively, and for BDI 60% and 87% (p<0.001). Thus, the average effect of placebo applied with fluvoxamine was a ca. 15% reduction of symptoms, while the concurrent application of magnetic field and SSRI treatment resulted in a 40-50% improvement. CONCLUSION Our study indicates that adding a two-week low-induction variable magnetic field stimulation to a classical pharmacologic therapy reduces the intensity of symptoms in patients with drug-resistant depressive disorders.
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Affiliation(s)
- Jarosław Sobiś
- Department of Psychiatry, Medical University of Silesia, Zabrze, Poland.
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Canbeyli R. Sensorimotor modulation of mood and depression: An integrative review. Behav Brain Res 2010; 207:249-64. [DOI: 10.1016/j.bbr.2009.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 10/29/2009] [Accepted: 11/02/2009] [Indexed: 02/05/2023]
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Lazutkin D, Husar P. Modeling of electromagnetic stimulation of the human brain. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:581-584. [PMID: 21095888 DOI: 10.1109/iembs.2010.5626402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The World Health Organization estimates depression as a serious threat to the health of millions of people worldwide. The purpose of this paper is to introduce the ongoing research devoted to the investigation of a possibility to use low-field electromagnetic stimulation of the human brain in the treatment of depressive disorder. In the course of the work the 3D models of transcranial magnetic stimulation and low-field magnetic stimulation based upon the use of a layered sphere head model have been developed. An initial approach towards the realistic human head reconstruction has been made. The revealed order of the stimulating electromagnetic field suitable for operation makes it possible to draft a technical specification for the stimulation device.
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Affiliation(s)
- Dmitry Lazutkin
- Division of Biological Signal Processing, Department of Biomedical Engineering and Medical Informatics, Ilmenau University of Technology, PO Box 100565, 98684, Germany.
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Antidepressant-like effects of echo-planar magnetic resonance imaging in mice determined using the forced swimming test. Brain Res 2008; 1236:194-9. [PMID: 18755160 DOI: 10.1016/j.brainres.2008.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 08/06/2008] [Accepted: 08/08/2008] [Indexed: 02/06/2023]
Abstract
Echo-planar magnetic resonance imaging (EP-MRI), which is novel variant of MRI, is thought to have antidepressant properties in humans and animal models. Using the forced swimming test (FST), we investigated which monoaminergic system in mice is affected by EP-MRI. The short- and long-term effects of EP-MRI on immobility time in the FST and motor activity within a locomotor activity cage were examined. Two groups of mice underwent 20 min of EP-MRI in an MR scanner (Siemens, 1.5 T Symphony) either 23.5 or 1 h before the start of the second session of the FST. In both groups, the immobility duration in the FST was reduced, similar to effective antidepressant drug treatments. Climbing behavior in the 1-h group and swimming behavior in the 23.5-h group increased significantly, similar to that seen after the administration of desipramine (a noradrenaline reuptake inhibitor) and sertraline (a selective serotonin reuptake inhibitor), respectively. The findings support the hypothesis that EP-MRI has an antidepressant-like effect. We suggest that the antidepressant-like effect begins in the early period with noradrenaline systems and is maintained in the late period with serotonin systems.
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Effects of a static magnetic field on audiogenic seizures in black Swiss mice. Epilepsy Res 2008; 80:119-31. [DOI: 10.1016/j.eplepsyres.2008.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 01/03/2008] [Accepted: 03/13/2008] [Indexed: 11/18/2022]
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Rokni-Yazdi H, Sotoudeh H, Akhondzadeh S, Sotoudeh E, Asadi H, Shakiba M. Antidepressant-like effect of magnetic resonance imaging-based stimulation in mice. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:503-9. [PMID: 17218047 DOI: 10.1016/j.pnpbp.2006.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 11/25/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION It has been reported that a novel type of magnetic resonance imaging (MRI) scan called echo planar magnetic resonance spectroscopic imaging (EP-MRSI) may show antidepressant effects. We examined whether the two routine diagnostic protocols of MRI [T1 and echo planar diffusion weighted imaging (EPI-DWI)], have antidepressant-like effects in an animal model of depression. METHODS The effects of standard EPI-DWI and T1 MRI on immobility, swimming and climbing times in the modified forced swimming test (FST) in mice were examined. After exposure to the first session of modified forced swimming test, we randomly divided the mice into four groups. The first group (T1 MRI group, n=21) received a 15-minute stimulation of T1 sequence. The second group (EPI-DWI MRI group, n=21) received a 15-minute stimulation of EPI-DWI protocol. The third group (sham group, n=21) spent 15 min in a tunnel similar to the MRI gantry in terms of size, temperature and light intensity and received recorded sounds from a normal session of EPI-DWI with similar duration and intensity. The fourth group acted as controls (n=21). The second session of the modified FST was conducted twelve hours later. The mean of immobility, swimming and climbing times in this session were compared to the control group. RESULTS T1 weighted and EPI-DWI MRI groups showed a reduction in immobility time compared to the control group (P value<0.002, P value<0.017 respectively). This effect is comparable to that seen in the FST after the administration of antidepressant agents. The climbing time in the group subjected to EPI-DWI MRI was longer than the control group (P value<0.035). Previous studies showed similar effects after the administration of antidepressant drugs affecting the catecholamine systems. The swimming time in the T1 MRI group was significantly longer than the control group (P value<0.037). Previous studies showed qualitatively similar effect to that of anti-depressant drugs affecting the serotoninergic systems. The swimming, climbing and immobility times in the sham and control groups showed no significant difference. CONCLUSIONS Our findings raise the possibility that MRI-based stimulation may have antidepressant-like effects in mice. This is likely to be through different mechanisms in T1 weighted and EPI-DWI protocols. However the possible biological basis of this effect is not yet understood and we would advocate further studies of MRI-based stimulation effects on transmitters in the different organs in the body specially the brain.
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Affiliation(s)
- Hadi Rokni-Yazdi
- Department of Radiology and Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Keshavarz Blvd., Tehran 14197-33141, Iran.
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Cook CM, Saucier DM, Thomas AW, Prato FS. Exposure to ELF magnetic and ELF-modulated radiofrequency fields: the time course of physiological and cognitive effects observed in recent studies (2001-2005). Bioelectromagnetics 2006; 27:613-27. [PMID: 16724317 DOI: 10.1002/bem.20247] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2002, we published a review of the cognitive and physiological effects of extremely low frequency magnetic fields (ELF MFs) and ELF-modulated radiofrequency fields associated with mobile phones. Since the original preparation of that review, a significant number of studies have been published using techniques such as electroencephalography, event-related potentials and positron emission tomography to investigate electromagnetic field effects upon human physiology and various measures of performance (cognitive, perceptual, behavioral). We review these recent studies, and when effects were observed, we reference the time course of observed effects (immediate or delayed). In our concluding remarks, we discuss a number of variables that are not often considered in human bioelectromagnetics studies, such as personality, individual differences and the specific laterality of ELF MF and mobile phone exposure over the brain. We also consider the sensitivity of various physiological assays and performance measures in the study of biological effects of electromagnetic fields.
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Affiliation(s)
- C M Cook
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Youngs RM, Chu MS, Meloni EG, Naydenov A, Carlezon WA, Konradi C. Lithium administration to preadolescent rats causes long-lasting increases in anxiety-like behavior and has molecular consequences. J Neurosci 2006; 26:6031-9. [PMID: 16738246 PMCID: PMC4205587 DOI: 10.1523/jneurosci.0580-06.2006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lithium (Li) is frequently used in the treatment of bipolar disorder (BPD), a debilitating condition that is increasingly diagnosed in children and adolescents. Because the symptoms of BPD in children are different from the typical symptoms in adulthood and have significant overlap with other childhood psychiatric disorders, this disorder is notoriously difficult to diagnose. This raises the possibility that some children not affected by BPD are treated with Li during key periods of brain development. The objective of this investigation was to examine the long-term effects of Li on the developing brain via a series of behavioral and molecular studies in rats. Rat pups were reared on Li chow for 3 weeks. Parallel groups were tested while on Li chow or 2 and 6 weeks after discontinuation of treatment. We found increased measures of anxiety-like behavior at all times tested. Gene microarray studies of the amygdala revealed that Li affected the expression of gene transcripts of the synapse and the cytoskeleton, suggesting that the treatment induced synaptic adjustments. Our study indicates that Li can alter the trajectory of brain development. Although the effects of Li on the normal brain seems unfavorable, effects on the abnormal brain cannot be determined from these studies alone and may well be therapeutic. Our results indicate that Li administration to the normal brain has the potential for lasting adverse effects.
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Millan MJ. Multi-target strategies for the improved treatment of depressive states: Conceptual foundations and neuronal substrates, drug discovery and therapeutic application. Pharmacol Ther 2006; 110:135-370. [PMID: 16522330 DOI: 10.1016/j.pharmthera.2005.11.006] [Citation(s) in RCA: 388] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 11/28/2005] [Indexed: 12/20/2022]
Abstract
Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost. Depressed patients generally display co-morbid symptoms, and depression frequently accompanies other serious disorders. Currently available drugs display limited efficacy and a pronounced delay to onset of action, and all provoke distressing side effects. Cloning of the human genome has fuelled expectations that symptomatic treatment may soon become more rapid and effective, and that depressive states may ultimately be "prevented" or "cured". In pursuing these objectives, in particular for genome-derived, non-monoaminergic targets, "specificity" of drug actions is often emphasized. That is, priority is afforded to agents that interact exclusively with a single site hypothesized as critically involved in the pathogenesis and/or control of depression. Certain highly selective drugs may prove effective, and they remain indispensable in the experimental (and clinical) evaluation of the significance of novel mechanisms. However, by analogy to other multifactorial disorders, "multi-target" agents may be better adapted to the improved treatment of depressive states. Support for this contention is garnered from a broad palette of observations, ranging from mechanisms of action of adjunctive drug combinations and electroconvulsive therapy to "network theory" analysis of the etiology and management of depressive states. The review also outlines opportunities to be exploited, and challenges to be addressed, in the discovery and characterization of drugs recognizing multiple targets. Finally, a diversity of multi-target strategies is proposed for the more efficacious and rapid control of core and co-morbid symptoms of depression, together with improved tolerance relative to currently available agents.
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Affiliation(s)
- Mark J Millan
- Institut de Recherches Servier, Centre de Recherches de Croissy, Psychopharmacology Department, 125, Chemin de Ronde, 78290-Croissy/Seine, France.
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Goussakov I, Chartoff EH, Tsvetkov E, Gerety LP, Meloni EG, Carlezon WA, Bolshakov VY. LTP in the lateral amygdala during cocaine withdrawal. Eur J Neurosci 2006; 23:239-50. [PMID: 16420433 DOI: 10.1111/j.1460-9568.2005.04538.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The amygdala plays key roles in several aspects of addiction to drugs of abuse. This brain structure has been implicated in behaviours that reflect drug reward, drug seeking, and the aversive effects of drug withdrawal. Using a model that involves repeated cocaine injections to approximate 'binge' intoxication, we show in rats that during cocaine withdrawal, the impact of rewarding brain stimulation is attenuated, as quantified by alterations in intracranial self-stimulation (ICSS) behaviour. These behavioural signs of withdrawal are accompanied by enhancements of glutamatergic synaptic transmission within the lateral amygdala (LA) that occlude electrically induced long-term potentiation (LTP) in tissue slices. Synaptic enhancements during periods of cocaine withdrawal are mechanistically similar to LTP induced with electrical stimulation in control slices, as both forms of synaptic plasticity involve an increase in glutamate release. These results suggest that mechanisms of LTP within the amygdala are recruited during withdrawal from repeated exposure to cocaine. As such, they raise the possibility that the development and maintenance of addictive behaviours may involve, at least in part, mechanisms of synaptic plasticity within specific amygdala circuits.
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Affiliation(s)
- Ivan Goussakov
- Department of Psychiatry, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, Massachusetts 02478, USA
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Lei Y, Liu T, Wilson FAW, Zhou D, Ma Y, Hu X. Effects of extremely low-frequency electromagnetic fields on morphine-induced conditioned place preferences in rats. Neurosci Lett 2005; 390:72-5. [PMID: 16125316 DOI: 10.1016/j.neulet.2005.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 07/15/2005] [Accepted: 08/01/2005] [Indexed: 10/25/2022]
Abstract
In the present study, we examined the effects of extremely low-frequency (ELF) electromagnetic fields on morphine-induced conditioned place preferences in rats. During the conditioning phase (12 days), three groups of rats were placed in a sensory cue-defined environment paired with morphine (10mg/kg, i.p.) following exposure to either 20 Hz (1.80 mT) or 50 Hz (2.20 mT) or sham electromagnetic fields for 60 min/day, respectively, and were placed in another sensory cue-defined environment paired with physiological saline (1 ml/kg, i.p.) without exposure to electromagnetic fields. After finishing 12 days of conditioning, preference tests for the morphine-paired place were performed during a 10-day withdrawal period. The exposure to electromagnetic fields substantially potentiated morphine-induced place preferences in rodents, suggesting that ELF electromagnetic fields can increase the propensity for morphine-induced conditioned behaviors.
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Affiliation(s)
- Yanlin Lei
- Laboratory of Cognitive Brain Research, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650223, PR China
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