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Zeng K, Li Z, Xia X, Wang Z, Darmani G, Li X, Chen R. Effects of different sonication parameters of theta burst transcranial ultrasound stimulation on human motor cortex. Brain Stimul 2024; 17:258-268. [PMID: 38442800 DOI: 10.1016/j.brs.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Theta burst TUS (tbTUS) can induce increased cortical excitability in human, but how different sonication parameters influence the effects are still unknown. OBJECTIVE To examine how a range of sonication parameters, including acoustic intensity, pulse repetition frequency, duty cycle and sonication duration, influence the effects of tbTUS on human motor cortical excitability. METHODS 14 right-handed healthy subjects underwent 8 sessions with different tbTUS parameters in a randomized, cross-over design on separate days. The original tbTUS protocol was studied in one session and one parameter was changed in each of the seven sessions. To examine changes in cortical excitability induced by tbTUS, we measured the motor-evoked potential (MEP) amplitude, resting motor threshold, short-interval intracortical inhibition and intracortical facilitation, as well as short-interval intracortical facilitation before and up to 90 min after tbTUS. RESULTS All conditions increased MEP amplitudes except the condition with low acoustic intensity of 10 W/cm2. Pulse repetition frequency of 5 Hz produced higher MEP amplitudes compared to pulse repetition frequencies of 2 and 10 Hz. In addition, higher duty cycles (5%, 10%, and 15%) and longer sonication durations (40, 80, and 120 s) were associated with longer duration of increased MEP amplitudes. Resting motor threshold remained stable in all conditions. For paired-pulse TMS measures, tbTUS reduced short-interval intracortical inhibition and enhanced short-interval intracortical facilitation, but had no effect on intracortical facilitation. CONCLUSIONS Ultrasound bursts repeated at theta (∼5 Hz) frequency is optimal to produce increased cortical excitability with the range of 2-10 Hz. Furthermore, there was a dose-response effect regarding duty cycle and sonication duration in tbTUS for plasticity induction. The aftereffects of tbTUS were associated with a shift of the inhibition/excitation balance toward less inhibition and more excitation in the motor cortex. These findings can be used to determine the optimal tbTUS parameters in neuroscience research and treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Ke Zeng
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai, Guangdong, China; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Zhiwei Li
- School of Electrical Engineering, Yanshan University, Qinhuangdao, China
| | - Xue Xia
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; School of Social Development and Health Management, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhen Wang
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; School of Sport and Health Science, Xi'an Physical Education University, Xi'an, China
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiaoli Li
- Center for Cognition and Neuroergonomics, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Zhuhai, Guangdong, China
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Tan X, Goh SE, Lee JJ, Vanniasingham SD, Brunelin J, Lee J, Tor PC. Efficacy of Using Intermittent Theta Burst Stimulation to Treat Negative Symptoms in Patients with Schizophrenia-A Systematic Review and Meta-Analysis. Brain Sci 2023; 14:18. [PMID: 38248233 PMCID: PMC10813174 DOI: 10.3390/brainsci14010018] [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: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/16/2023] [Indexed: 01/23/2024] Open
Abstract
Negative symptoms in schizophrenia impose a significant burden with limited effective pharmacological treatment options. Recent trials have shown preliminary evidence for the efficacy of using intermittent theta burst stimulation (iTBS) in treating negative symptoms in schizophrenia. We aim to systematically review the current evidence of iTBS in the treatment of the negative symptoms of schizophrenia as an augmentation therapy. The study protocol was developed and registered on Prospero (registration ID: 323381). MEDLINE, EMBASE, Web of Science (Scopus), PsycINFO and Wan Fang databases were searched for sham-controlled, randomized trials of iTBS among patients with schizophrenia. The mean difference in major outcome assessments for negative symptoms was calculated. The quality of evidence was assessed using the Cochrane Risk of Bias Tool (version 1) and the GRADE system. Moreover, 12 studies including a total of 637 participants were included. Compared to sham treatment, the pooled analysis was in favor of iTBS treatment for negative symptoms (mean weight effect size: 0.59, p = 0.03) but not for positive symptoms (mean weight effect size: 0.01, p = 0.91) and depressive symptoms (mean weight effect size: 0.35, p = 0.16). A significant treatment effect was also observed on the iTBS target site left dorsal prefrontal cortex (mean weight effect size: 0.86, p = 0.007) and for stimulation with 80% motor threshold (mean weight effect size: 0.86, p = 0.02). Thus, our synthesized data support iTBS as a potential treatment for negative symptoms among patients with schizophrenia. However, the long-term efficacy and safety issues of iTBS in a larger population have yet to be examined.
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Affiliation(s)
- Xiaowei Tan
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore; (X.T.); (S.E.G.); (J.J.L.)
| | - Shih Ee Goh
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore; (X.T.); (S.E.G.); (J.J.L.)
| | - Jonathan Jie Lee
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore; (X.T.); (S.E.G.); (J.J.L.)
| | | | - Jérôme Brunelin
- PSYR2 Team, Lyon Neuroscience Research Center, University Lyon 1, INSERM U1028, CNRS UMR5292, 69000 Lyon, France;
- Centre Hospitalier Le Vinatier, 69500 Bron, France
| | - Jimmy Lee
- Department of Psychosis, Institute of Mental Health, Singapore 539747, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore; (X.T.); (S.E.G.); (J.J.L.)
- Department of Psychiatric Medicine, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
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Wilson MT, Goldsworthy MR, Vallence AM, Fornito A, Rogasch NC. Finding synaptic couplings from a biophysical model of motor evoked potentials after theta-burst transcranial magnetic stimulation. Brain Res 2023; 1801:148205. [PMID: 36563834 DOI: 10.1016/j.brainres.2022.148205] [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: 07/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We aimed to use measured input-output (IO) data to identify the best fitting model for motor evoked potentials. METHODS We analyzed existing IO data before and after intermittent and continuous theta-burst stimulation (iTBS & cTBS) from a small group of subjects (18 for each). We fitted individual synaptic couplings and sensitivity parameters using variations of a biophysical model. A best performing model was selected and analyzed. RESULTS cTBS gives a broad reduction in MEPs for amplitudes larger than resting motor threshold (RMT). Close to threshold, iTBS gives strong potentiation. The model captures individual IO curves. There is no change to the population average synaptic weights post TBS but the change in excitatory-to-excitatory synaptic coupling is strongly correlated with the experimental post-TBS response relative to baseline. CONCLUSIONS The model describes population-averaged and individual IO curves, and their post-TBS change. Variation among individuals is accounted for with variation in synaptic couplings, and variation in sensitivity of neural response to stimulation. SIGNIFICANCE The best fitting model could be applied more broadly and validation studies could elucidate underlying biophysical meaning of parameters.
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Affiliation(s)
- Marcus T Wilson
- Te Aka Mātuatua-School of Science, University of Waikato, Hamilton, New Zealand.
| | - Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Ann-Maree Vallence
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging, Monash University, Victoria, Australia
| | - Nigel C Rogasch
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, and Monash Biomedical Imaging, Monash University, Victoria, Australia; South Australian Health and Medical Research Institute, Australia
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Feng Y, Zhang JJ, Zhu J, Tan X, Huang S, Bai Z, Yin Y. Does intermittent theta burst stimulation improve working memory capacity? A randomized controlled cross-over experiment. Behav Brain Res 2022; 436:114086. [DOI: 10.1016/j.bbr.2022.114086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022]
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Draaisma L, Wessel M, Moyne M, Morishita T, Hummel F. Targeting the frontoparietal network using bifocal transcranial alternating current stimulation during a motor sequence learning task in healthy older adults. Brain Stimul 2022; 15:968-979. [DOI: 10.1016/j.brs.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
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Determining the optimal pulse number for theta burst induced change in cortical excitability. Sci Rep 2021; 11:8726. [PMID: 33888752 PMCID: PMC8062542 DOI: 10.1038/s41598-021-87916-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
Theta-burst stimulation (TBS) is a form of non-invasive neuromodulation which is delivered in an intermittent (iTBS) or continuous (cTBS) manner. Although 600 pulses is the most common dose, the goal of these experiments was to evaluate the effect of higher per-dose pulse numbers on cortical excitability. Sixty individuals were recruited for 2 experiments. In Experiment 1, participants received 600, 1200, 1800, or sham (600) iTBS (4 visits, counterbalanced, left motor cortex, 80% active threshold). In Experiment 2, participants received 600, 1200, 1800, 3600, or sham (600) cTBS (5 visits, counterbalanced). Motor evoked potentials (MEP) were measured in 10-min increments for 60 min. For iTBS, there was a significant interaction between dose and time (F = 3.8296, p = 0.01), driven by iTBS (1200) which decreased excitability for up to 50 min (t = 3.1267, p = 0.001). For cTBS, there was no overall interaction between dose and time (F = 1.1513, p = 0.33). Relative to sham, cTBS (3600) increased excitability for up to 60 min (t = 2.0880, p = 0.04). There were no other significant effects of dose relative to sham in either experiment. Secondary analyses revealed high within and between subject variability. These results suggest that iTBS (1200) and cTBS (3600) are, respectively, the most effective doses for decreasing and increasing cortical excitability.
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Kleimaker M, Kleimaker A, Weissbach A, Colzato LS, Beste C, Bäumer T, Münchau A. Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome. Front Neurol 2020; 11:592258. [PMID: 33244309 PMCID: PMC7683779 DOI: 10.3389/fneur.2020.592258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Maximilian Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Alexander Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Lorenza S Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
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Pellegrini M, Zoghi M, Jaberzadeh S. A Checklist to Reduce Response Variability in Studies Using Transcranial Magnetic Stimulation for Assessment of Corticospinal Excitability: A Systematic Review of the Literature. Brain Connect 2020; 10:53-71. [PMID: 32093486 DOI: 10.1089/brain.2019.0715] [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] [Indexed: 12/22/2022] Open
Abstract
Response variability between individuals (interindividual variability) and within individuals (intraindividual variability) is an important issue in the transcranial magnetic stimulation (TMS) literature. This has raised questions of the validity of TMS to assess changes in corticospinal excitability (CSE) in a predictable and reliable manner. Several participant-specific factors contribute to this observed response variability with a current lack of consensus on the degree each factor contributes. This highlights a need for consistency and structure in reporting study designs and methodologies. Currently, there is no summarized review of the participant-specific factors that can be controlled and may contribute to response variability. This systematic review aimed to develop a checklist of methodological measures taken by previously published research to increase the homogeneity of participant selection criteria, preparation of participants before experimental testing, participant scheduling, and the instructions given to participants throughout experimental testing to minimize their effect on response variability. Seven databases were searched in full. Studies were included if CSE was measured via TMS and included methodological measures to increase the homogeneity of the participants. Eighty-four studies were included. Twenty-three included measures to increase participant selection homogeneity, 21 included measures to increase participant preparation homogeneity, while 61 included measures to increase participant scheduling and instructions during experimental testing homogeneity. These methodological measures were summarized into a user-friendly checklist with considerations, suggestions, and rationale/justification for their inclusion. This may provide the framework for further insights into ways to reduce response variability in TMS research.
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Affiliation(s)
- Michael Pellegrini
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, Discipline of Physiotherapy, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shapour Jaberzadeh
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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9
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Gutiérrez-Muto AM, Castilla J, Freire M, Oliviero A, Tornero J. Theta burst stimulation: Technical aspects about TMS devices. Brain Stimul 2020; 13:562-564. [PMID: 32289677 DOI: 10.1016/j.brs.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 12/31/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Javier Castilla
- Unidad Avanzada de Neurorrehabilitación, Hospital Los Madroños, Brunete, Spain
| | - Manuel Freire
- Departamento de Electrónica y Electromagnetismo, Universidad de Sevilla, Sevilla, Spain
| | - Antonio Oliviero
- Unidad Avanzada de Neurorrehabilitación, Hospital Los Madroños, Brunete, Spain; Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
| | - Jesús Tornero
- Unidad Avanzada de Neurorrehabilitación, Hospital Los Madroños, Brunete, Spain.
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10
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Jannati A, Block G, Ryan MA, Kaye HL, Kayarian FB, Bashir S, Oberman LM, Pascual-Leone A, Rotenberg A. Continuous Theta-Burst Stimulation in Children With High-Functioning Autism Spectrum Disorder and Typically Developing Children. Front Integr Neurosci 2020; 14:13. [PMID: 32231523 PMCID: PMC7083078 DOI: 10.3389/fnint.2020.00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: A neurophysiologic biomarker for autism spectrum disorder (ASD) is highly desirable and can improve diagnosis, monitoring, and assessment of therapeutic response among children with ASD. We investigated the utility of continuous theta-burst stimulation (cTBS) applied to the motor cortex (M1) as a biomarker for children and adolescents with high-functioning (HF) ASD compared to their age- and gender-matched typically developing (TD) controls. We also compared the developmental trajectory of long-term depression- (LTD-) like plasticity in the two groups. Finally, we explored the influence of a common brain-derived neurotrophic factor (BDNF) polymorphism on cTBS aftereffects in a subset of the ASD group. Methods: Twenty-nine children and adolescents (age range 10-16) in ASD (n = 11) and TD (n = 18) groups underwent M1 cTBS. Changes in MEP amplitude at 5-60 min post-cTBS and their cumulative measures in each group were calculated. We also assessed the relationship between age and maximum cTBS-induced MEP suppression (ΔMEPMax) in each group. Finally, we compared cTBS aftereffects in BDNF Val/Val (n = 4) and Val/Met (n = 4) ASD participants. Results: Cumulative cTBS aftereffects were significantly more facilitatory in the ASD group than in the TD group (P FDR's < 0.03). ΔMEPMax was negatively correlated with age in the ASD group (r = -0.67, P = 0.025), but not in the TD group (r = -0.12, P = 0.65). Cumulative cTBS aftereffects were not significantly different between the two BDNF subgroups (P-values > 0.18). Conclusions: The results support the utility of cTBS measures of cortical plasticity as a biomarker for children and adolescents with HF-ASD and an aberrant developmental trajectory of LTD-like plasticity in ASD.
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Affiliation(s)
- Ali Jannati
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gabrielle Block
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Mary A Ryan
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Harper L Kaye
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Fae B Kayarian
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E. P. Bradley Hospital, Warren Alpert Medical School, Brown University, East Providence, RI, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Badalona, Spain
| | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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11
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Chen L, Chung SW, Hoy KE, Fitzgerald PB. Is theta burst stimulation ready as a clinical treatment for depression? Expert Rev Neurother 2019; 19:1089-1102. [PMID: 31282224 DOI: 10.1080/14737175.2019.1641084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Major depression is a common and debilitating mental disorder that can be difficult to treat. Substantive evidence over the past two decades has established repetitive transcranial magnetic stimulation (rTMS) as an effective antidepressant therapy, although scope exists to improve its efficacy and efficiency. Theta burst stimulation (TBS) is a novel rTMS pattern attracting much research interest as a tool to study neurophysiology and treat neuropsychiatric disorders. Areas covered: This article outlines rTMS' state of development and explores the physiology studies underpinning TBS development and its observable neuronal conditioning and metabolic effects. We present a systematic review of studies that applied TBS to treat depression, followed by commentary on safety and practical considerations. Expert opinion: Much experimental and clinical research have advanced our understanding of the antidepressant effects of TBS, although unanswered questions remain relating to its physiological effects, response variability and optimal parameters for therapeutic purposes. A small number of sham-controlled trials, and one large comparative trial, support the therapeutic efficacy of TBS and demonstrates its non-inferiority relative to traditional rTMS. In this light, TBS can reasonably be offered as an alternative to rTMS in treatment-resistant depression, while ongoing research is likely to inform its therapeutic potential.
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Affiliation(s)
- Leo Chen
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia.,Alfred Mental and Addiction Health, Alfred Health , Melbourne , Australia
| | - Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia
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12
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Jannati A, Fried PJ, Block G, Oberman LM, Rotenberg A, Pascual-Leone A. Test-Retest Reliability of the Effects of Continuous Theta-Burst Stimulation. Front Neurosci 2019; 13:447. [PMID: 31156361 PMCID: PMC6533847 DOI: 10.3389/fnins.2019.00447] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The utility of continuous theta-burst stimulation (cTBS) as index of cortical plasticity is limited by inadequate characterization of its test-retest reliability. We thus evaluated the reliability of cTBS aftereffects, and explored the roles of age and common single-nucleotide polymorphisms in the brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) genes. METHODS Twenty-eight healthy adults (age range 21-65) underwent two identical cTBS sessions (median interval = 9.5 days) targeting the motor cortex. Intraclass correlation coefficients (ICCs) of the log-transformed, baseline-corrected amplitude of motor evoked potentials (ΔMEP) at 5-60 min post-cTBS (T5-T60) were calculated. Adjusted effect sizes for cTBS aftereffects were then calculated by taking into account the reliability of each cTBS measure. RESULTS ΔMEP at T50 was the most-reliable cTBS measure in the whole sample (ICC = 0.53). Area under-the-curve (AUC) of ΔMEPs was most reliable when calculated over the full 60 min post-cTBS (ICC = 0.40). cTBS measures were substantially more reliable in younger participants (< 35 years) and in those with BDNF Val66Val and APOE ε4- genotypes. CONCLUSION cTBS aftereffects are most reliable when assessed 50 min post-cTBS, or when cumulative ΔMEP measures are calculated over 30-60 min post-cTBS. Reliability of cTBS aftereffects is influenced by age, and BDNF and APOE polymorphisms. Reliability coefficients are used to adjust effect-size calculations for interpretation and planning of cTBS studies.
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Affiliation(s)
- Ali Jannati
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Gabrielle Block
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lindsay M. Oberman
- Neuroplasticity and Autism Spectrum Disorder Program, Department of Psychiatry and Human Behavior, E.P. Bradley Hospital, Warren Alpert Medical School, Brown University, East Providence, RI, United States
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Institut Guttman de Neurorehabilitació, Universitat Autónoma de Barcelona, Barcelona, Spain
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13
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Chung SW, Sullivan CM, Rogasch NC, Hoy KE, Bailey NW, Cash RFH, Fitzgerald PB. The effects of individualised intermittent theta burst stimulation in the prefrontal cortex: A TMS-EEG study. Hum Brain Mapp 2018; 40:608-627. [PMID: 30251765 DOI: 10.1002/hbm.24398] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 01/08/2023] Open
Abstract
Recent studies have highlighted variability in response to theta burst stimulation (TBS) in humans. TBS paradigm was originally developed in rodents to mimic gamma bursts coupled with theta rhythms, and was shown to elicit long-term potentiation. The protocol was subsequently adapted for humans using standardised frequencies of stimulation. However, each individual has different rhythmic firing pattern. The present study sought to explore whether individualised intermittent TBS (Ind iTBS) could outperform the effects of two other iTBS variants. Twenty healthy volunteers received iTBS over left prefrontal cortex using 30 Hz at 6 Hz, 50 Hz at 5 Hz, or individualised frequency in separate sessions. Ind iTBS was determined using theta-gamma coupling during the 3-back task. Concurrent use of transcranial magnetic stimulation and electroencephalography (TMS-EEG) was used to track changes in cortical plasticity. We also utilised mood ratings using a visual analogue scale and assessed working memory via the 3-back task before and after stimulation. No group-level effect was observed following either 30 or 50 Hz iTBS in TMS-EEG. Ind iTBS significantly increased the amplitude of the TMS-evoked P60, and decreased N100 and P200 amplitudes. A significant positive correlation between neurophysiological change and change in mood rating was also observed. Improved accuracy in the 3-back task was observed following both 50 Hz and Ind iTBS conditions. These findings highlight the critical importance of frequency in the parameter space of iTBS. Tailored stimulation parameters appear more efficacious than standard paradigms in neurophysiological and mood changes. This novel approach presents a promising option and benefits may extend to clinical applications.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Caley M Sullivan
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Nigel C Rogasch
- Brain and Mental Health Laboratory, School of Psychological Sciences and Monash Biomedical Imaging, Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Neil W Bailey
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Robin F H Cash
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia.,Epworth Clinic, Epworth Healthcare, Melbourne, Australia
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14
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Ulrich M, Lorenz S, Spitzer MW, Steigleder L, Kammer T, Grön G. Theta-burst modulation of mid-ventrolateral prefrontal cortex affects salience coding in the human ventral tegmental area. Appetite 2017; 123:91-100. [PMID: 29247796 DOI: 10.1016/j.appet.2017.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 01/01/2023]
Abstract
In the context of hedonic (over-)eating the ventral tegmental area (VTA) as a core part of the dopaminergic reward system plays a central role in coding incentive salience of high-caloric food. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate whether transcranial magnetic theta-burst stimulation (TBS) over the right mid-ventrolateral prefrontal cortex (mid-VLPFC) can induce modulation of calorie-sensitive brain activation in the VTA. The prefrontal location for TBS had been predetermined by seed-based resting-state fMRI with a functionally defined portion of the VTA serving as seed region obtained from an independent second fMRI experiment. In a sample of 15 healthy male participants, modulation of calorie-sensitive VTA activation did not significantly differ between the two TBS protocols. Comparisons with baseline revealed that both TBS protocols significantly affected calorie-sensitive neural processing of the mid-VLPFC in a rather similar way. In the VTA significant modulation of calorie-sensitive activation was observed after continuous TBS, whereas the modulatory effect of intermittent TBS was less reliable but also associated with a decrease of activation for high-caloric food images. Neurostimulation of right mid-VLPFC is suggestive as a main entry point of downstream signal changes for high- and low-caloric food cues that could enforce a shift in valuating stimuli of initially different incentive salience.
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Affiliation(s)
- Martin Ulrich
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Sabrina Lorenz
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Markus W Spitzer
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Leon Steigleder
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Thomas Kammer
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany
| | - Georg Grön
- Department of Psychiatry, University of Ulm, Leimgrubenweg 12-14, 89075 Ulm, Germany.
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15
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Chung SW, Rogasch NC, Hoy KE, Sullivan CM, Cash RFH, Fitzgerald PB. Impact of different intensities of intermittent theta burst stimulation on the cortical properties during TMS-EEG and working memory performance. Hum Brain Mapp 2017; 39:783-802. [PMID: 29124791 DOI: 10.1002/hbm.23882] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023] Open
Abstract
Intermittent theta burst stimulation (iTBS) is a noninvasive brain stimulation technique capable of increasing cortical excitability beyond the stimulation period. Due to the rapid induction of modulatory effects, prefrontal application of iTBS is gaining popularity as a therapeutic tool for psychiatric disorders such as depression. In an attempt to increase efficacy, higher than conventional intensities are currently being applied. The assumption that this increases neuromodulatory may be mechanistically false for iTBS. This study examined the influence of intensity on the neurophysiological and behavioural effects of iTBS in the prefrontal cortex. Sixteen healthy participants received iTBS over prefrontal cortex at either 50, 75 or 100% resting motor threshold in separate sessions. Single-pulse TMS and concurrent electroencephalography (EEG) was used to assess changes in cortical reactivity measured as TMS-evoked potentials and oscillations. The n-back task was used to assess changes in working memory performance. The data can be summarised as an inverse U-shape relationship between intensity and iTBS plastic effects, where 75% iTBS yielded the largest neurophysiological changes. Improvement in reaction time in the 3-back task was supported by the change in alpha power, however, comparison between conditions revealed no significant differences. The assumption that higher intensity results in greater neuromodulatory effects may be false, at least in healthy individuals, and should be carefully considered for clinical populations. Neurophysiological changes associated with working memory following iTBS suggest functional relevance. However, the effects of different intensities on behavioural performance remain elusive in the present healthy sample.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Nigel C Rogasch
- Brain and Mental Health Laboratory, School of Psychological Sciences and Monash Biomedical Imaging, Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Melbourne, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Caley M Sullivan
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Robin F H Cash
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School and The Alfred, Melbourne, Australia.,Epworth Clinic, Epworth Healthcare, Camberwell, VIC, Australia
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16
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Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation. Brain Stimul 2017; 10:214-222. [DOI: 10.1016/j.brs.2017.01.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 12/10/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022] Open
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17
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Priming theta burst stimulation enhances motor cortex plasticity in young but not old adults. Brain Stimul 2017; 10:298-304. [PMID: 28089653 DOI: 10.1016/j.brs.2017.01.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 01/03/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Primary motor cortex neuroplasticity is reduced in old adults, which may contribute to the motor deficits commonly observed in the elderly. Previous research in young subjects suggests that the neuroplastic response can be enhanced using non-invasive brain stimulation (NIBS), with a larger plastic response observed following priming with both long-term potentiation (LTP) and depression (LTD)-like protocols. However, it is not known if priming stimulation can also modulate plasticity in older adults. OBJECTIVE To investigate if priming NIBS can be used to modulate motor cortical plasticity in old subjects. METHODS In 16 young (22.3 ± 1.0 years) and 16 old (70.2 ± 1.7 years) subjects, we investigated the response to intermittent theta burst stimulation (iTBS; LTP-like) when applied 10 min after sham stimulation, continuous TBS (cTBS; LTD-like) or an identical block of iTBS. Corticospinal plasticity was assessed by recording changes in motor evoked potential (MEP) amplitude. RESULTS In young subjects, priming with cTBS (cTBS + iTBS) resulted in larger MEPs than priming with either iTBS (iTBS + iTBS; P = 0.001) or sham (sham + iTBS; P < 0.0001), while larger MEPs were seen following iTBS + iTBS than sham + iTBS (P < 0.0001). In old subjects, the response to iTBS + iTBS was not different to sham + iTBS (P > 0.9), whereas the response to cTBS + iTBS was reduced relative to iTBS + iTBS (P = 0.02) and sham + iTBS (P = 0.04). CONCLUSIONS Priming TBS is ineffective for modifying M1 plasticity in older adults, which may limit the therapeutic use of priming stimulation in neurological conditions common in the elderly.
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18
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Hannah R, Rocchi L, Tremblay S, Rothwell JC. Controllable Pulse Parameter TMS and TMS-EEG As Novel Approaches to Improve Neural Targeting with rTMS in Human Cerebral Cortex. Front Neural Circuits 2016; 10:97. [PMID: 27965543 PMCID: PMC5126103 DOI: 10.3389/fncir.2016.00097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/15/2016] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology London, UK
| | - Lorenzo Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology London, UK
| | - Sara Tremblay
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology London, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology London, UK
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19
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Opie GM, Vosnakis E, Ridding MC, Ziemann U, Semmler JG. WITHDRAWN: Priming theta burst stimulation enhances motor cortex plasticity in young but not old adults. Brain Stimul 2016:S1935-861X(16)30311-4. [PMID: 27888026 DOI: 10.1016/j.brs.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- George M Opie
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Eleni Vosnakis
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Michael C Ridding
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Ulf Ziemann
- Department of Neurology & Stroke, Hertie-Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - John G Semmler
- Discipline of Physiology, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
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20
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Sykes M, Matheson NA, Brownjohn PW, Tang AD, Rodger J, Shemmell JBH, Reynolds JNJ. Differences in Motor Evoked Potentials Induced in Rats by Transcranial Magnetic Stimulation under Two Separate Anesthetics: Implications for Plasticity Studies. Front Neural Circuits 2016; 10:80. [PMID: 27766073 PMCID: PMC5052269 DOI: 10.3389/fncir.2016.00080] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is primarily used in humans to change the state of corticospinal excitability. To assess the efficacy of different rTMS stimulation protocols, motor evoked potentials (MEPs) are used as a readout due to their non-invasive nature. Stimulation of the motor cortex produces a response in a targeted muscle, and the amplitude of this twitch provides an indirect measure of the current state of the cortex. When applied to the motor cortex, rTMS can alter MEP amplitude, however, results are variable between participants and across studies. In addition, the mechanisms underlying any change and its locus are poorly understood. In order to better understand these effects, MEPs have been investigated in vivo in animal models, primarily in rats. One major difference in protocols between rats and humans is the use of general anesthesia in animal experiments. Anesthetics are known to affect plasticity-like mechanisms and so may contaminate the effects of an rTMS protocol. In the present study, we explored the effect of anesthetic on MEP amplitude, recorded before and after intermittent theta burst stimulation (iTBS), a patterned rTMS protocol with reported facilitatory effects. MEPs were assessed in the brachioradialis muscle of the upper forelimb under two anesthetics: a xylazine/zoletil combination and urethane. We found MEPs could be induced under both anesthetics, with no differences in the resting motor threshold or the average baseline amplitudes. However, MEPs were highly variable between animals under both anesthetics, with the xylazine/zoletil combination showing higher variability and most prominently a rise in amplitude across the baseline recording period. Interestingly, application of iTBS did not facilitate MEP amplitude under either anesthetic condition. Although it is important to underpin human application of TMS with mechanistic examination of effects in animals, caution must be taken when selecting an anesthetic and in interpreting results during prolonged TMS recording.
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Affiliation(s)
- Matthew Sykes
- Brain Health Research Centre and Brain Research New Zealand Centre of Research ExcellenceDunedin, New Zealand; Department of Anatomy, University of OtagoDunedin, New Zealand; Experimental and Regenerative Neuroscience, School of Animal Biology, University of Western AustraliaPerth, WA, Australia
| | - Natalie A Matheson
- Brain Health Research Centre and Brain Research New Zealand Centre of Research ExcellenceDunedin, New Zealand; Department of Anatomy, University of OtagoDunedin, New Zealand
| | - Philip W Brownjohn
- Brain Health Research Centre and Brain Research New Zealand Centre of Research ExcellenceDunedin, New Zealand; School of Physical Education, Sport and Exercise Sciences, University of OtagoDunedin, New Zealand
| | - Alexander D Tang
- Experimental and Regenerative Neuroscience, School of Animal Biology, University of Western Australia Perth, WA, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neuroscience, School of Animal Biology, University of Western Australia Perth, WA, Australia
| | - Jonathan B H Shemmell
- Brain Health Research Centre and Brain Research New Zealand Centre of Research ExcellenceDunedin, New Zealand; School of Physical Education, Sport and Exercise Sciences, University of OtagoDunedin, New Zealand
| | - John N J Reynolds
- Brain Health Research Centre and Brain Research New Zealand Centre of Research ExcellenceDunedin, New Zealand; Department of Anatomy, University of OtagoDunedin, New Zealand
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21
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Georgiev D, Rocchi L, Tocco P, Speekenbrink M, Rothwell JC, Jahanshahi M. Continuous Theta Burst Stimulation Over the Dorsolateral Prefrontal Cortex and the Pre-SMA Alter Drift Rate and Response Thresholds Respectively During Perceptual Decision-Making. Brain Stimul 2016; 9:601-8. [PMID: 27157058 DOI: 10.1016/j.brs.2016.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The speed-accuracy trade-off (SAT) refers to the balancing of speed versus accuracy during decision-making. SAT is very commonly investigated with perceptual decision-making tasks such as the moving dots task (MDT). The dorsolateral prefrontal cortex (DLPFC) and the pre-supplementary motor area (pre-SMA) are two brain regions considered to be involved in the control of SAT. OBJECTIVES/HYPOTHESES The study tested whether the DLPFC and the pre-SMA play an essential role in the control of SAT. We hypothesized that continuous theta burst stimulation (cTBS) over the right DLPFC would primarily alter the rate of accumulation of evidence, whereas stimulation of the pre-SMA would influence the threshold for reaching a decision. METHODS Fifteen (5 females; mean age = 30, SD =5.40) healthy volunteers participated in the study. We used two versions of the MDT and cTBS over the right DLPFC, pre-SMA and sham stimulation. The drift diffusion model was fit to the behavioural data (reaction time and error rate) in order to calculate the drift rate, boundary separation (threshold) and non-decision time. RESULTS cTBS over the right DLPFC decreased the rate of accumulation of evidence (i.e. the drift rate from the diffusion model) in high (0.35 and 0.5) but not in low coherence trials. cTBS over the pre-SMA changed the boundary separation/threshold required to reach a decision on accuracy, but not on speed trials. CONCLUSIONS The results suggest for the first time that both the DLPFC and the pre-SMA make essential but distinct contributions to the modulation of SAT.
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Affiliation(s)
- Dejan Georgiev
- Cognitive Motor Neuroscience Group, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK; Department of Neurology, University of Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Lorenzo Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK; Department of Neurology and Psychiatry, Università di Roma "Sapienza", Viale dell'Università 30, 00185 Rome, Italy
| | - Pierluigi Tocco
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK
| | - Maarten Speekenbrink
- Division of Psychology and Language Sciences, UCL Cognitive, Perceptual and Brain Sciences, London WC1E 6BT, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK
| | - Marjan Jahanshahi
- Cognitive Motor Neuroscience Group, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK.
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22
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Chung SW, Hill AT, Rogasch NC, Hoy KE, Fitzgerald PB. Use of theta-burst stimulation in changing excitability of motor cortex: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 63:43-64. [PMID: 26850210 DOI: 10.1016/j.neubiorev.2016.01.008] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/30/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022]
Abstract
Noninvasive brain stimulation has been demonstrated to modulate cortical activity in humans. In particular, theta burst stimulation (TBS) has gained notable attention due to its ability to induce lasting physiological changes after short stimulation durations. The present study aimed to provide a comprehensive meta-analytic review of the efficacy of two TBS paradigms; intermittent (iTBS) and continuous (cTBS), on corticospinal excitability in healthy individuals. Literature searches yielded a total of 87 studies adhering to the inclusion criteria. iTBS yielded moderately large MEP increases lasting up to 30 min with a pooled SMD of 0.71 (p<0.00001). cTBS produced a reduction in MEP amplitudes lasting up to 60 min, with the largest effect size seen at 5 min post stimulation (SMD=-0.9, P<0.00001). The collected studies were of heterogeneous nature, and a series of tests conducted indicated a degree of publication bias. No significant change in SICI and ICF was observed, with exception to decrease in SICI with cTBS at the early time point (SMD=0.42, P=0.00036). The results also highlight several factors contributing to TBS efficacy, including the number of pulses, frequency of stimulation and BDNF polymorphisms. Further research investigating optimal TBS stimulation parameters, particularly for iTBS, is needed in order for these paradigms to be successfully translated into clinical settings.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia.
| | - Aron T Hill
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
| | - Nigel C Rogasch
- Brain and Mental Health Laboratory, School of Psychological Sciences and Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
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23
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Goldsworthy MR, Vallence AM, Yang R, Pitcher JB, Ridding MC. Combined transcranial alternating current stimulation and continuous theta burst stimulation: a novel approach for neuroplasticity induction. Eur J Neurosci 2016; 43:572-9. [DOI: 10.1111/ejn.13142] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Mitchell R. Goldsworthy
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide 5005 Australia
| | - Ann-Maree Vallence
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide 5005 Australia
- School of Psychology and Exercise Science; Murdoch University; Perth WA Australia
| | - Ruiting Yang
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide 5005 Australia
| | - Julia B. Pitcher
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide 5005 Australia
| | - Michael C. Ridding
- The Robinson Research Institute; School of Medicine; University of Adelaide; Adelaide 5005 Australia
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24
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Wischnewski M, Schutter DJ. Efficacy and time course of paired associative stimulation in cortical plasticity: Implications for neuropsychiatry. Clin Neurophysiol 2016; 127:732-739. [DOI: 10.1016/j.clinph.2015.04.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/16/2015] [Accepted: 04/24/2015] [Indexed: 12/20/2022]
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25
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Zénon A, Klein PA, Alamia A, Boursoit F, Wilhelm E, Duque J. Increased Reliance on Value-based Decision Processes Following Motor Cortex Disruption. Brain Stimul 2015; 8:957-64. [PMID: 26279406 DOI: 10.1016/j.brs.2015.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND During motor decision making, the neural activity in primary motor cortex (M1) encodes dynamically the competition occurring between potential action plans. A common view is that M1 represents the unfolding of the outcome of a decision process taking place upstream. Yet, M1 could also be directly involved in the decision process. OBJECTIVE Here we tested this hypothesis by assessing the effect of M1 disruption on a motor decision-making task. METHODS We applied continuous theta burst stimulation (cTBS) to inhibit either left or right M1 in different groups of subjects and included a third control group with no stimulation. Following cTBS, participants performed a task that required them to choose between two finger key-presses with the right hand according to both perceptual and value-based information. Effects were assessed by means of generalized linear mixed models and computational simulations. RESULTS In all three groups, subjects relied both on perceptual (P < 0.0001) and value-based information (P = 0.003) to reach a decision. Yet, left M1 disruption led to an increased reliance on value-based information (P = 0.03). This result was confirmed by a computational model showing an increased weight of the valued-based process on the right hand finger choices following left M1 cTBS (P < 0.01). CONCLUSION These results indicate that M1 is involved in motor decision making, possibly by weighting the final integration of multiple sources of evidence driving motor behaviors.
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Affiliation(s)
- Alexandre Zénon
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | | | - Andrea Alamia
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - François Boursoit
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuelle Wilhelm
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Duque
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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26
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Wischnewski M, Schutter DJLG. Efficacy and Time Course of Theta Burst Stimulation in Healthy Humans. Brain Stimul 2015; 8:685-92. [PMID: 26014214 DOI: 10.1016/j.brs.2015.03.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the past decade research has shown that continuous (cTBS) and intermittent theta burst stimulation (iTBS) alter neuronal excitability levels in the primary motor cortex. OBJECTIVE Quantitatively review the magnitude and time course on cortical excitability of cTBS and iTBS. METHODS Sixty-four TBS studies published between January 2005 and October 2014 were retrieved from the scientific search engine PubMED and included for analyses. The main inclusion criteria involved stimulation of the primary motor cortex in healthy volunteers with no motor practice prior to intervention and motor evoked potentials as primary outcome measure. RESULTS ITBS applied for 190 s significantly increases cortical excitability up to 60 min with a mean maximum potentiation of 35.54 ± 3.32%. CTBS applied for 40 s decreases cortical excitability up to 50 min with a mean maximum depression of -22.81 ± 2.86%, while cTBS applied for 20 s decreases cortical excitability (mean maximum -27.84 ± 4.15%) for 20 min. CONCLUSION The present findings offer normative insights into the magnitude and time course of TBS-induced changes in cortical excitability levels.
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Affiliation(s)
- Miles Wischnewski
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands.
| | - Dennis J L G Schutter
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, the Netherlands
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Chung SW, Hoy KE, Fitzgerald PB. Theta-burst stimulation: a new form of TMS treatment for depression? Depress Anxiety 2015; 32:182-92. [PMID: 25450537 DOI: 10.1002/da.22335] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/17/2014] [Accepted: 10/21/2014] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a common debilitating condition where only one third of patients achieve remission after the first antidepressant treatment. Inadequate efficacy and adverse effects of current treatment strategies call for more effective and tolerable treatment options. Transcranial magnetic stimulation (TMS) is a noninvasive approach to manipulate brain activity and alter cortical excitability. There has been more than 15 years of research on the use of repetitive form of TMS (rTMS) for the treatment of patients with depression, which has shown it to be an effective antidepressant treatment. Even though rTMS treatment has shown efficacy in treating depression, there is a high degree of interindividual variability in response. A newer form of rTMS protocol, known as theta-burst stimulation (TBS), has been shown to produce similar if not greater effects on brain activity than standard rTMS. TBS protocols have a major advantage over standard rTMS approaches in their reduced administration duration. Conventional rTMS procedures last between 20 and 45 min, as compared to TBS paradigms that require 1 to 3 min of stimulation. Recently, a small number of studies have suggested that TBS has similar or better efficacy in treating depression compared to rTMS. Optimization, identification of response predictors, and clarification of neurobiological mechanisms of TBS is required if it is to be further developed as a less time intensive, safe, and effective treatment for MDD.
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Affiliation(s)
- Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Central Clinical School, The Alfred and Monash University, Melbourne, Australia
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Barry MD, Boddington LJ, Igelström KM, Gray JP, Shemmell J, Tseng KY, Oorschot DE, Reynolds JN. Utility of intracerebral theta burst electrical stimulation to attenuate interhemispheric inhibition and to promote motor recovery after cortical injury in an animal model. Exp Neurol 2014; 261:258-66. [DOI: 10.1016/j.expneurol.2014.05.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/12/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
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