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Klooster D, Voetterl H, Baeken C, Arns M. Evaluating Robustness of Brain Stimulation Biomarkers for Depression: A Systematic Review of Magnetic Resonance Imaging and Electroencephalography Studies. Biol Psychiatry 2024; 95:553-563. [PMID: 37734515 DOI: 10.1016/j.biopsych.2023.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Abstract
Noninvasive brain stimulation (NIBS) treatments have gained considerable attention as potential therapeutic intervention for psychiatric disorders. The identification of reliable biomarkers for predicting clinical response to NIBS has been a major focus of research in recent years. Neuroimaging techniques, such as electroencephalography (EEG) and functional magnetic resonance imaging (MRI), have been used to identify potential biomarkers that could predict response to NIBS. However, identifying clinically actionable brain biomarkers requires robustness. In this systematic review, we aimed to summarize the current state of brain biomarker research for NIBS in depression, focusing only on well-powered studies (N ≥ 88) and/or studies that aimed at independently replicating previous findings, either successfully or unsuccessfully. A total of 220 studies were initially identified, of which 18 MRI studies and 18 EEG studies met the inclusion criteria. All focused on repetitive transcranial magnetic stimulation treatment in depression. After reviewing the included studies, we found the following MRI and EEG biomarkers to be most robust: 1) functional MRI-based functional connectivity between the dorsolateral prefrontal cortex and subgenual anterior cingulate cortex, 2) functional MRI-based network connectivity, 3) task-induced EEG frontal-midline theta, and 4) EEG individual alpha frequency. Future prospective studies should further investigate the clinical actionability of these specific EEG and MRI biomarkers to bring biomarkers closer to clinical reality.
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Affiliation(s)
- Debby Klooster
- Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; 4BRAIN Team, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Center for Care and Cure, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Helena Voetterl
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Chris Baeken
- Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Center for Care and Cure, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Department of Psychiatry, Brussels, Belgium
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Singh A, Arun P, Singh GP, Kaur D, Kaur S. QEEG Predictors of Treatment Response in Major Depressive Disorder- A Replication Study from Northwest India. Clin EEG Neurosci 2024; 55:176-184. [PMID: 36448183 DOI: 10.1177/15500594221142396] [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] [Indexed: 12/05/2022]
Abstract
Background: Predicting treatment response with antidepressant is a challenging task for clinicians and researchers. An important limitation of an antidepressant trial is the increased time spent before an adequacy of trial can be decided. Quantitative Electroencephalography has shown some evidence in identifying early changes seen with antidepressants. No data has been reported from Indian population on its predictive capabilities. Aim: To examine whether early changes in frontal and prefrontal theta value in QEEG could predict antidepressant treatment response. Methods: Structured clinical assessments were conducted at baseline and after one week in a sample of treatment-seeking adults with major depressive disorder (n = 50). Patients were started on SSRI (Escitalopram, fluoxetine, paroxetine or sertraline) and followed for 8 weeks. QEEG recordings were carried out at baseline and week 1 and its parameters (relative theta power and cordance) were assessed to identify its predictive value for treatment response. Treatment response was assessed using Hamilton depression rating scale with 50% reduction after 8 weeks being considered as response. Results: Mean age of the sample was 39 ± 10 years and majority of them were females (64%). A significant reduction was found in relative frontal theta value (p = 0.021) from baseline to one week in responders. However, linear regression revealed that this change could not predict the treatment response (p = 0.37). Conclusions: QEEG changes are observed in initial phase of antidepressant treatment but these changes can't predict the treatment response.
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Affiliation(s)
- Akashdeep Singh
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Priti Arun
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Gurvinder Pal Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Damanjeet Kaur
- Department of Electrical and Electronic Engineering, University Institute of Engineering and Technology, Chandigarh, India
| | - Simranjit Kaur
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala, Punjab, India
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Zhu L, Pei Z, Dang G, Shi X, Su X, Lan X, Lian C, Yan N, Guo Y. Predicting response to repetitive transcranial magnetic stimulation in patients with chronic insomnia disorder using electroencephalography: A pilot study. Brain Res Bull 2024; 206:110851. [PMID: 38141788 DOI: 10.1016/j.brainresbull.2023.110851] [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: 08/07/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
Predicting responsvienss to repetitive transcranial magnetic stimulation (rTMS) can facilitate personalized treatments with improved efficacy; however, predictive features related to this response are still lacking. We explored whether resting-state electroencephalography (rsEEG) functional connectivity measured at baseline or during treatment could predict the response to 10-day rTMS targeted to the right dorsolateral prefrontal cortex (DLPFC) in 36 patients with chronic insomnia disorder (CID). Pre- and post-treatment rsEEG scans and the Pittsburgh Sleep Quality Index (PSQI) were evaluated, with an additional rsEEG scan conducted after four rTMS sessions. Machine-learning approaches were employed to assess the ability of each connectivity measure to distinguish between responders (PSQI improvement > 25%) and non-responders (PSQI improvement ≤ 25%). Furthermore, we analyzed the connectivity trends of the two subgroups throughout the treatment. Our results revealed that the machine learning model based on baseline theta connectivity achieved the highest accuracy (AUC = 0.843) in predicting treatment response. Decreased baseline connectivity at the stimulated site was associated with higher responsiveness to TMS, emphasizing the significance of functional connectivity characteristics in rTMS treatment. These findings enhance the clinical application of EEG functional connectivity markers in predicting treatment outcomes.
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Affiliation(s)
- Lin Zhu
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Zian Pei
- Shenzhen Bay Laboratory, Shenzhen 518020, Guangdong, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Xue Shi
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Xiaoyong Lan
- Shenzhen Bay Laboratory, Shenzhen 518020, Guangdong, China
| | - Chongyuan Lian
- Shenzhen Bay Laboratory, Shenzhen 518020, Guangdong, China
| | - Nan Yan
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China; Shenzhen Bay Laboratory, Shenzhen 518020, Guangdong, China.
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Ebrahimzadeh E, Dehghani A, Asgarinejad M, Soltanian-Zadeh H. Non-linear processing and reinforcement learning to predict rTMS treatment response in depression. Psychiatry Res Neuroimaging 2024; 337:111764. [PMID: 38043370 DOI: 10.1016/j.pscychresns.2023.111764] [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: 01/07/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Forecasting the efficacy of repetitive transcranial magnetic stimulation (rTMS) therapy can lead to substantial time and cost savings by preventing futile treatments. To achieve this objective, we've formulated a machine learning approach aimed at categorizing patients with major depressive disorder (MDD) into two groups: individuals who respond (R) positively to rTMS treatment and those who do not respond (NR). METHODS Preceding the commencement of treatment, we obtained resting-state EEG data from 106 patients diagnosed with MDD, employing 32 electrodes for data collection. These patients then underwent a 7-week course of rTMS therapy, and 54 of them exhibited positive responses to the treatment. Employing Independent Component Analysis (ICA) on the EEG data, we successfully pinpointed relevant brain sources that could potentially serve as markers of neural activity within the dorsolateral prefrontal cortex (DLPFC). These identified sources were further scrutinized to estimate the sources of activity within the sensor domain. Then, we integrated supplementary physiological data and implemented specific criteria to yield more realistic estimations when compared to conventional EEG analysis. In the end, we selected components corresponding to the DLPFC region within the sensor domain. Features were derived from the time-series data of these relevant independent components. To identify the most significant features, we used Reinforcement Learning (RL). In categorizing patients into two groups - R and NR to rTMS treatment - we utilized three distinct classification algorithms including K-Nearest Neighbor (KNN), Support Vector Machine (SVM), and Multilayer Perceptron (MLP). We assessed the performance of these classifiers through a ten-fold cross-validation method. Additionally, we conducted a statistical test to evaluate the discriminative capacity of these features between responders and non-responders, opening the door for further exploration in this field. RESULTS We identified EEG features that can anticipate the response to rTMS treatment. The most robust discriminators included EEG beta power, the sum of bispectrum diagonal elements in the delta and beta frequency bands. When these features were combined into a single vector, the classification of responders and non-responders achieved impressive performance, with an accuracy of 95.28 %, specificity at 94.23 %, sensitivity reaching 96.29 %, and precision standing at 94.54 %, all achieved using SVM. CONCLUSIONS The results of this study suggest that the proposed approach, utilizing power, non-linear, and bispectral features extracted from relevant independent component time-series, has the capability to forecast the treatment outcome of rTMS for MDD patients based solely on a single pre-treatment EEG recording session. The achieved findings demonstrate the superior performance of our method compared to previous techniques.
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Affiliation(s)
- Elias Ebrahimzadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
| | - Amin Dehghani
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | | | - Hamid Soltanian-Zadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
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Li CT, Chen CS, Cheng CM, Chen CP, Chen JP, Chen MH, Bai YM, Tsai SJ. Prediction of antidepressant responses to non-invasive brain stimulation using frontal electroencephalogram signals: Cross-dataset comparisons and validation. J Affect Disord 2023; 343:86-95. [PMID: 37579885 DOI: 10.1016/j.jad.2023.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND 10-Hz repetitive transcranial magnetic stimulation(rTMS) and intermittent theta-burst stimulation(iTBS) over left prefrontal cortex are FDA-approved, effective options for treatment-resistant depression (TRD). Optimal prediction models for iTBS and rTMS remain elusive. Therefore, our primary objective was to compare prediction accuracy between classification by frontal theta activity alone and machine learning(ML) models by linear and non-linear frontal signals. The second objective was to study an optimal ML model for predicting responses to rTMS and iTBS. METHODS Two rTMS and iTBS datasets (n = 163) were used: one randomized controlled trial dataset (RCTD; n = 96) and one outpatient dataset (OPD; n = 67). Frontal theta and non-linear EEG features that reflect trend, stability, and complexity were extracted. Pretreatment frontal EEG and ML algorithms, including classical support vector machine(SVM), random forest(RF), XGBoost, and CatBoost, were analyzed. Responses were defined as ≥50 % depression improvement after treatment. Response rates between those with and without pretreatment prediction in another independent outpatient cohort (n = 208) were compared. RESULTS Prediction accuracy using combined EEG features by SVM was better than frontal theta by logistic regression. The accuracy for OPD patients significantly dropped using the RCTD-trained SVM model. Modern ML models, especially RF (rTMS = 83.3 %, iTBS = 88.9 %, p-value(ACC > NIR) < 0.05 for iTBS), performed significantly above chance and had higher accuracy than SVM using both selected features (p < 0.05, FDR corrected for multiple comparisons) or all EEG features. Response rates among those receiving prediction before treatment were significantly higher than those without prediction (p = 0.035). CONCLUSION The first study combining linear and non-linear EEG features could accurately predict responses to left PFC iTBS. The bootstraps-based ML model (i.e., RF) had the best predictive accuracy for rTMS and iTBS.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
| | - Chi-Sheng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Ping Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Jen-Ping Chen
- Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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6
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Stolz LA, Kohn JN, Smith SE, Benster LL, Appelbaum LG. Predictive Biomarkers of Treatment Response in Major Depressive Disorder. Brain Sci 2023; 13:1570. [PMID: 38002530 PMCID: PMC10669981 DOI: 10.3390/brainsci13111570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Major depressive disorder (MDD) is a highly prevalent, debilitating disorder with a high rate of treatment resistance. One strategy to improve treatment outcomes is to identify patient-specific, pre-intervention factors that can predict treatment success. Neurophysiological measures such as electroencephalography (EEG), which measures the brain's electrical activity from sensors on the scalp, offer one promising approach for predicting treatment response for psychiatric illnesses, including MDD. In this study, a secondary data analysis was conducted on the publicly available Two Decades Brainclinics Research Archive for Insights in Neurophysiology (TDBRAIN) database. Logistic regression modeling was used to predict treatment response, defined as at least a 50% improvement on the Beck's Depression Inventory, in 119 MDD patients receiving repetitive transcranial magnetic stimulation (rTMS). The results show that both age and baseline symptom severity were significant predictors of rTMS treatment response, with older individuals and more severe depression scores associated with decreased odds of a positive treatment response. EEG measures contributed predictive power to these models; however, these improvements in outcome predictability only trended towards statistical significance. These findings provide confirmation of previous demographic and clinical predictors, while pointing to EEG metrics that may provide predictive information in future studies.
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Affiliation(s)
- Louise A. Stolz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (L.A.S.); (J.N.K.); (L.L.B.)
| | - Jordan N. Kohn
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (L.A.S.); (J.N.K.); (L.L.B.)
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Sydney E. Smith
- Department of Cognitive Science, University of California San Diego, La Jolla, CA 92093, USA;
| | - Lindsay L. Benster
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (L.A.S.); (J.N.K.); (L.L.B.)
- Department Clinical Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Lawrence G. Appelbaum
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; (L.A.S.); (J.N.K.); (L.L.B.)
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Xu Y, Zhong H, Ying S, Liu W, Chen G, Luo X, Li G. Depressive Disorder Recognition Based on Frontal EEG Signals and Deep Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:8639. [PMID: 37896732 PMCID: PMC10611358 DOI: 10.3390/s23208639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
Depressive disorder (DD) has become one of the most common mental diseases, seriously endangering both the affected person's psychological and physical health. Nowadays, a DD diagnosis mainly relies on the experience of clinical psychiatrists and subjective scales, lacking objective, accurate, practical, and automatic diagnosis technologies. Recently, electroencephalogram (EEG) signals have been widely applied for DD diagnosis, but mainly with high-density EEG, which can severely limit the efficiency of the EEG data acquisition and reduce the practicability of diagnostic techniques. The current study attempts to achieve accurate and practical DD diagnoses based on combining frontal six-channel electroencephalogram (EEG) signals and deep learning models. To this end, 10 min clinical resting-state EEG signals were collected from 41 DD patients and 34 healthy controls (HCs). Two deep learning models, multi-resolution convolutional neural network (MRCNN) combined with long short-term memory (LSTM) (named MRCNN-LSTM) and MRCNN combined with residual squeeze and excitation (RSE) (named MRCNN-RSE), were proposed for DD recognition. The results of this study showed that the higher EEG frequency band obtained the better classification performance for DD diagnosis. The MRCNN-RSE model achieved the highest classification accuracy of 98.48 ± 0.22% with 8-30 Hz EEG signals. These findings indicated that the proposed analytical framework can provide an accurate and practical strategy for DD diagnosis, as well as essential theoretical and technical support for the treatment and efficacy evaluation of DD.
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Affiliation(s)
- Yanting Xu
- College of Engineering, Zhejiang Normal University, Jinhua 321004, China; (Y.X.); (S.Y.)
| | - Hongyang Zhong
- College of Computer Science and Technology, Zhejiang Normal University, Jinhua 321004, China; (H.Z.); (W.L.); (G.C.)
| | - Shangyan Ying
- College of Engineering, Zhejiang Normal University, Jinhua 321004, China; (Y.X.); (S.Y.)
| | - Wei Liu
- College of Computer Science and Technology, Zhejiang Normal University, Jinhua 321004, China; (H.Z.); (W.L.); (G.C.)
| | - Guibin Chen
- College of Computer Science and Technology, Zhejiang Normal University, Jinhua 321004, China; (H.Z.); (W.L.); (G.C.)
| | - Xiaodong Luo
- The Second Hospital of Jinhua, Jinhua 321016, China
| | - Gang Li
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua 321004, China
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Rezaei M, Shariat Bagheri MM, Khazaei S, Garavand H. tDCS efficacy and utility of anhedonia and rumination as clinical predictors of response to tDCS in major depressive disorder (MDD). J Affect Disord 2023; 339:756-762. [PMID: 37481126 DOI: 10.1016/j.jad.2023.07.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/14/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Anhedonia and rumination are mental disorders' transdiagnostic features but remain difficult to treat. Transcranial direct current stimulation (tDCS) is a proven treatment for depression, but its effects on anhedonia and rumination and whether anhedonia and rumination can be used as a predictive biomarker of treatment response is not well known. This study aimed to investigate the tDCS efficacy and identify the predictive role of anhedonia and rumination in response to tDCS in patients with MDD. METHODS 182 patients received 10 tDCS sessions delivered at 2 mA to left (anode) dorsolateral prefrontal cortex (DLPFC). Hamilton Rating Scale for Depression (HRSD-17), Snaith-Hamilton Pleasure Scale (SHAPS), and the 10-item Ruminative Response Scale (RRS-10) was administered to patients with MDD before treatment, following it, and after two weeks of tDCS. RESULTS There was an overall significant improvement in anhedonia from pre- to post-treatment. Regression analyses revealed that responders had higher baseline anhedonia and rumination (reflective pondering) scores. We found that the reduction in HRSD scores after tDCS was significantly associated with anhedonia's baseline values while no relation was found between baseline rumination and tDCS treatment response. CONCLUSION These results provide new evidence that pronounced anhedonia may be a significant clinical predictor of response to tDCS. Patients with severe or low baseline rumination had an equal chance of achieving clinical response. Prospective tDCS studies are necessary to validate the predictive value of the derived model.
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Affiliation(s)
- Mehdi Rezaei
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran.
| | | | - Samaneh Khazaei
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Birjand, Birjand, Iran
| | - Houshang Garavand
- Psychology Department, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran
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Shim M, Hwang HJ, Lee SH. Toward practical machine-learning-based diagnosis for drug-naïve women with major depressive disorder using EEG channel reduction approach. J Affect Disord 2023; 338:199-206. [PMID: 37302509 DOI: 10.1016/j.jad.2023.06.007] [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: 07/18/2022] [Revised: 03/30/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND A machine-learning-based computer-aided diagnosis (CAD) system can complement the traditional diagnostic error for major depressive disorder (MDD) using trait-like neurophysiological biomarkers. Previous studies have shown that the CAD system has the potential to differentiate between female MDD patients and healthy controls. The aim of this study was to develop a practically useful resting-state electroencephalography (EEG)-based CAD system to assist in the diagnosis of drug-naïve female MDD patients by considering both the drug and gender effects. In addition, the feasibility of the practical use of the resting-state EEG-based CAD system was evaluated using a channel reduction approach. METHODS Eyes-closed, resting-state EEG data were recorded from 49 drug-naïve female MDD patients and 49 sex-matched healthy controls. Six different EEG feature sets were extracted: power spectrum densities (PSDs), phase-locking values (PLVs), and network indices for both sensor- and source-level, and four different EEG channel montages (62, 30, 19, and 10-channels) were designed to investigate the channel reduction effects in terms of classification performance. RESULTS The classification performances for each feature set were evaluated using a support vector machine with leave-one-out cross-validation. The optimum classification performance was achieved when using sensor-level PLVs (accuracy: 83.67 % and area under curve: 0.92). Moreover, the classification performance was maintained until the number of EEG channels was reduced to 19 (over 80 % accuracy). CONCLUSION We demonstrated the promising potential of sensor-level PLVs as diagnostic features when developing a resting-state EEG-based CAD system for the diagnosis of drug-naïve female MDD patients and verified the feasibility of the practical use of the developed resting-state EEG-based CAD system using the channel reduction approach.
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Affiliation(s)
- Miseon Shim
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea; Industry Development Institute, Korea University, Sejong, Republic of Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea; Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Korea University, Sejong, Republic of Korea.
| | - Seung-Hwan Lee
- Psychiatry Department, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea; Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea; BWAVE Inc., Goyang, Republic of Korea.
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Pan R, Ye S, Zhong Y, Chen Q, Cai Y. Transcranial alternating current stimulation for the treatment of major depressive disorder: from basic mechanisms toward clinical applications. Front Hum Neurosci 2023; 17:1197393. [PMID: 37731669 PMCID: PMC10507344 DOI: 10.3389/fnhum.2023.1197393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Non-pharmacological treatment is essential for patients with major depressive disorder (MDD) that is medication resistant or who are unable to take medications. Transcranial alternating current stimulation (tACS) is a non-invasive brain stimulation method that manipulates neural oscillations. In recent years, tACS has attracted substantial attention for its potential as an MDD treatment. This review summarizes the latest advances in tACS treatment for MDD and outlines future directions for promoting its clinical application. We first introduce the neurophysiological mechanism of tACS and its novel developments. In particular, two well-validated tACS techniques have high application potential: high-definition tACS targeting local brain oscillations and bifocal tACS modulating interarea functional connectivity. Accordingly, we summarize the underlying mechanisms of tACS modulation for MDD. We sort out the local oscillation abnormalities within the reward network and the interarea oscillatory synchronizations among multiple MDD-related networks in MDD patients, which provide potential modulation targets of tACS interventions. Furthermore, we review the latest clinical studies on tACS treatment for MDD, which were based on different modulation mechanisms and reported alleviations in MDD symptoms. Finally, we discuss the main challenges of current tACS treatments for MDD and outline future directions to improve intervention target selection, tACS implementation, and clinical validations.
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Affiliation(s)
- Ruibo Pan
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengfeng Ye
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
| | - Yun Zhong
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
| | - Qiaozhen Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Ying Cai
- Department of Psychology and Behavioral Science, Zhejiang University, Hangzhou, China
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Shahabi MS, Shalbaf A, Rostami R. Prediction of response to repetitive transcranial magnetic stimulation for major depressive disorder using hybrid Convolutional recurrent neural networks and raw Electroencephalogram Signal. Cogn Neurodyn 2023; 17:909-920. [PMID: 37522037 PMCID: PMC10374518 DOI: 10.1007/s11571-022-09881-4] [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: 03/10/2022] [Revised: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022] Open
Abstract
Major Depressive Disorder (MDD) is a high prevalence disease that needs an effective and timely treatment to prevent its progress and additional costs. Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective treatment option for MDD patients which uses strong magnetic pulses to stimulate specific regions of the brain. However, some patients do not respond to this treatment which causes the waste of multiple weeks as treatment time and clinical resources. Therefore developing an effective way for the prediction of response to the rTMS treatment of depression is necessary. In this work, we proposed a hybrid model created by pre-trained Convolutional Neural Networks (CNN) models and Bidirectional Long Short-Term Memory (BLSTM) cells to predict response to rTMS treatment from raw EEG signal. Three pre-trained CNN models named VGG16, InceptionResNetV2, and EffecientNetB0 were utilized as Transfer Learning (TL) models to construct hybrid TL-BLSTM models. Then an ensemble of these models was created using weighted majority voting which the weights were optimized by Differential Evolution (DE) optimization algorithm. Evaluation of these models shows the superior performance of the ensemble model by the accuracy of 98.51%, sensitivity of 98.64%, specificity of 98.36%, F1-score of 98.6%, and AUC of 98.5%. Therefore, the ensemble of the proposed hybrid convolutional recurrent networks can efficiently predict the treatment outcome of rTMS using raw EEG data.
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Affiliation(s)
- Mohsen Sadat Shahabi
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
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12
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Sadat Shahabi M, Nobakhsh B, Shalbaf A, Rostami R, Kazemi R. Prediction of treatment outcome for repetitive transcranial magnetic stimulation in major depressive disorder using connectivity measures and ensemble of pre-trained deep learning models. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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13
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Richter K, Kellner S, Licht C. rTMS in mental health disorders. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:943223. [PMID: 37577037 PMCID: PMC10417823 DOI: 10.3389/fnetp.2023.943223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an innovative and non-invasive technique used in the diagnosis and treatment of psychiatric and neurological disorders. Repetitive TMS (rTMS) can modulate neuronal activity, neuroplasticity and arousal of the waking and sleeping brain, and, more generally, overall mental health. Numerous studies have examined the predictors of the efficacy of rTMS on clinical outcome variables in various psychiatric disorders. These predictors often encompass the stimulated brain region's location, electroencephalogram (EEG) activity patterns, potential morphological and neurophysiological anomalies, and individual patient's response to treatment. Most commonly, rTMS is used in awake patients with depression, catatonia, and tinnitus. Interestingly, rTMS has also shown promise in inducing slow-wave oscillations in insomnia patients, opening avenues for future research into the potential beneficial effects of these oscillations on reports of non-restorative sleep. Furthermore, neurophysiological measures emerge as potential, disease-specific biomarkers, aiding in predicting treatment response and monitoring post-treatment changes. The study posits the convergence of neurophysiological biomarkers and individually tailored rTMS treatments as a gateway to a new era in psychiatric care. The potential of rTMS to induce slow-wave activity also surfaces as a significant contribution to personalized treatment approaches. Further investigations are called for to validate the imaging and electrophysiological biomarkers associated with rTMS. In conclusion, the potential for rTMS to significantly redefine treatment strategies through personalized approaches could enhance the outcomes in neuropsychiatric disorders.
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Affiliation(s)
- Kneginja Richter
- Paracelsus Medical Private University, Nuremberg, Germany
- Department for Social Sciences, Georg Simon Ohm University of Applied Sciences Nuremberg, Nuremberg, Germany
- Faculty of Medical Sciences, Goce Delcev University, Stip, North Macedonia
| | - Stefanie Kellner
- Department for Social Sciences, Georg Simon Ohm University of Applied Sciences Nuremberg, Nuremberg, Germany
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14
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Zebhauser PT, Hohn VD, Ploner M. Resting-state electroencephalography and magnetoencephalography as biomarkers of chronic pain: a systematic review. Pain 2023; 164:1200-1221. [PMID: 36409624 PMCID: PMC10184564 DOI: 10.1097/j.pain.0000000000002825] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACT Reliable and objective biomarkers promise to improve the assessment and treatment of chronic pain. Resting-state electroencephalography (EEG) is broadly available, easy to use, and cost efficient and, therefore, appealing as a potential biomarker of chronic pain. However, results of EEG studies are heterogeneous. Therefore, we conducted a systematic review (PROSPERO CRD42021272622) of quantitative resting-state EEG and magnetoencephalography (MEG) studies in adult patients with different types of chronic pain. We excluded populations with severe psychiatric or neurologic comorbidity. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Semiquantitative data synthesis was conducted using modified albatross plots. We included 76 studies after searching MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and EMBASE. For cross-sectional studies that can serve to develop diagnostic biomarkers, we found higher theta and beta power in patients with chronic pain than in healthy participants. For longitudinal studies, which can yield monitoring and/or predictive biomarkers, we found no clear associations of pain relief with M/EEG measures. Similarly, descriptive studies that can yield diagnostic or monitoring biomarkers showed no clear correlations of pain intensity with M/EEG measures. Risk of bias was high in many studies and domains. Together, this systematic review synthesizes evidence on how resting-state M/EEG might serve as a diagnostic biomarker of chronic pain. Beyond, this review might help to guide future M/EEG studies on the development of pain biomarkers.
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Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Vanessa D. Hohn
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Markus Ploner
- Department of Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
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15
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Alterations in EEG functional connectivity in individuals with depression: A systematic review. J Affect Disord 2023; 328:287-302. [PMID: 36801418 DOI: 10.1016/j.jad.2023.01.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023]
Abstract
The brain works as an organised, network-like structure of functionally interconnected regions. Disruptions to interconnectivity in certain networks have been linked to symptoms of depression and impairments in cognition. Electroencephalography (EEG) is a low-burden tool by which differences in functional connectivity (FC) can be assessed. This systematic review aims to provide a synthesis of evidence relating to EEG FC in depression. A comprehensive electronic literature search for terms relating to depression, EEG, and FC was conducted on studies published before the end of November 2021, according to PRISMA guidelines. Studies comparing EEG measures of FC of individuals with depression to that of healthy control groups were included. Data was extracted by two independent reviewers, and the quality of EEG FC methods was assessed. Fifty-two studies assessing EEG FC in depression were identified: 36 assessed resting-state FC, and 16 assessed task-related or other (i.e., sleep) FC. Somewhat consistent findings in resting-state studies suggest for no differences between depression and control groups in EEG FC in the delta and gamma frequencies. However, while most resting-state studies noted a difference in alpha, theta, and beta, no clear conclusions could be drawn about the direction of the difference, due to considerable inconsistencies between study design and methodology. This was also true for task-related and other EEG FC. More robust research is needed to understand the true differences in EEG FC in depression. Given that the FC between brain regions drives behaviour, cognition, and emotion, characterising how FC differs in depression is essential for understanding the aetiology of depression.
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16
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Morris AT, Temereanca S, Zandvakili A, Thorpe R, Sliva DD, Greenberg BD, Carpenter LL, Philip NS, Jones SR. Fronto-central resting-state 15-29 Hz transient beta events change with therapeutic transcranial magnetic stimulation for posttraumatic stress disorder and major depressive disorder. Sci Rep 2023; 13:6366. [PMID: 37076496 PMCID: PMC10115889 DOI: 10.1038/s41598-023-32801-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/03/2023] [Indexed: 04/21/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD) and shows promise for posttraumatic stress disorder (PTSD), yet effectiveness varies. Electroencephalography (EEG) can identify rTMS-associated brain changes. EEG oscillations are often examined using averaging approaches that mask finer time-scale dynamics. Recent advances show some brain oscillations emerge as transient increases in power, a phenomenon termed "Spectral Events," and that event characteristics correspond with cognitive functions. We applied Spectral Event analyses to identify potential EEG biomarkers of effective rTMS treatment. Resting 8-electrode EEG was collected from 23 patients with MDD and PTSD before and after 5 Hz rTMS targeting the left dorsolateral prefrontal cortex. Using an open-source toolbox ( https://github.com/jonescompneurolab/SpectralEvents ), we quantified event features and tested for treatment associated changes. Spectral Events in delta/theta (1-6 Hz), alpha (7-14 Hz), and beta (15-29 Hz) bands occurred in all patients. rTMS-induced improvement in comorbid MDD PTSD were associated with pre- to post-treatment changes in fronto-central electrode beta event features, including frontal beta event frequency spans and durations, and central beta event maxima power. Furthermore, frontal pre-treatment beta event duration correlated negatively with MDD symptom improvement. Beta events may provide new biomarkers of clinical response and advance the understanding of rTMS.
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Affiliation(s)
- Alexander T Morris
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
| | - Simona Temereanca
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA.
- Department of Neuroscience, Brown University, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
| | - Amin Zandvakili
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ryan Thorpe
- Department of Neuroscience, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Danielle D Sliva
- Department of Neuroscience, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Benjamin D Greenberg
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
| | - Linda L Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- COBRE Center for Neuromodulation, Butler Hospital, Providence, RI, USA
| | - Stephanie R Jones
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence, Providence, RI, USA.
- Department of Neuroscience, Brown University, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
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17
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Morris AT, Temereanca S, Zandvakili A, Thorpe R, Sliva DD, Greenberg BD, Carpenter LL, Philip NS, Jones SR. Fronto-central resting-state 15-29Hz transient beta events change with therapeutic transcranial magnetic stimulation for posttraumatic stress disorder and major depressive disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.11.23286902. [PMID: 36993547 PMCID: PMC10055566 DOI: 10.1101/2023.03.11.23286902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD) and shows promise for posttraumatic stress disorder (PTSD), yet effectiveness varies. Electroencephalography (EEG) can identify rTMS-associated brain changes. EEG oscillations are often examined using averaging approaches that mask finer time-scale dynamics. Recent advances show some brain oscillations emerge as transient increases in power, a phenomenon termed "Spectral Events," and that event characteristics correspond with cognitive functions. We applied Spectral Event analyses to identify potential EEG biomarkers of effective rTMS treatment. Resting 8-electrode EEG was collected from 23 patients with MDD and PTSD before and after 5Hz rTMS targeting the left dorsolateral prefrontal cortex. Using an open-source toolbox ( https://github.com/jonescompneurolab/SpectralEvents ), we quantified event features and tested for treatment associated changes. Spectral Events in delta/theta (1-6 Hz), alpha (7-14 Hz), and beta (15-29 Hz) bands occurred in all patients. rTMS-induced improvement in comorbid MDD PTSD were associated with pre-to post-treatment changes in fronto-central electrode beta event features, including frontal beta event frequency spans and durations, and central beta event maxima power. Furthermore, frontal pre-treatment beta event duration correlated negatively with MDD symptom improvement. Beta events may provide new biomarkers of clinical response and advance the understanding of rTMS.
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18
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Ebrahimzadeh E, Fayaz F, Rajabion L, Seraji M, Aflaki F, Hammoud A, Taghizadeh Z, Asgarinejad M, Soltanian-Zadeh H. Machine learning approaches and non-linear processing of extracted components in frontal region to predict rTMS treatment response in major depressive disorder. Front Syst Neurosci 2023; 17:919977. [PMID: 36968455 PMCID: PMC10034109 DOI: 10.3389/fnsys.2023.919977] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Predicting the therapeutic result of repetitive transcranial magnetic stimulation (rTMS) treatment could save time and costs as ineffective treatment can be avoided. To this end, we presented a machine-learning-based strategy for classifying patients with major depression disorder (MDD) into responders (R) and nonresponders (NR) to rTMS treatment. Resting state EEG data were recorded using 32 electrodes from 88 MDD patients before treatment. Then, patients underwent 7 weeks of rTMS, and 46 of them responded to treatment. By applying Independent Component Analysis (ICA) on EEG, we identified the relevant brain sources as possible indicators of neural activity in the dorsolateral prefrontal cortex (DLPFC). This was served through estimating the generators of activity in the sensor domain. Subsequently, we added physiological information and placed certain terms and conditions to offer a far more realistic estimation than the classic EEG. Ultimately, those components mapped in accordance with the region of the DLPFC in the sensor domain were chosen. Features extracted from the relevant ICs time series included permutation entropy (PE), fractal dimension (FD), Lempel-Ziv Complexity (LZC), power spectral density, correlation dimension (CD), features based on bispectrum, frontal and prefrontal cordance, and a combination of them. The most relevant features were selected by a Genetic Algorithm (GA). For classifying two groups of R and NR, K-Nearest Neighbor (KNN), Support Vector Machine (SVM), and Multilayer Perceptron (MLP) were applied to predict rTMS treatment response. To evaluate the performance of classifiers, a 10-fold cross-validation method was employed. A statistical test was used to assess the capability of features in differentiating R and NR for further research. EEG characteristics that can predict rTMS treatment response were discovered. The strongest discriminative indicators were EEG beta power, the sum of bispectrum diagonal elements in delta and beta bands, and CD. The Combined feature vector classified R and NR with a high performance of 94.31% accuracy, 92.85% specificity, 95.65% sensitivity, and 92.85% precision using SVM. This result indicates that our proposed method with power and nonlinear and bispectral features from relevant ICs time-series can predict the treatment outcome of rTMS for MDD patients only by one session pretreatment EEG recording. The obtained results show that the proposed method outperforms previous methods.
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Affiliation(s)
- Elias Ebrahimzadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
- *Correspondence: Elias Ebrahimzadeh
| | - Farahnaz Fayaz
- Biomedical Engineering Department, School of Electrical Engineering, Payame Noor University of North Tehran, Tehran, Iran
| | - Lila Rajabion
- School of Graduate Studies, SUNY Empire State College, Manhattan, NY, United States
| | - Masoud Seraji
- Department of Psychology, University of Texas at Austin, Austin, TX, United States
| | - Fatemeh Aflaki
- Department of Biomedical Engineering, Islamic Azad University Central Tehran Branch, Tehran, Iran
| | - Ahmad Hammoud
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, Moscow, Russia
| | - Zahra Taghizadeh
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Mostafa Asgarinejad
- Department of Cognitive Neuroscience, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hamid Soltanian-Zadeh
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
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19
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van Dijk H, Koppenberg M, Arns M. Towards Robust, Reproducible, and Clinically Actionable EEG Biomarkers: Large Open Access EEG Database for Discovery and Out-of-sample Validation. Clin EEG Neurosci 2023; 54:103-105. [PMID: 35975621 DOI: 10.1177/15500594221120516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Hanneke van Dijk
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands.,Faculty of Psychology & Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Mark Koppenberg
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands.,Faculty of Psychology & Neuroscience, Department of Cognitive Neuroscience, Maastricht University, Maastricht, the Netherlands
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20
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Corlier J, Tadayonnejad R, Wilson AC, Lee JC, Marder KG, Ginder ND, Wilke SA, Levitt J, Krantz D, Leuchter AF. Repetitive transcranial magnetic stimulation treatment of major depressive disorder and comorbid chronic pain: response rates and neurophysiologic biomarkers. Psychol Med 2023; 53:823-832. [PMID: 34154683 PMCID: PMC9976020 DOI: 10.1017/s0033291721002178] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and chronic pain are highly comorbid, and pain symptoms are associated with a poorer response to antidepressant medication treatment. It is unclear whether comorbid pain also is associated with a poorer response to treatment with repetitive transcranial magnetic stimulation (rTMS). METHODS 162 MDD subjects received 30 sessions of 10 Hz rTMS treatment administered to the left dorsolateral prefrontal cortex (DLPFC) with depression and pain symptoms measured before and after treatment. For a subset of 96 patients, a resting-state electroencephalogram (EEG) was recorded at baseline. Clinical outcome was compared between subjects with and without comorbid pain, and the relationships among outcome, pain severity, individual peak alpha frequency (PAF), and PAF phase-coherence in the EEG were examined. RESULTS 64.8% of all subjects reported pain, and both depressive and pain symptoms were significantly reduced after rTMS treatment, irrespective of age or gender. Patients with severe pain were 27% less likely to respond to MDD treatment than pain-free individuals. PAF was positively associated with pain severity. PAF phase-coherence in the somatosensory and default mode networks was significantly lower for MDD subjects with pain who failed to respond to MDD treatment. CONCLUSIONS Pain symptoms improved after rTMS to left DLPFC in MDD irrespective of age or gender, although the presence of chronic pain symptoms reduced the likelihood of treatment response. Individual PAF and baseline phase-coherence in the sensorimotor and midline regions may represent predictors of rTMS treatment outcome in comorbid pain and MDD.
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Affiliation(s)
- Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, USA
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jonathan C Lee
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Katharine G Marder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Jennifer Levitt
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - David Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, USA
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21
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Abo Aoun M, Meek BP, Clair L, Wikstrom S, Prasad B, Modirrousta M. Prognostic factors in major depressive disorder: comparing responders and non-responders to Repetitive Transcranial Magnetic Stimulation (rTMS), a naturalistic retrospective chart review. Psychiatry Clin Neurosci 2023; 77:38-47. [PMID: 36207801 DOI: 10.1111/pcn.13488] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/18/2022] [Accepted: 10/04/2022] [Indexed: 01/06/2023]
Abstract
AIM Repetitive transcranial magnetic stimulation (rTMS) is widely utilized as an effective treatment for major depressive disorder (MDD) with varying response rates. Factors associated with better treatment outcome remain scarce. This naturalistic retrospective chart review hopes to shed light on easily obtainable and measurable predictive factors for patients referred to rTMS. METHODS Protocol parameters, medication, rated scales, rTMS protocols, and treatment outcomes were reviewed for 196 patients with MDD who received rTMS at Saint Boniface Hospital between 2013 and 2019. Logistic regression and marginal effects were used to assess the different predictor variables for response (50% reduction or more on the Hamilton Depression Rating Scale (Ham-D)) and remission (Ham-D of ≤7 by the last session). RESULTS HamD at 10 sessions was predictive of remission, and Sheehan Disability Scale (SDS) at 10 sessions was predictive of response to rTMS. Ham-D, SDS, and Beck Anxiety Inventory were predictive of remission and response by Beck Anxiety Inventory 20 sessions. High frequency rTMS had a similar response and remission rate to low frequency, but higher response rate to intermittent Theta Burst Stimulation with no difference in remission rate. Positive predictive factors of response were lower age and bupropion use. Negative predictive factors were antipsychotics, anticonvulsants, or benzodiazepine use. For remission, antipsychotics or anticonvulsants use were negative predictors; bupropion use and higher resting motor threshold were positive predictors. Severity of depression as measured by baseline HamD was not associated with different probabilities of treatment success.
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Affiliation(s)
| | - Benjamin P Meek
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Luc Clair
- Department of Economics, University of Winnipeg, Winnipeg, Canada.,Canadian Centre for Agri-Food Research in Health and Medicine, Saint Boniface Research Hospital, Winnipeg, Canada
| | - Sara Wikstrom
- Saint Boniface Hospital, Psychiatry, Winnipeg, Canada
| | | | - Mandana Modirrousta
- BrainWave Clinic, Winnipeg, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Canada
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22
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Hsieh JC, Li Y, Wang H, Perz M, Tang Q, Tang KWK, Pyatnitskiy I, Reyes R, Ding H, Wang H. Design of hydrogel-based wearable EEG electrodes for medical applications. J Mater Chem B 2022; 10:7260-7280. [PMID: 35678148 DOI: 10.1039/d2tb00618a] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The electroencephalogram (EEG) is considered to be a promising method for studying brain disorders. Because of its non-invasive nature, subjects take a lower risk compared to some other invasive methods, while the systems record the brain signal. With the technological advancement of neural and material engineering, we are in the process of achieving continuous monitoring of neural activity through wearable EEG. In this article, we first give a brief introduction to EEG bands, circuits, wired/wireless EEG systems, and analysis algorithms. Then, we review the most recent advances in the interfaces used for EEG recordings, focusing on hydrogel-based EEG electrodes. Specifically, the advances for important figures of merit for EEG electrodes are reviewed. Finally, we summarize the potential medical application of wearable EEG systems.
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Affiliation(s)
- Ju-Chun Hsieh
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Yang Li
- Department of Chemical Engineering, Polytechnique Montréal, Montréal, Québec H3C3J7, Canada
| | - Huiqian Wang
- Department of Mathematics, The University of Texas at Austin, Austin, TX 78712, USA
| | - Matt Perz
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Qiong Tang
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, TX 78712, USA
| | - Kai Wing Kevin Tang
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Ilya Pyatnitskiy
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Raymond Reyes
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Hong Ding
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Huiliang Wang
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.
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Kayasandik CB, Velioglu HA, Hanoglu L. Predicting the Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Functions in Patients With Alzheimer's Disease by Automated EEG Analysis. Front Cell Neurosci 2022; 16:845832. [PMID: 35663423 PMCID: PMC9160828 DOI: 10.3389/fncel.2022.845832] [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: 12/30/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive, neurodegenerative brain disorder that generally affects the elderly. Today, after the limited benefit of the pharmacological treatment strategies, numerous noninvasive brain stimulation techniques have been developed. Transcranial magnetic stimulation (TMS), based on electromagnetic stimulation, is one of the most widely used methods. The main problem in the use of TMS is the existence of large individual variability in the results. This causes a waste of money, time, and more importantly, a burden for delicate patients. Hence, it is a necessity to form an efficient and personalized TMS application protocol. In this paper, we performed a machine-learning analysis to see whether it is possible to predict the responses of patients with AD to TMS by analyzing their electroencephalography (EEG) signals. For that purpose, we analyzed both the EEG signals collected before and after the TMS application (EEG1 and EEG2, respectively). Through correlating EEG1 and repetitive transcranial magnetic stimulation (rTMS) outcomes, we tried to see whether it is possible to predict patients' responses before the treatment application. On the other hand, by EEG2 analysis, we investigated TMS impacts on EEG, more importantly if this impact is correlated with patients' response to the treatment. We used the support vector machine (SVM) classifier due to its multiple advantages for the current task with feature selection processes by stepwise linear discriminant analysis (SWLDA) and SVM. However, to justify our numerical analysis framework, we examined and compared the performances of different feature selection and classification techniques. Since we have a limited sample number, we used the leave-one-out method for the validation with the Monte Carlo technique to eliminate bias by a small sample size. In the conclusion, we observed that the correlation between rTMS outcomes and EEG2 is stronger than EEG1, since we observed, respectively, 93 and 79% of accuracies during our data analysis. Besides the informative features of EEG2 are focused on theta band, it indicates that TMS is characterizing the theta band signals in patients with AD in direct relation to patients' response to rTMS. This shows that it is more possible to determine patients' benefit from the TMS at the early stages of the treatment, which would increase the efficiency of rTMS applications in patients with Alzheimer's disease.
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Affiliation(s)
- Cihan Bilge Kayasandik
- Department of Computer Engineering, School of Engineering and Natural Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Halil Aziz Velioglu
- Department of Women's and Childrens' Health, Karolinska Institutet, Stockholm, Sweden
- Functional Imaging and Cognitive-Affective Neuroscience Lab (fINCAN), Regenerative and Restorative Medicine Research Center (REMER), Health Sciences and Technology Research Institute (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoglu
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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24
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Spitz NA, Pace BD, Ten Eyck P, Trapp NT. Early Improvement Predicts Clinical Outcomes Similarly in 10 Hz rTMS and iTBS Therapy for Depression. Front Psychiatry 2022; 13:863225. [PMID: 35633811 PMCID: PMC9130587 DOI: 10.3389/fpsyt.2022.863225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prior studies have demonstrated that early treatment response with transcranial magnetic stimulation (TMS) can predict overall response, yet none have directly compared that predictive capacity between intermittent theta-burst stimulation (iTBS) and 10 Hz repetitive transcranial magnetic stimulation (rTMS) for depression. Our study sought to test the hypothesis that early clinical improvement could predict ultimate treatment response in both iTBS and 10 Hz rTMS patient groups and that there would not be significant differences between the modalities. Methods We retrospectively evaluated response to treatment in 105 participants with depression that received 10 Hz rTMS (n = 68) and iTBS (n = 37) to the dorsolateral prefrontal cortex (DLPFC). Percent changes from baseline to treatment 10 (t10), and to final treatment (tf), were used to calculate confusion matrices including negative predictive value (NPV). Treatment non-response was defined as <50% reduction in PHQ-9 scores according to literature, and population, data-driven non-response was defined as <40% for 10 Hz and <45% for iTBS. Results For both modalities, the NPV related to degree of improvement at t10. NPV for 10 Hz was 80%, 63% and 46% at t10 in those who failed to improve >20, >10, and >0% respectively; while iTBS NPV rates were 65, 50, and 35%. There were not significant differences between protocols at any t10 cut-off assessed, whether research defined 50% improvement as response or data driven kernel density estimates (p = 0.22-0.44). Conclusion Patients who fail to achieve >20% improvement by t10 with both 10 Hz rTMS and iTBS therapies have ~70% chance of non-response to treatment. With no significant differences between predictive capacities, identifying patients at-risk for non-response affords psychiatrists greater opportunity to adapt treatment strategies.
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Affiliation(s)
- Nathen A. Spitz
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Benjamin D. Pace
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
| | - Nicholas T. Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States
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25
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Moretti J, Rodger J. A little goes a long way: Neurobiological effects of low intensity rTMS and implications for mechanisms of rTMS. CURRENT RESEARCH IN NEUROBIOLOGY 2022; 3:100033. [PMID: 36685761 PMCID: PMC9846462 DOI: 10.1016/j.crneur.2022.100033] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widespread technique in neuroscience and medicine, however its mechanisms are not well known. In this review, we consider intensity as a key therapeutic parameter of rTMS, and review the studies that have examined the biological effects of rTMS using magnetic fields that are orders of magnitude lower that those currently used in the clinic. We discuss how extensive characterisation of "low intensity" rTMS has set the stage for translation of new rTMS parameters from a mechanistic evidence base, with potential for innovative and effective therapeutic applications. Low-intensity rTMS demonstrates neurobiological effects across healthy and disease models, which include depression, injury and regeneration, abnormal circuit organisation, tinnitus etc. Various short and long-term changes to metabolism, neurotransmitter release, functional connectivity, genetic changes, cell survival and behaviour have been investigated and we summarise these key changes and the possible mechanisms behind them. Mechanisms at genetic, molecular, cellular and system levels have been identified with evidence that low-intensity rTMS and potentially rTMS in general acts through several key pathways to induce changes in the brain with modulation of internal calcium signalling identified as a major mechanism. We discuss the role that preclinical models can play to inform current clinical research as well as uncover new pathways for investigation.
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Affiliation(s)
- Jessica Moretti
- School of Biological Sciences, The University of Western Australia, Perth, WA, Australia,Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Jennifer Rodger
- School of Biological Sciences, The University of Western Australia, Perth, WA, Australia,Perron Institute for Neurological and Translational Science, Perth, WA, Australia,Corresponding author. School of Biological Sciences M317, The University of Western Australia, 35 Stirling Highway, Crawley WA, 6009, Australia.
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26
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Proulx-Bégin L, Herrero Babiloni A, Bouferguene S, Roy M, Lavigne GJ, Arbour C, De Beaumont L. Conditioning to Enhance the Effects of Repetitive Transcranial Magnetic Stimulation on Experimental Pain in Healthy Volunteers. Front Psychiatry 2022; 13:768288. [PMID: 35273527 PMCID: PMC8901579 DOI: 10.3389/fpsyt.2022.768288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In this proof-of-concept study we sought to explore whether the combination of conditioning procedure based on a surreptitious reduction of a noxious stimulus (SRPS) could enhance rTMS hypoalgesic effects [i.e., increase heat pain threshold (HPT)] and augment intervention expectations in a healthy population. METHODS Forty-two healthy volunteers (19-35 years old) were enrolled in a randomized crossover-controlled study and were assigned to one of two groups: (1) SRPS and (2) No SRPS. Each participant received two consecutive sessions of active or sham rTMS over the M1 area of the right hand on two visits (1) active, (2) sham rTMS separated by at least one-week interval. HPT and the temperature needed to elicit moderate heat pain were measured before and after each rTMS intervention on the right forearm. In the SRPS group, conditioning consisted of deliberately decreasing thermode temperature by 3°C following intervention before reassessing HPT, while thermode temperature was held constant in the No SRPS group. Intervention expectations were measured before each rTMS session. RESULTS SRPS conditioning procedure did not enhance hypoalgesic effects of rTMS intervention, neither did it modify intervention expectations. Baseline increases in HPT were found on the subsequent intervention session, suggesting variability of this measure over time, habituation or a possible "novelty effect." CONCLUSION Using a SRPS procedure in healthy volunteers did not enhance rTMS modulating effects on experimental pain sensation (i.e., HPT). Future studies are therefore needed to come up with a conditioning procedure which allows significant enhancement of rTMS pain modulating effects in healthy volunteers.
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Affiliation(s)
- Léa Proulx-Bégin
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.,Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Alberto Herrero Babiloni
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Division of Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Sabrina Bouferguene
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Mathieu Roy
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Caroline Arbour
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Louis De Beaumont
- Centre de recherche du CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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27
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Wendt K, Denison T, Foster G, Krinke L, Thomson A, Wilson S, Widge AS. Physiologically informed neuromodulation. J Neurol Sci 2021; 434:120121. [PMID: 34998239 PMCID: PMC8976285 DOI: 10.1016/j.jns.2021.120121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/09/2023]
Abstract
The rapid evolution of neuromodulation techniques includes an increasing amount of research into stimulation paradigms that are guided by patients' neurophysiology, to increase efficacy and responder rates. Treatment personalisation and target engagement have shown to be effective in fields such as Parkinson's disease, and closed-loop paradigms have been successfully implemented in cardiac defibrillators. Promising avenues are being explored for physiologically informed neuromodulation in psychiatry. Matching the stimulation frequency to individual brain rhythms has shown some promise in transcranial magnetic stimulation (TMS). Matching the phase of those rhythms may further enhance neuroplasticity, for instance when combining TMS with electroencephalographic (EEG) recordings. Resting-state EEG and event-related potentials may be useful to demonstrate connectivity between stimulation sites and connected areas. These techniques are available today to the psychiatrist to diagnose underlying sleep disorders, epilepsy, or lesions as contributing factors to the cause of depression. These technologies may also be useful in assessing the patient's brain network status prior to deciding on treatment options. Ongoing research using invasive recordings may allow for future identification of mood biomarkers and network structure. A core limitation is that biomarker research may currently be limited by the internal heterogeneity of psychiatric disorders according to the current DSM-based classifications. New approaches are being developed and may soon be validated. Finally, care must be taken when incorporating closed-loop capabilities into neuromodulation systems, by ensuring the safe operation of the system and understanding the physiological dynamics. Neurophysiological tools are rapidly evolving and will likely define the next generation of neuromodulation therapies.
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Affiliation(s)
- Karen Wendt
- Department of Engineering Science and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
| | - Timothy Denison
- Department of Engineering Science and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Gaynor Foster
- Welcony Inc., Plymouth, MN, United States of America
| | - Lothar Krinke
- Welcony Inc., Plymouth, MN, United States of America; Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Alix Thomson
- Welcony Inc., Plymouth, MN, United States of America
| | - Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, United States of America; Medical Discovery Team on Additions, University of Minnesota, Minneapolis, MN, United States of America
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28
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Voetterl H, Miron JP, Mansouri F, Fox L, Hyde M, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Sack AT, Downar J. Investigating EEG biomarkers of clinical response to low frequency rTMS in depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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29
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Mindfulness augmentation for anxiety through concurrent use of transcranial direct current stimulation: a randomized double-blind study. Sci Rep 2021; 11:22734. [PMID: 34815458 PMCID: PMC8610980 DOI: 10.1038/s41598-021-02177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) have revealed the capability to augment various types of behavioural interventions. We aimed to augment the effects of mindfulness, suggested for reducing anxiety, with concurrent use of tDCS. We conducted a double-blind randomized study with 58 healthy individuals. We introduced treadmill walking for focused meditation and active or sham tDCS on the left dorsolateral prefrontal cortex for 20 min. We evaluated outcomes using State-Trait Anxiety Inventory-State Anxiety (STAI) before the intervention as well as immediately, 60 min, and 1 week after the intervention, and current density from electroencephalograms (EEG) before and after the intervention. The linear mixed-effect models demonstrated that STAI-state anxiety showed a significant interaction effect between 1 week after the intervention and tDCS groups. As for alpha-band EEG activity, the current density in the rostral anterior cingulate cortex (rACC) was significantly reduced in the active compared with the sham stimulation group, and a significant correlation was seen between changes in STAI-trait anxiety and the current density of the rACC in the active stimulation group. Our study provided that despite this being a one-shot and short intervention, the reduction in anxiety lasts for one week, and EEG could potentially help predict its anxiolytic effect.
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30
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Schaffer DR, Okhravi HR, Neumann SA. Low-Frequency Transcranial Magnetic Stimulation (LF-TMS) in Treating Depression in Patients With Impaired Cognitive Functioning. Arch Clin Neuropsychol 2021; 36:801-814. [PMID: 33140093 DOI: 10.1093/arclin/acaa095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Common methodologies for treating depressive symptoms have demonstrated decreased efficacy among individuals with impaired cognitive functioning. While transcranial magnetic stimulation (TMS) has been approved to treat major depressive disorder, few studies have analyzed the ability of TMS to treat depressive symptoms among individuals with cognitive impairments. The present study had two objectives: to determine whether low-frequency TMS (LF-TMS) might demonstrate efficacy in treating depressive symptoms among individuals with impaired cognitive functioning; and to determine whether LF-TMS might improve neurocognitive functioning above and beyond depressive symptom improvements. METHODS Data were derived from a pre-existing database at Eastern Virginia Medical School. Fifty-three (N=53) participants completed LF-TMS treatment. The Beck Depression Inventory II (BDI-II) and CNS Vital Signs (CNS-VS) neurocognitive assessment were administered at multiple time points throughout treatment. Participants were classified as impaired cognitive functioning or average cognitive functioning based on baseline CNS-VS scores. Data were analyzed using restricted maximum likelihood (REML) measures-within-persons longitudinal hierarchical linear modeling (HLM) with time-varying covariates. RESULTS LF-TMS produced significant reductions in depressive symptoms for individuals in both cognitive functioning groups; however, a significant group-by-time interaction indicates differential effects between these two groups. Low-frequency TMS produced significant improvements in three neurocognitive domains above and beyond improvements in depressive symptoms; however, the reliability of these changes may be questionable. CONCLUSIONS This study adds to the growing body of empirical findings for LF-TMS treatment in improving neurocognitive functioning above and beyond other treatment-related effects.
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Affiliation(s)
- Daniel R Schaffer
- Virginia Consortium Program in Clinical Psychology (VCPCP), Norfolk, VA 23504, USA.,Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
| | - Hamid R Okhravi
- Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
| | - Serina A Neumann
- Virginia Consortium Program in Clinical Psychology (VCPCP), Norfolk, VA 23504, USA.,Eastern Virginia Medical School (EVMS), Norfolk, VA 23507, USA
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31
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Rezaei M, Shariat Bagheri MM, Ahmadi M. Clinical and demographic predictors of response to anodal tDCS treatment in major depression disorder (MDD). J Psychiatr Res 2021; 138:68-74. [PMID: 33831679 DOI: 10.1016/j.jpsychires.2021.03.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022]
Abstract
Transcranial direct current stimulation (tDCS) of the prefrontal cortex is known as a promising intervention in major depression disorder (MDD). However, limited information on predictors of therapeutic response to tDCS are available. This study aimed to investigate clinical and demographic predictors of therapeutic response in patients taking no medications. For this purpose, the required data were collected from 2 independent tDCS trials on 116 MDD patients. Accordingly, 84 patients underwent 10 sessions of 2 mA tDCS daily each one lasted for 20 min and 32 patients received 10 twice sessions of 2 mA tDCS daily each one lasted for 20 min. Anodal electrode was located over the left dorsolateral prefrontal cortex (DLPFC), and cathode was over the right supraorbital region. Depression symptoms and the underlying clinical dimensions were assessed using the Beck Depression Inventory (BDI-II) at baseline and after the tDCS treatment. Of the included 116 patients, 47.4% showed an antidepressant response. Results of logistic regression analysis showed that the reduction in BDI-II scores after tDCS was associated with the baseline values of cognitive-affective symptoms factor, loss of pleasure, loss of interest, and sleep problems. Pronounced sleep disturbances and cognitive-affective symptoms were identified as the potential clinical predictors of response to tDCS. However, more prospective tDCS studies are necessary to validate the predictive value of the derived model.
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Affiliation(s)
- Mehdi Rezaei
- Department of Psychology, Shahryar Branch, Islamic Azad University, Shahryar, Iran.
| | | | - Mehdi Ahmadi
- Department of Clinical Psychology, Shahed University, Tehran, Iran
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32
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Chou PH, Lin YF, Lu MK, Chang HA, Chu CS, Chang WH, Kishimoto T, Sack AT, Su KP. Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:190-205. [PMID: 33888649 PMCID: PMC8077054 DOI: 10.9758/cpn.2021.19.2.190] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 12/19/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are evidenced-based treatments for patients with major depressive disorder (MDD) who fail to respond to standard first-line therapies. However, although various TMS protocols have been proven to be clinically effective, the response rate varies across clinical applications due to the heterogeneity of real-world psychiatric comorbidities, such as generalized anxiety disorder, posttraumatic stress disorder, panic disorder, or substance use disorder, which are often observed in patients with MDD. Therefore, individualized treatment approaches are important to increase treatment response by assigning a given patient to the most optimal TMS treatment protocol based on his or her individual profile. This literature review summarizes different rTMS or TBS protocols that have been applied in researches investigating MDD patients with certain psychiatric comorbidities and discusses biomarkers that may be used to predict rTMS treatment response. Furthermore, we highlight the need for the validation of neuroimaging and electrophysiological biomarkers associated with rTMS treatment responses. Finally, we discuss on which directions future efforts should focus for developing the personalization of the treatment of depression with rTMS or iTBS.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.,Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.,Taiwan Allied Clinics for Integrative TMS, Taipei, Taiwan
| | - Yen-Feng Lin
- Taiwan Allied Clinics for Integrative TMS, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan.,Department of Public Health & Medical Humanities, Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Balance Psychiatric Clinic, Hsinchu, Taiwan
| | - Ming-Kuei Lu
- Ph.D. Program for Translational Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei Hung Chang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Kuan-Pin Su
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
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33
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Li CT, Cheng CM, Juan CH, Tsai YC, Chen MH, Bai YM, Tsai SJ, Su TP. Task-Modulated Brain Activity Predicts Antidepressant Responses of Prefrontal Repetitive Transcranial Magnetic Stimulation: A Randomized Sham-Control Study. CHRONIC STRESS 2021; 5:24705470211006855. [PMID: 33889790 PMCID: PMC8040384 DOI: 10.1177/24705470211006855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022]
Abstract
Background Prolonged intermittent theta-burst stimulation (piTBS) and repetitive transcranial magnetic stimulation (rTMS) are effective antidepressant interventions for major depressive disorder (MDD). Cognition-modulated frontal theta (frontalθ) activity had been identified to predict the antidepressant response to 10-Hz left prefrontal rTMS. However, whether this marker also predicts that of piTBS needs further investigation. Methods The present double-blind randomized trial recruited 105 patients with MDD who showed no response to at least one adequate antidepressant treatment in the current episode. The recruited patients were randomly assigned to one of three groups: group A received piTBS monotherapy; group B received rTMS monotherapy; and group C received sham stimulation. Before a 2-week acute treatment period, electroencephalopgraphy (EEG) and cognition-modulated frontal theta changes (Δfrontalθ) were measured. Depression scores were evaluated at baseline, 1 week, and 2 weeks after the initiation of treatment. Results The Δfrontalθ at baseline was significantly correlated with depression score changes at week 1 (r = -0.383, p = 0.025) and at week 2 for rTMS group (r = -0.419, p = 0.014), but not for the piTBS and sham groups. The area under the receiver operating characteristic curve for Δfrontalθ was 0.800 for the rTMS group (p = 0.003) and was 0.549 for the piTBS group (p = 0.619). Conclusion The predictive value of higher baseline Δfrontalθ for antidepressant efficacy for rTMS not only replicates previous results but also implies that the antidepressant responses to rTMS could be predicted reliably at baseline and both piTBS and rTMS could be effective through different neurobiological mechanisms.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei.,Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Cognitive Neuroscience, National Central University, Jhongli
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Jhongli
| | - Yi-Chun Tsai
- Institute of Cognitive Neuroscience, National Central University, Jhongli
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei.,Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei.,Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei.,Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei.,Division of Psychiatry, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Department of Psychiatry, Cheng Hsin General Hospital, Taipei
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Zhang Y, Wu W, Toll RT, Naparstek S, Maron-Katz A, Watts M, Gordon J, Jeong J, Astolfi L, Shpigel E, Longwell P, Sarhadi K, El-Said D, Li Y, Cooper C, Chin-Fatt C, Arns M, Goodkind MS, Trivedi MH, Marmar CR, Etkin A. Identification of psychiatric disorder subtypes from functional connectivity patterns in resting-state electroencephalography. Nat Biomed Eng 2021; 5:309-323. [PMID: 33077939 PMCID: PMC8053667 DOI: 10.1038/s41551-020-00614-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
The understanding and treatment of psychiatric disorders, which are known to be neurobiologically and clinically heterogeneous, could benefit from the data-driven identification of disease subtypes. Here, we report the identification of two clinically relevant subtypes of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) on the basis of robust and distinct functional connectivity patterns, prominently within the frontoparietal control network and the default mode network. We identified the disease subtypes by analysing, via unsupervised and supervised machine learning, the power-envelope-based connectivity of signals reconstructed from high-density resting-state electroencephalography in four datasets of patients with PTSD and MDD, and show that the subtypes are transferable across independent datasets recorded under different conditions. The subtype whose functional connectivity differed most from those of healthy controls was less responsive to psychotherapy treatment for PTSD and failed to respond to an antidepressant medication for MDD. By contrast, both subtypes responded equally well to two different forms of repetitive transcranial magnetic stimulation therapy for MDD. Our data-driven approach may constitute a generalizable solution for connectome-based diagnosis.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, China
- Alto Neuroscience, Inc., Los Altos, CA, USA
| | - Russell T Toll
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sharon Naparstek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Adi Maron-Katz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Mallissa Watts
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Joseph Gordon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Alto Neuroscience, Inc., Los Altos, CA, USA
| | - Jisoo Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Laura Astolfi
- Department of Computer, Control and Management Engineering "Antonio Ruberti", University of Rome Sapienza, Rome, Italy
- IRCCF Fondazione Santa Lucia, Rome, Italy
| | - Emmanuel Shpigel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Parker Longwell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Kamron Sarhadi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Dawlat El-Said
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Yuanqing Li
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
| | - Crystal Cooper
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Cherise Chin-Fatt
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
- neuroCare Group, Munich, Germany
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Location AMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
- O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY, USA
- Center for Alcohol Use Disorder and PTSD, New York University Langone School of Medicine, New York, NY, USA
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Alto Neuroscience, Inc., Los Altos, CA, USA.
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35
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Chu HT, Cheng CM, Liang CS, Chang WH, Juan CH, Huang YZ, Jeng JS, Bai YM, Tsai SJ, Chen MH, Li CT. Efficacy and tolerability of theta-burst stimulation for major depression: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110168. [PMID: 33166668 DOI: 10.1016/j.pnpbp.2020.110168] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is the current treatment option for major depression (MD). Theta-burst stimulation (TBS), a variation of rTMS, affords a short stimulation duration, low stimulation pulse intensity, and possibility to improve rTMS efficiency. This systematic review and meta-analysis examined the studies on efficacy and tolerability of TBS in patients with MD. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the literature from 1990 until May 24, 2020, and performed a random-effects meta-analysis by including response and remission rates of depression and dropout rates as main outcome measures. RESULTS In total, 10 studies including 6 randomized controlled trials (RCTs; n = 294) and 4 uncontrolled clinical trials (non-RCTs; n = 297) were included. The overall effect size of response rate and remission rates were 0.38 (95% confidence interval [CI]: 0.29-0.48) and 0.20 (95% CI: 0.13-0.29), respectively. Notably, the TBS group showed favorable efficacy without major adverse events. CONCLUSIONS TBS treatment was more efficient in terms of time and energy than the standard rTMS was. Our meta-analysis provided evidence that the application of TBS to the dorsolateral prefrontal cortex is associated with significant antidepressant effects along with favorable tolerability.
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Affiliation(s)
- Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ming Cheng
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan
| | - Ying-Zu Huang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jia-Shyun Jeng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Mei Bai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Ta Li
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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36
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Konopka LM, Glowacki A, Konopka CJ, Wuest R. Objective Assessments in Diagnoses and Treatment: A Proposed Change in Paradigm. Clin EEG Neurosci 2021; 52:90-97. [PMID: 33370217 DOI: 10.1177/1550059420983998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For patients with psychiatric disorders, current diagnostic and treatment approaches are far from optimal. The clinical interview drives the standard approach-matching symptoms to diagnostic criteria-and results in standardized pharmacological and behavioral treatments, often, with inadequate outcome; but now, recent imaging advances can correlate behavioral assessments with brain function and measure them against normative databases to provide data critical for the reevaluation of patient diagnosis and treatment. This article addresses the data that support a redefinition of our current paradigm. We believe a neurobehavioral approach provides for more personalized treatment approaches unbound from classically defined diagnostic biases.
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Affiliation(s)
| | | | - Christian J Konopka
- Department of Bioengineering, 14589University of Illinois at Urbana-Champaign, Urbana, IL, USA.,97472Beckman Institute for Advanced Science and Technology, Urbana, IL, USA.,43988University of Illinois College of Medicine, Urbana, IL, USA
| | - Ronald Wuest
- Institute for Personal Development, Romeiville, IL, USA
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37
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Kumar R, Chhikara BS, Gulia K, Chhillar M. Review of nanotheranostics for molecular mechanisms underlying psychiatric disorders and commensurate nanotherapeutics for neuropsychiatry: The mind knockout. Nanotheranostics 2021; 5:288-308. [PMID: 33732601 PMCID: PMC7961125 DOI: 10.7150/ntno.49619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Bio-neuronal led psychiatric abnormalities transpired by the loss of neuronal structure and function (neurodegeneration), pro-inflammatory cytokines, microglial dysfunction, altered neurotransmission, toxicants, serotonin deficiency, kynurenine pathway, and excessively produced neurotoxic substances. These uncontrolled happenings in the etiology of psychiatric disorders initiate further changes in neurotransmitter metabolism, pathologic microglial, cell activation, and impaired neuroplasticity. Inflammatory cytokines, the outcome of dysfunctional mitochondria, dysregulation of the immune system, and under stress functions of the brain are leading biochemical factors for depression and anxiety. Nanoscale drug delivery platforms, inexpensive diagnostics using nanomaterials, nano-scale imaging technologies, and ligand-conjugated nanocrystals used for elucidating the molecular mechanisms and foremost cellular communications liable for such disorders are highly capable features to study for efficient diagnosis and therapy of the mental illness. These theranostic tools made up of multifunctional nanomaterials have the potential for effective and accurate diagnosis, imaging of psychiatric disorders, and are at the forefront of leading technologies in nanotheranostics openings field as they can collectively and efficiently target the stimulated territories of the cerebellum (cells and tissues) through molecular-scale interactions with higher bioavailability, and bio-accessibility. Specifically, the nanoplatforms based neurological changes are playing a significant role in the diagnosis of psychiatric disorders and portraying the routes of functional restoration of mental disorders by newer imaging tools at nano-level in all directions. Because of these nanotherapeutic platforms, the molecules of nanomedicine can penetrate the Blood-Brain Barrier with an increased half-life of drug molecules. The discoveries in nanotheranostics and nanotherapeutics inbuilt unique multi-functionalities are providing the best multiplicities of novel nanotherapeutic potentialities with no toxicity concerns at the level of nano range.
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Affiliation(s)
- Rajiv Kumar
- NIET, National Institute of Medical Science, India
| | - Bhupender S Chhikara
- Department of Chemistry, Aditi Mahavidyalaya, University of Delhi. Delhi, 110039, India
| | - Kiran Gulia
- Materials and Manufacturing, School of Engineering, University of Wolverhampton, England, TF2 9NN, UK
| | - Mitrabasu Chhillar
- Institute of Nuclear Medicine and Allied Sciences (INMAS) Brig. S. K. Mazumdar Marg Delhi 110054, India
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38
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The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuropsychiatric conditions: A systematic review. Sleep Med Rev 2021; 55:101381. [DOI: 10.1016/j.smrv.2020.101381] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
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Individual Alpha Peak Frequency, an Important Biomarker for Live Z-Score Training Neurofeedback in Adolescents with Learning Disabilities. Brain Sci 2021; 11:brainsci11020167. [PMID: 33525458 PMCID: PMC7911657 DOI: 10.3390/brainsci11020167] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 01/19/2023] Open
Abstract
Learning disabilities (LDs) have an estimated prevalence between 5% and 9% in the pediatric population and are associated with difficulties in reading, arithmetic, and writing. Previous electroencephalography (EEG) research has reported a lag in alpha-band development in specific LD phenotypes, which seems to offer a possible explanation for differences in EEG maturation. In this study, 40 adolescents aged 10–15 years with LDs underwent 10 sessions of Live Z-Score Training Neurofeedback (LZT-NF) Training to improve their cognition and behavior. Based on the individual alpha peak frequency (i-APF) values from the spectrogram, a group with normal i-APF (ni-APF) and a group with low i-APF (li-APF) were compared in a pre-and-post-LZT-NF intervention. There were no statistical differences in age, gender, or the distribution of LDs between the groups. The li-APF group showed a higher theta absolute power in P4 (p = 0.016) at baseline and higher Hi-Beta absolute power in F3 (p = 0.007) post-treatment compared with the ni-APF group. In both groups, extreme waves (absolute Z-score of ≥1.5) were more likely to move toward the normative values, with better results in the ni-APF group. Conversely, the waves within the normal range at baseline were more likely to move out of the range after treatment in the li-APF group. Our results provide evidence of a viable biomarker for identifying optimal responders for the LZT-NF technique based on the i-APF metric reflecting the patient’s neurophysiological individuality.
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40
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Santopetro NJ, Brush CJ, Bruchnak A, Klawohn J, Hajcak G. A reduced P300 prospectively predicts increased depressive severity in adults with clinical depression. Psychophysiology 2021; 58:e13767. [PMID: 33433019 DOI: 10.1111/psyp.13767] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/14/2020] [Accepted: 12/17/2020] [Indexed: 01/02/2023]
Abstract
Neurocognitive impairments commonly observed in depressive disorders are thought to be reflected in reduced P300 amplitudes. To date, depression-related P300 amplitude reduction has mostly been demonstrated cross-sectionally, while its clinical implication for the course of depression remains largely unclear. Moreover, the relationship between P300 and specific clinical characteristics of depression is uncertain. To shed light on the functional significance of the P300 in depression, we examined whether initial P300 amplitude prospectively predicted changes in depressive symptoms among a community sample of 58 adults (mean age = 38.86 years old, 81% female) with a current depressive disorder. This sample was assessed at two-time points, separated by approximately nine months (range = 6.6-15.9). At the initial visit, participants completed clinical interviews, self-report measures, and a flanker task, while EEG was recorded to derive P300 amplitude. At the follow-up visit, participants again completed the same clinical interviews and self-report measures. Results indicated that a reduced P300 amplitude at the initial visit was associated with higher total depressive symptoms at follow-up, even after controlling for initial depressive symptoms. These data indicate the potential clinical utility for the P300 as a neural marker of disease course among adults with a current depressive disorder. Future research may target P300 in interventions to determine whether depression-related outcomes can be improved.
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Affiliation(s)
| | - C J Brush
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Alec Bruchnak
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Julia Klawohn
- Department of Psychology, Florida State University, Tallahassee, FL, USA.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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41
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Olbrich S, Brunovsky M. The way ahead for predictive EEG biomarkers in treatment of depression. Clin Neurophysiol 2021; 132:616-617. [PMID: 33386211 DOI: 10.1016/j.clinph.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Sebastian Olbrich
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Switzerland.
| | - Martin Brunovsky
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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42
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Perone S, Anderson AJ, Weybright EH. It is all relative: Contextual influences on boredom and neural correlates of regulatory processes. Psychophysiology 2020; 58:e13746. [PMID: 33314169 DOI: 10.1111/psyp.13746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/23/2020] [Accepted: 11/18/2020] [Indexed: 02/01/2023]
Abstract
Interest in the influences on and strategies to mitigate boredom has grown immensely. Boredom emerges in contexts in which people have difficulty paying attention, such as underchallenging relative to optimally challenging conditions. The current study probed contextual influences on peoples' experience of boredom by manipulating the order with which people performed easy and optimally challenging conditions of a task (N = 113). We measured frontal alpha asymmetry (FAA) and theta/beta as neural correlates of self-regulatory and attentional control processes, respectively. Results showed self-reported boredom was higher in the easy condition when the optimal condition was completed before it. Similarly, participant's FAA shifted rightward from the first to the second task when the optimal condition was completed prior to the easy condition, indicating that self-regulatory processes were strongly engaged under these context-specific conditions. Theta/beta was lower during the easy relative to the optimal condition, regardless of the task order, indicating that maintaining attention in the easy condition was more difficult. No relations between perceptions of the task and neural correlates were observed. Exploratory analyses revealed higher levels of variability in FAA and theta/beta were associated with less enjoyment and more boredom, respectively. We speculate these observations reflect the less consistent engagement of self-regulatory and attentional control and, in turn, might play a role in peoples' subjective experience. We discuss the implications of our findings for our understanding of influences on and strategies to mitigate boredom, as well as how attentional and self-regulatory processes operate under conditions boredom typically emerges.
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Affiliation(s)
- Sammy Perone
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Alana J Anderson
- Department of Human Development, Washington State University, Pullman, WA, USA
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43
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Roelofs CL, Krepel N, Corlier J, Carpenter LL, Fitzgerald PB, Daskalakis ZJ, Tendolkar I, Wilson A, Downar J, Bailey NW, Blumberger DM, Vila-Rodriguez F, Leuchter AF, Arns M. Individual alpha frequency proximity associated with repetitive transcranial magnetic stimulation outcome: An independent replication study from the ICON-DB consortium. Clin Neurophysiol 2020; 132:643-649. [PMID: 33243617 DOI: 10.1016/j.clinph.2020.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the current study was to attempt to replicate the finding that the individual alpha frequency (IAF) as well as the absolute difference between IAF and 10 Hz stimulation frequency (IAF-prox) is related to treatment outcome. METHODS Correlations were performed to investigate the relationship between IAF-prox and percentage symptom improvement in a sample of 153 patients with major depressive disorder treated with 10 Hz (N = 59) to the left dorsolateral prefrontal cortex (DLPFC) or 1 Hz (N = 94) to the right DLPFC repetitive Transcranial Magnetic Stimulation (rTMS). RESULTS There was a significant negative correlation between IAF-prox and the percentage of symptom improvement only for the 10 Hz group. Curve fitting models revealed that there was a quadratic association between IAF and treatment response in the 10 Hz group, with a peak at 10 Hz IAF. CONCLUSION The main result of Corlier and colleagues was replicated, and the findings suggest that the distance between 10 Hz stimulation frequency and the IAF may influence clinical outcome in a non-linear manner. SIGNIFICANCE rTMS is often administered at a frequency of 10 Hz, which is the center of the EEG alpha frequency band. The results can make a significant contribution to optimizing the clinical application of rTMS.
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Affiliation(s)
- Charlotte L Roelofs
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands
| | - Noralie Krepel
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Dept. of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Linda L Carpenter
- Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Dept. of Psychiatry and Human Behavior Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare and Monash University Department of Psychiatry, Camberwell, VIC, Australia
| | - Zafiris J Daskalakis
- Dept. of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Dept. of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrew Wilson
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Dept. of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Downar
- Dept. of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Neil W Bailey
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Australia, Epworth Centre for Innovation in Mental Health, Epworth HealthCare, VIC, Australia
| | - Daniel M Blumberger
- Dept. of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Dept. Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Dept. of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Location AMC, Amsterdam Neuroscience, Amsterdam, the Netherlands.
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44
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Bučková B, Brunovský M, Bareš M, Hlinka J. Predicting Sex From EEG: Validity and Generalizability of Deep-Learning-Based Interpretable Classifier. Front Neurosci 2020; 14:589303. [PMID: 33192274 PMCID: PMC7652844 DOI: 10.3389/fnins.2020.589303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
Explainable artificial intelligence holds a great promise for neuroscience and plays an important role in the hypothesis generation process. We follow-up a recent machine learning-oriented study that constructed a deep convolutional neural network to automatically identify biological sex from EEG recordings in healthy individuals and highlighted the discriminative role of beta-band power. If generalizing, this finding would be relevant not only theoretically by pointing to some specific neurobiological sexual dimorphisms, but potentially also as a relevant confound in quantitative EEG diagnostic practice. To put this finding to test, we assess whether the automatic identification of biological sex generalizes to another dataset, particularly in the presence of a psychiatric disease, by testing the hypothesis of higher beta power in women compared to men on 134 patients suffering from Major Depressive Disorder. Moreover, we construct ROC curves and compare the performance of the classifiers in determining sex both before and after the antidepressant treatment. We replicate the observation of a significant difference in beta-band power between men and women, providing classification accuracy of nearly 77%. The difference was consistent across the majority of electrodes, however multivariate classification models did not generally improve the performance. Similar results were observed also after the antidepressant treatment (classification accuracy above 70%), further supporting the robustness of the initial finding.
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Affiliation(s)
- Barbora Bučková
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia.,Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czechia
| | - Martin Brunovský
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Bareš
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Hlinka
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czechia.,National Institute of Mental Health, Klecany, Czechia
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45
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Resting EEG theta connectivity and alpha power to predict repetitive transcranial magnetic stimulation response in depression: A non-replication from the ICON-DB consortium. Clin Neurophysiol 2020; 132:650-659. [PMID: 33223495 DOI: 10.1016/j.clinph.2020.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our previous research showed high predictive accuracy at differentiating responders from non-responders to repetitive transcranial magnetic stimulation (rTMS) for depression using resting electroencephalography (EEG) and clinical data from baseline and one-week following treatment onset using a machine learning algorithm. In particular, theta (4-8 Hz) connectivity and alpha power (8-13 Hz) significantly differed between responders and non-responders. Independent replication is a necessary step before the application of potential predictors in clinical practice. This study attempted to replicate the results in an independent dataset. METHODS We submitted baseline resting EEG data from an independent sample of participants who underwent rTMS treatment for depression (N = 193, 128 responders) (Krepel et al., 2018) to the same between group comparisons as our previous research (Bailey et al., 2019). RESULTS Our previous results were not replicated, with no difference between responders and non-responders in theta connectivity (p = 0.250, Cohen's d = 0.1786) nor alpha power (p = 0.357, ηp2 = 0.005). CONCLUSIONS These results suggest that baseline resting EEG theta connectivity or alpha power are unlikely to be generalisable predictors of response to rTMS treatment for depression. SIGNIFICANCE These results highlight the importance of independent replication, data sharing and using large datasets in the prediction of response research.
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46
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Corlier J, Wilson A, Hunter AM, Vince-Cruz N, Krantz D, Levitt J, Minzenberg MJ, Ginder N, Cook IA, Leuchter AF. Changes in Functional Connectivity Predict Outcome of Repetitive Transcranial Magnetic Stimulation Treatment of Major Depressive Disorder. Cereb Cortex 2020; 29:4958-4967. [PMID: 30953441 DOI: 10.1093/cercor/bhz035] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/28/2019] [Accepted: 02/12/2019] [Indexed: 12/15/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD) is associated with changes in brain functional connectivity (FC). These changes may be related to the mechanism of action of rTMS and explain the variability in clinical outcome. We examined changes in electroencephalographic FC during the first rTMS treatment in 109 subjects treated with 10 Hz stimulation to left dorsolateral prefrontal cortex. All subjects subsequently received 30 treatments and clinical response was defined as ≥40% improvement in the inventory of depressive symptomatology-30 SR score at treatment 30. Connectivity change was assessed with coherence, envelope correlation, and a novel measure, alpha spectral correlation (αSC). Machine learning was used to develop predictive models of outcome for each connectivity measure, which were compared with prediction based upon early clinical improvement. Significant connectivity changes were associated with clinical outcome (P < 0.001). Machine learning models based on αSC yielded the most accurate prediction (area under the curve, AUC = 0.83), and performance improved when combined with early clinical improvement measures (AUC = 0.91). The initial rTMS treatment session produced robust changes in FC, which were significant predictors of clinical outcome of a full course of treatment for MDD.
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Affiliation(s)
- Juliana Corlier
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Andrew Wilson
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Aimee M Hunter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Nikita Vince-Cruz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - David Krantz
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Jennifer Levitt
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Michael J Minzenberg
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Nathaniel Ginder
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Ian A Cook
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences at UCLA, Los Angeles, CA 90024, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles CA 90024, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
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47
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Santopetro NJ, Kallen AM, Threadgill AH, Hajcak G. Reduced flanker P300 prospectively predicts increases in depression in female adolescents. Biol Psychol 2020; 156:107967. [DOI: 10.1016/j.biopsycho.2020.107967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/13/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022]
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48
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Rajpurkar P, Yang J, Dass N, Vale V, Keller AS, Irvin J, Taylor Z, Basu S, Ng A, Williams LM. Evaluation of a Machine Learning Model Based on Pretreatment Symptoms and Electroencephalographic Features to Predict Outcomes of Antidepressant Treatment in Adults With Depression: A Prespecified Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206653. [PMID: 32568399 PMCID: PMC7309440 DOI: 10.1001/jamanetworkopen.2020.6653] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Despite the high prevalence and potential outcomes of major depressive disorder, whether and how patients will respond to antidepressant medications is not easily predicted. OBJECTIVE To identify the extent to which a machine learning approach, using gradient-boosted decision trees, can predict acute improvement for individual depressive symptoms with antidepressants based on pretreatment symptom scores and electroencephalographic (EEG) measures. DESIGN, SETTING, AND PARTICIPANTS This prognostic study analyzed data collected as part of the International Study to Predict Optimized Treatment in Depression, a randomized, prospective open-label trial to identify clinically useful predictors and moderators of response to commonly used first-line antidepressant medications. Data collection was conducted at 20 sites spanning 5 countries and including 518 adult outpatients (18-65 years of age) from primary care or specialty care practices who received a diagnosis of current major depressive disorder between December 1, 2008, and September 30, 2013. Patients were antidepressant medication naive or willing to undergo a 1-week washout period of any nonprotocol antidepressant medication. Statistical analysis was conducted from January 5 to June 30, 2019. EXPOSURES Participants with major depressive disorder were randomized in a 1:1:1 ratio to undergo 8 weeks of treatment with escitalopram oxalate (n = 162), sertraline hydrochloride (n = 176), or extended-release venlafaxine hydrochloride (n = 180). MAIN OUTCOMES AND MEASURES The primary objective was to predict improvement in individual symptoms, defined as the difference in score for each of the symptoms on the 21-item Hamilton Rating Scale for Depression from baseline to week 8, evaluated using the C index. RESULTS The resulting data set contained 518 patients (274 women; mean [SD] age, 39.0 [12.6] years; mean [SD] 21-item Hamilton Rating Scale for Depression score improvement, 13.0 [7.0]). With the use of 5-fold cross-validation for evaluation, the machine learning model achieved C index scores of 0.8 or higher on 12 of 21 clinician-rated symptoms, with the highest C index score of 0.963 (95% CI, 0.939-1.000) for loss of insight. The importance of any single EEG feature was higher than 5% for prediction of 7 symptoms, with the most important EEG features being the absolute delta band power at the occipital electrode sites (O1, 18.8%; Oz, 6.7%) for loss of insight. Over and above the use of baseline symptom scores alone, the use of both EEG and baseline symptom features was associated with a significant increase in the C index for improvement in 4 symptoms: loss of insight (C index increase, 0.012 [95% CI, 0.001-0.020]), energy loss (C index increase, 0.035 [95% CI, 0.011-0.059]), appetite changes (C index increase, 0.017 [95% CI, 0.003-0.030]), and psychomotor retardation (C index increase, 0.020 [95% CI, 0.008-0.032]). CONCLUSIONS AND RELEVANCE This study suggests that machine learning may be used to identify independent associations of symptoms and EEG features to predict antidepressant-associated improvements in specific symptoms of depression. The approach should next be prospectively validated in clinical trials and settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00693849.
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Affiliation(s)
- Pranav Rajpurkar
- Department of Computer Science, Stanford University, Stanford, California
| | - Jingbo Yang
- Department of Computer Science, Stanford University, Stanford, California
| | - Nathan Dass
- Department of Computer Science, Stanford University, Stanford, California
| | - Vinjai Vale
- Department of Computer Science, Stanford University, Stanford, California
| | - Arielle S. Keller
- Stanford Center for Precision Mental Health and Wellness, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Jeremy Irvin
- Department of Computer Science, Stanford University, Stanford, California
| | - Zachary Taylor
- Stanford Center for Precision Mental Health and Wellness, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Sanjay Basu
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts
- Research and Analytics, Collective Health, San Francisco, California
- Division of Primary Care and Public Health, Imperial College London School of Public Health, London, United Kingdom
| | - Andrew Ng
- Department of Computer Science, Stanford University, Stanford, California
| | - Leanne M. Williams
- Stanford Center for Precision Mental Health and Wellness, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
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49
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Wu W, Zhang Y, Jiang J, Lucas MV, Fonzo GA, Rolle CE, Cooper C, Chin-Fatt C, Krepel N, Cornelssen CA, Wright R, Toll RT, Trivedi HM, Monuszko K, Caudle TL, Sarhadi K, Jha MK, Trombello JM, Deckersbach T, Adams P, McGrath PJ, Weissman MM, Fava M, Pizzagalli DA, Arns M, Trivedi MH, Etkin A. An electroencephalographic signature predicts antidepressant response in major depression. Nat Biotechnol 2020; 38:439-447. [PMID: 32042166 PMCID: PMC7145761 DOI: 10.1038/s41587-019-0397-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
Antidepressants are widely prescribed, but their efficacy relative to placebo is modest, in part because the clinical diagnosis of major depression encompasses biologically heterogeneous conditions. Here, we sought to identify a neurobiological signature of response to antidepressant treatment as compared to placebo. We designed a latent-space machine-learning algorithm tailored for resting-state electroencephalography (EEG) and applied it to data from the largest imaging-coupled, placebo-controlled antidepressant study (n = 309). Symptom improvement was robustly predicted in a manner both specific for the antidepressant sertraline (versus placebo) and generalizable across different study sites and EEG equipment. This sertraline-predictive EEG signature generalized to two depression samples, wherein it reflected general antidepressant medication responsivity and related differentially to a repetitive transcranial magnetic stimulation treatment outcome. Furthermore, we found that the sertraline resting-state EEG signature indexed prefrontal neural responsivity, as measured by concurrent transcranial magnetic stimulation and EEG. Our findings advance the neurobiological understanding of antidepressant treatment through an EEG-tailored computational model and provide a clinical avenue for personalized treatment of depression.
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Affiliation(s)
- Wei Wu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Yu Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Jing Jiang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Molly V. Lucas
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Gregory A. Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Camarin E. Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Crystal Cooper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Cherise Chin-Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Noralie Krepel
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478
| | - Carena A. Cornelssen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Rachael Wright
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Russell T. Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Hersh M. Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Karen Monuszko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Trevor L. Caudle
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Kamron Sarhadi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Joseph M. Trombello
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thilo Deckersbach
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Phil Adams
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Patrick J. McGrath
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Myrna M. Weissman
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Maurizio Fava
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Diego A. Pizzagalli
- New York State Psychiatric Institute & Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Martijn Arns
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478
- Department of Experimental Psychology, Utrecht University, Utrecht, the Netherlands
- neuroCare Group Netherlands, Nijmegen, the Netherlands
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
- Wu Tsai Neuroscience Institute Stanford University, Stanford, CA 94305
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
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50
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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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