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Jin K, Chen B, Han S, Dong J, Cheng S, Qin B, Lu J. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves Cognitive Impairment and Intestinal Microecological Dysfunction Induced by High-Fat Diet in Rats. RESEARCH (WASHINGTON, D.C.) 2024; 7:0384. [PMID: 38826566 PMCID: PMC11140411 DOI: 10.34133/research.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 06/04/2024]
Abstract
Consuming a high-fat diet (HFD) is widely recognized to cause obesity and result in chronic brain inflammation that impairs cognitive function. Repetitive transcranial magnetic stimulation (rTMS) has shown effectiveness in both weight loss and cognitive improvement, although the exact mechanism is still unknown. Our study examined the effects of rTMS on the brain and intestinal microecological dysfunction. rTMS successfully reduced cognitive decline caused by an HFD in behavioral assessments involving the Y maze and novel object recognition. This was accompanied by an increase in the number of new neurons and the transcription level of genes related to synaptic plasticity (spindlin 1, synaptophysin, and postsynaptic protein-95) in the hippocampus. It was reached that rTMS decreased the release of high mobility group box 1, activation of microglia, and inflammation in the brains of HFD rats. rTMS also reduced hypothalamic hypocretin levels and improved peripheral blood lipid metabolism. In addition, rTMS recovered the HFD-induced gut microbiome imbalances, metabolic disorders, and, in particular, reduced levels of the microvirus. Our research emphasized that rTMS enhanced cognitive abilities, resulting in positive impacts on brain inflammation, neurodegeneration, and the microbiota in the gut, indicating the potential connection between the brain and gut, proposing that rTMS could be a new approach to addressing cognitive deficits linked to obesity.
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Affiliation(s)
- Kangyu Jin
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
| | - Bing Chen
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
| | - Shengyi Han
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou City 310003, China
| | - Jingyi Dong
- School of Life Sciences,
Zhejiang Chinese Medical University, Hangzhou, China
| | - Shangping Cheng
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Bin Qin
- School of Life Sciences,
Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Lu
- Department of Psychiatry, the First Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou 310003, China
- The Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou 310003, China
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Kang D, Zhang Y, Wu G, Song C, Peng X, Long Y, Yu G, Tang H, Gui Y, Wang Q, Yuan T, Wu R. The Effect of Accelerated Continuous Theta Burst Stimulation on Weight Loss in Overweight Individuals With Schizophrenia: A Double-Blind, Randomized, Sham-Controlled Clinical Trial. Schizophr Bull 2024; 50:589-599. [PMID: 37921353 PMCID: PMC11059792 DOI: 10.1093/schbul/sbad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND HYPOTHESIS Obesity is a common comorbidity in individuals with schizophrenia and is associated with poor clinical outcomes. At present, there are limited effective approaches for addressing this issue. We conducted a double-blind, randomized, sham-controlled clinical trial to investigate the efficacy of noninvasive magnetic stimulation techniques in reducing obesity in individuals with schizophrenia. STUDY DESIGN Forty overweight individuals with schizophrenia were recruited and randomly assigned to receive either the active or sham intervention. The active group received 50 accelerated continuous theta burst stimulation (cTBS) sessions over the left primary motor area (M1), while the sham group received sham stimulation. The primary outcomes were the change in body weight and body mass index (BMI), and the secondary outcomes were the psychiatric symptoms, eating behavior scales, metabolic measures, and electrophysiological to food picture stimuli. STUDY RESULTS The study demonstrated a significant decrease in body weight and BMI after the intervention selectively in the active group (mean = -1.33 kg, P = .002), and this improvement remained at the 1-month follow-up (mean = -2.02 kg, P = .008). The score on the Barratt Impulsivity Scale (mean = -1.78, P = 0.036) decreased in the active group and mediated the effect of accelerated cTBS on body weight. In the food picture cue electroencephalograph task, the late positive potential component, which is related to motivated attention and emotional processing, decreased in frontal brain regions and increased in posterior regions after the active intervention. CONCLUSIONS The accelerated cTBS may offer a promising approach for treating obesity in individuals with schizophrenia. Further research with a larger sample size or individualized stimulation protocol should be promising. TRIAL REGISTRATION Clinical trial registered with clinicaltrials.gov (NCT05086133).
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Affiliation(s)
- Dongyu Kang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guowei Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinjie Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yujun Long
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guo Yu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yawei Gui
- Key Laboratory of Spectral Imaging Technology, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
- Key Laboratory of Biomedical Spectroscopy of Xi’an, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
| | - Quan Wang
- Key Laboratory of Spectral Imaging Technology, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
- Key Laboratory of Biomedical Spectroscopy of Xi’an, Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences, Xi’an, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Kang D, Song C, Peng X, Yu G, Yang Y, Chen C, Long Y, Shao P, Wu R. The effect of continuous theta burst stimulation on antipsychotic-induced weight gain in first-episode drug-naive individuals with schizophrenia: a double-blind, randomized, sham-controlled feasibility trial. Transl Psychiatry 2024; 14:61. [PMID: 38272892 PMCID: PMC10810827 DOI: 10.1038/s41398-024-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
Antipsychotic intake may induce weight gain in drug-naive individuals with schizophrenia, leading to poor compliance in clinical management. However, there is still a lack of effective approaches to treat or prevent this side-effect. Therefore, we conducted this pilot study to investigate the effect of continuous theta burst stimulation (cTBS), a non-invasive magnetic stimulation technique, on preventing olanzapine-induced weight gain. Thirty-nine first-episode drug-naive individuals with schizophrenia were randomly assigned to receive either the active or sham cTBS intervention for 25 sessions (5 times per day for 5 consecutive days). The primary outcomes were changes in body weight and body mass index (BMI). Secondary outcomes included psychiatric symptoms, eating behavior scales, behavior tasks, and metabolic measures. For the result, the body weight and BMI increased significantly in the sham group but not in the active group, with a significant group effect. The active group exhibited a selective increase in the cognitive restraint domain in the Three-Factor Eating Questionnaire (TFEQ-CR) and a decrease in stop-signal reaction time compared to the sham group. The effect of cTBS on body weight was mediated by TFEQ-CR. Our findings demonstrated the feasibility that cTBS intervention could be a potential method for preventing olanzapine-induced weight gain in drug-naive first-episode schizophrenia patients through enhancing cognitive restraint to food. Trial registration: clinical trial registered with clinicaltrials.gov (NCT05086133).
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Affiliation(s)
- Dongyu Kang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Xingjie Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Guo Yu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Ye Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Chuwei Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Yujun Long
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Ping Shao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China.
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Alhindi YA, Khalifa N, Al-Khyatt W, Idris I. The use of non-invasive brain stimulation techniques to reduce body weight and food cravings: A systematic review and meta-analysis. Clin Obes 2023; 13:e12611. [PMID: 37577814 DOI: 10.1111/cob.12611] [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: 09/13/2022] [Revised: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023]
Abstract
Several studies demonstrated non-invasive brain stimulation (NIBS) techniques such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are safe and simple techniques that can reduce body weight, food cravings, and food consumption in patients with obesity. However, a systematic to evaluate the efficacy of active NIBS versus sham stimulation in reducing body weight and food cravings in patients with obesity is not available. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) using PubMed, Embase, MEDLINE, and Cochrane Central Register of Control Trial between January 1990 and February 2022. Mean differences (MDs) for continuous outcome variables with 95% confidence intervals (95% CIs) were used to examine the effects of NIBS on body weight and body mass index (BMI), whereas the hedges's g test was used to measure the effects on food craving. Nineteen RCTs involving 571 participants were included in this study. Active neurostimulation (TMS and tDCS) was significantly more likely than sham stimulation to reduce body weight (TMS: -3.29 kg, 95% CI [-5.32, -1.26]; I2 = 48%; p < .001; tDCS: -0.82 kg, 95% CI [-1.01, -0.62]; I2 = 0.0%; p = .00) and BMI (TMS: -0.74, 95% CI [-1.17, -0.31]; I2 = 0% p = .00; tDCS: MD = -0.55, 95% CI [-2.32, 1.21]; I2 = 0% p = .54) as well as food cravings (TMS: g = -0.91, 95% CI [-1.68, -0.14]; I2 = 88 p = .00; tDCS: g = -0.32, 95% CI [-0.62, -0.02]; p = .04). Compared with sham stimulation, our findings indicate that active NIBS can significantly help to reduce body weight and food cravings. Hence, these novel techniques may be used as primary or adjunct tools in treating patients with obesity.
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Affiliation(s)
- Yousef Abdullah Alhindi
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital, Nottingham, UK
- East Midlands Bariatric Metabolic Institute, Royal Derby Hospital, Derby, UK
- Division of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Najat Khalifa
- Queen's University Department of Psychiatry, Kingston, Ontario, Canada
| | - Waleed Al-Khyatt
- East Midlands Bariatric Metabolic Institute, Royal Derby Hospital, Derby, UK
| | - Iskandar Idris
- Clinical, Metabolic and Molecular Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Royal Derby Hospital, Nottingham, UK
- East Midlands Bariatric Metabolic Institute, Royal Derby Hospital, Derby, UK
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5
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Luo S, Hsu E, Lawrence KE, Adise S, Pickering TA, Herting MM, Buchanan T, Page KA, Thompson PM. Associations among prenatal exposure to gestational diabetes mellitus, brain structure, and child adiposity markers. Obesity (Silver Spring) 2023; 31:2699-2708. [PMID: 37840377 PMCID: PMC11025497 DOI: 10.1002/oby.23901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the mediating role of child brain structure in the relationship between prenatal gestational diabetes mellitus (GDM) exposure and child adiposity. METHODS This was a cross-sectional study of 9- to 10-year-old participants and siblings across the US. Data were obtained from the baseline assessment of the Adolescent Brain Cognitive Development (ABCD) Study®. Brain structure was evaluated by magnetic resonance imaging. GDM exposure was self-reported, and discordance for GDM exposure within biological siblings was identified. Mixed effects and mediation models were used to examine associations among prenatal GDM exposure, brain structure, and adiposity markers with sociodemographic covariates. RESULTS The sample included 8521 children (7% GDM-exposed), among whom there were 28 sibling pairs discordant for GDM exposure. Across the entire study sample, prenatal exposure to GDM was associated with lower global and regional cortical gray matter volume (GMV) in the bilateral rostral middle frontal gyrus and superior temporal gyrus. GDM-exposed siblings also demonstrated lower global cortical GMV than unexposed siblings. Global cortical GMV partially mediated the associations between prenatal GDM exposure and child adiposity markers. CONCLUSIONS The results identify brain markers of prenatal GDM exposure and suggest that low cortical GMV may explain increased obesity risk for offspring prenatally exposed to GDM.
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Affiliation(s)
- Shan Luo
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Eustace Hsu
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Katherine E. Lawrence
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shana Adise
- Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Division of Research on Children, Youth, and Families, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Trevor A. Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Megan M. Herting
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Thomas Buchanan
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kathleen A. Page
- Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Diabetes and Obesity Research Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, USA
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Fatakdawala I, Ayaz H, Safati AB, Sakib MN, Hall PA. Effects of prefrontal theta burst stimulation on neuronal activity and subsequent eating behavior: an interleaved rTMS and fNIRS study. Soc Cogn Affect Neurosci 2023; 18:6146114. [PMID: 33615370 PMCID: PMC10074772 DOI: 10.1093/scan/nsab023] [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: 09/04/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
The dorsolateral prefrontal cortex (dlPFC) and dorsomedial prefrontal cortex (dmPFC) are both important nodes for self-control and decision-making but through separable processes (cognitive control vs evaluative processing). This study aimed to examine the effects of excitatory brain stimulation [intermittent theta burst stimulation (iTBS)] targeting the dlPFC and dmPFC on eating behavior. iTBS was hypothesized to decrease consumption of appetitive snack foods, via enhanced interference control for dlPFC stimulation and reduced delay discounting (DD) for dmPFC stimulation. Using a single-blinded, between-subjects design, participants (N = 43) were randomly assigned to one of three conditions: (i) iTBS targeting the left dlPFC, (ii) iTBS targeting bilateral dmPFC or (iii) sham. Participants then completed two cognitive tasks (DD and Flanker), followed by a bogus taste test. Functional near-infrared spectroscopy imaging revealed that increases in the medial prefrontal cortex activity were evident in the dmPFC stimulation group during the DD task; likewise, a neural efficiency effect was observed in the dlPFC stimulation group during the Flanker. Gender significantly moderated during the taste test, with females in the dmPFC showing paradoxical increases in food consumption compared to sham. Findings suggest that amplification of evaluative processing may facilitate eating indulgence when preponderant social cues are permissive and food is appetitive.
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Affiliation(s)
- Idris Fatakdawala
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CA, ON, Canada
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health, Drexel University, Philadelphia, PA, USA.,Department of Psychology, College of Arts and Sciences, Drexel University, Philadelphia, PA, USA.,Drexel Solutions Institute, Drexel University, Philadelphia, PA, USA.,Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, USA.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adrian B Safati
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CA, ON, Canada
| | - Mohammad N Sakib
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CA, ON, Canada
| | - Peter A Hall
- School of Public Health and Health Systems, University of Waterloo, Waterloo, CA, ON, Canada.,Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Canada.,Department of Psychology, University of Waterloo, Waterloo, ON, Canada
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Su X, Wang X, Pan X, Zhang X, Lu X, Zhao L, Chen Y, Shang Y, Zhu L, Lu S, Zhu X, Wu F, Xiu M. Effect of Repetitive Transcranial Magnetic Stimulation in Inducing Weight Loss in Patients with Chronic Schizophrenia: A Randomized, Double-Blind Controlled 4-Week Study. Curr Neuropharmacol 2023; 21:417-423. [PMID: 35611778 PMCID: PMC10190142 DOI: 10.2174/1570159x20666220524123315] [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: 08/09/2021] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES There is emerging evidence that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may promote weight loss in individuals with obesity in the general population. However, no study has been conducted on patients with schizophrenia (SZ). This study evaluated the efficacy of 10Hz rTMS in reducing body weight in patients with chronic SZ. METHODS Forty-seven SZ patients were randomly assigned to two groups: 10Hz rTMS or sham stimulation over DLPFC (applied once daily) for 20 consecutive treatments. Body weight was assessed at baseline, at the end of week 1, week 2, week 3 and week 4. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of week 4. RESULTS We found that compared with patients in the sham group, 10Hz rTMS treatment significantly reduced body weight in patients with chronic SZ after a period of 4 weeks of stimulation. Interestingly, further analysis found that from the first week (5 sessions) of treatment, there was a significant difference in body weight between active and sham groups after controlling for baseline weight. However, active rTMS treatment did not improve the psychotic symptoms compared to sham stimulation. CONCLUSION Our results suggest that add-on HF rTMS could be an effective therapeutic strategy for body weight control in patients with chronic SZ.
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Affiliation(s)
- Xiuru Su
- Hebei Province Veterans Hospital, Baoding, China
| | - Xuan Wang
- Hebei Province Veterans Hospital, Baoding, China
| | - Xiuling Pan
- Hebei Province Veterans Hospital, Baoding, China
| | - Xuan Zhang
- Hebei Province Veterans Hospital, Baoding, China
| | - Xinyan Lu
- Hebei Province Veterans Hospital, Baoding, China
| | - Long Zhao
- Hebei Province Veterans Hospital, Baoding, China
| | - Yingnan Chen
- Hebei Province Veterans Hospital, Baoding, China
| | - Yujie Shang
- Hebei Province Veterans Hospital, Baoding, China
| | - Lin Zhu
- Hebei Province Veterans Hospital, Baoding, China
| | - Shulan Lu
- Hebei Province Veterans Hospital, Baoding, China
| | - Xiaolin Zhu
- Peking University HuiLong Guan Clinical Medical School, Beijing HuiLong Guan Hospital, Beijing, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Meihong Xiu
- Peking University HuiLong Guan Clinical Medical School, Beijing HuiLong Guan Hospital, Beijing, China
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8
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Ferrulli A, Terruzzi I, Senesi P, Succi M, Cannavaro D, Luzi L. Turning the clock forward: New pharmacological and non pharmacological targets for the treatment of obesity. Nutr Metab Cardiovasc Dis 2022; 32:1320-1334. [PMID: 35354547 DOI: 10.1016/j.numecd.2022.02.016] [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: 11/30/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
AIMS Obesity and its main metabolic complication, type 2 diabetes, have attained the status of a global pandemic; there is need for novel strategies aimed at treating obesity and preventing the development of diabetes. A healthy diet and exercise are basic for treatment of obesity but often not enough. Pharmacotherapy can be helpful in maintaining compliance, ameliorating obesity-related health risks, and improving quality of life. In the last two decades, the knowledge of central and peripheral mechanisms underlying homeostatic and hedonic aspects of food intake has significantly increased. Dysregulation of one or more of these components could lead to obesity. DATA SYNTHESIS In order to better understand how potential innovative treatment options can affect obesity, homeostatic and reward mechanisms that regulate energy balance has been firstly illustrated. Then, an overview of potential therapeutic targets for obesity, distinguished according to the level of regulation of feeding behavior, has been provided. Moreover, several non-drug therapies have been recently tested in obesity, such as non-invasive neurostimulation: Transcranial Magnetic Stimulation or Transcranial Direct Current Stimulation. All of them are promising for obesity treatment and are almost devoid of side effects, constituting a potential resource for the prevention of metabolic diseases. CONCLUSIONS The plethora of current anti-obesity therapies creates the unique challenge for physicians to customize the intervention, according to the specific obesity characteristics and the intervention side effect profiles; moreover, it allows multimodal approaches addressed to treat obesity and metabolic adaptation with complementary mechanisms.
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Affiliation(s)
- Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ileana Terruzzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pamela Senesi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Massimiliano Succi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Daniele Cannavaro
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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9
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Azevedo EP, Ivan VJ, Friedman JM, Stern SA. Higher-Order Inputs Involved in Appetite Control. Biol Psychiatry 2022; 91:869-878. [PMID: 34593204 PMCID: PMC9704062 DOI: 10.1016/j.biopsych.2021.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 01/01/2023]
Abstract
The understanding of the neural control of appetite sheds light on the pathogenesis of eating disorders such as anorexia nervosa and obesity. Both diseases are a result of maladaptive eating behaviors (overeating or undereating) and are associated with life-threatening health problems. The fine regulation of appetite involves genetic, physiological, and environmental factors, which are detected and integrated in the brain by specific neuronal populations. For centuries, the hypothalamus has been the center of attention in the scientific community as a key regulator of appetite. The hypothalamus receives and sends axonal projections to several other brain regions that are important for the integration of sensory and emotional information. These connections ensure that appropriate behavioral decisions are made depending on the individual's emotional state and environment. Thus, the mechanisms by which higher-order brain regions integrate exteroceptive information to coordinate feeding is of great importance. In this review, we will focus on the functional and anatomical projections connecting the hypothalamus to the limbic system and higher-order brain centers in the cortex. We will also address the mechanisms by which specific neuronal populations located in higher-order centers regulate appetite and how maladaptive eating behaviors might arise from altered connections among cortical and subcortical areas with the hypothalamus.
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Affiliation(s)
- Estefania P Azevedo
- Laboratory of Molecular Genetics, The Rockefeller University, New York, New York.
| | - Violet J Ivan
- Laboratory of Molecular Genetics, The Rockefeller University, New York, New York
| | - Jeffrey M Friedman
- Laboratory of Molecular Genetics, The Rockefeller University, New York, New York; Howard Hughes Medical Institute, New York, New York
| | - Sarah A Stern
- Integrative Neural Circuits and Behavior Research Group, Max Planck Florida Institute for Neuroscience, Jupiter, Florida.
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10
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Gouveia FV, Silk E, Davidson B, Pople CB, Abrahao A, Hamilton J, Ibrahim GM, Müller DJ, Giacobbe P, Lipsman N, Hamani C. A systematic review on neuromodulation therapies for reducing body weight in patients with obesity. Obes Rev 2021; 22:e13309. [PMID: 34337843 DOI: 10.1111/obr.13309] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
The global prevalence of obesity increases yearly along with a rising demand for efficacious, safe, and accessible treatments. Neuromodulation interventions (i.e., deep brain stimulation [DBS], transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS], percutaneous neurostimulation [PENS], vagus nerve stimulation [VNS], and gastric electrical stimulation [GES]) have been proposed as novel therapies. This systematic review sought to examine the safety and efficacy of neuromodulation therapies in reducing body weight in patients with obesity. Using PRISMA guidelines, we performed a systematic review for studies on neuromodulation for the treatment of obesity, resulting in 60 trials included (7 DBS, 5 TMS, 7 tDCS, 17 PENS and VNS, and 24 GES; a total of 3,042 participants). While promising results have been reported in open label studies, double-blinded randomized clinical trials often did not reach their primary endpoints, with no technique inducing a striking reduction in body weight. Bearing in mind the complexity and multifactorial nature of obesity, it is possible that a single treatment may not be enough for patients to lose or maintain the weight lost at long term.
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Affiliation(s)
| | - Esther Silk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Pople
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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11
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Repetitive Transcranial Magnetic Stimulation: A Potential Treatment for Obesity in Patients with Schizophrenia. Behav Sci (Basel) 2021; 11:bs11060086. [PMID: 34208079 PMCID: PMC8230713 DOI: 10.3390/bs11060086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Obesity is highly prevalent in patients with schizophrenia and, in association with metabolic syndrome, contributes to premature deaths of patients due to cardiovascular disease complications. Moreover, pharmacologic, and behavioral interventions have not stemmed the tide of obesity in schizophrenia. Therefore, novel effective interventions are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for inducing weight loss in obese non-psychiatric samples but this promising intervention has not been evaluated as a weight loss intervention in patients with schizophrenia. In this narrative review, we describe three brain mechanisms (hypothalamic inflammation, dysregulated mesocorticolimbic reward system, and impaired prefrontal cortex function) implicated in the pathogenesis and pathophysiology of obesity and emphasize how the three mechanisms have also been implicated in the neurobiology of schizophrenia. We then argue that, based on the three overlapping brain mechanisms in obesity and schizophrenia, rTMS would be effective as a weight loss intervention in patients with schizophrenia and comorbid obesity. We end this review by describing how deep TMS, relative to conventional TMS, could potentially result in larger effect size for weight loss. While this review is mainly conceptual and based on an extrapolation of findings from non-schizophrenia samples, our aim is to stimulate research in the use of rTMS for weight loss in patients with schizophrenia.
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12
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Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS)in Inducing Weight Loss among Obese Filipino Patients:A Randomized Controlled Trial. J ASEAN Fed Endocr Soc 2020; 35:181-189. [PMID: 33442190 PMCID: PMC7784228 DOI: 10.15605/jafes.035.02.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/10/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the efficacy of rTMS in decreasing body mass index (BMI) versus sham stimulation among obese Filipino patients. Methodology This was a single-center, randomized, sham-controlled, single-blind, parallel group trial. Participants were 15-65 years old with BMI ≥30 kg/m2 and weight stable for 6 weeks. Participants were randomized to receive real rTMS or sham stimulation. Each underwent 4 sessions of stimulation over 2 weeks. Anthropometrics, total caloric intake (TCI), and VAS score for appetite were taken at baseline, 2, 4, 6, and 12 weeks. RESULTS A total of 31 patients were randomized with 15 to the treatment and 14 to sham stimulation completing treatment, with 2 lost to follow-up. A significant decrease in BMI was noted after 4 weeks from the start of rTMS in the treatment group, (0.6±0.6, p-value=0.001), with weight change of -1.3±1.3 kg (p-value=0.009), but was no longer observed at 6 weeks onwards. No severe adverse effects were noted. Conclusion rTMS to the DLPFC effectively decreased BMI (0.6±0.6) and weight (-1.3±1.3 kg) from baseline to 4 weeks. At 6-12 weeks after rTMS however, there was no longer a significant difference, indicating that 4 sessions of rTMS may not be enough to produce a prolonged effect on weight loss.
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13
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Stramba-Badiale C, Mancuso V, Cavedoni S, Pedroli E, Cipresso P, Riva G. Transcranial Magnetic Stimulation Meets Virtual Reality: The Potential of Integrating Brain Stimulation With a Simulative Technology for Food Addiction. Front Neurosci 2020; 14:720. [PMID: 32760243 PMCID: PMC7372037 DOI: 10.3389/fnins.2020.00720] [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: 02/14/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022] Open
Abstract
The aim of this perspective is to propose and discuss the integration of transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex with virtual reality (VR) food exposure for therapeutic interventions for food addiction. "Food addiction" is a dysfunctional eating pattern which is typically observed in eating disorders (ED) such as bulimia nervosa and binge eating disorder. Food addiction has been compared to substance use disorder due to the necessity of consuming a substance (food) and the presence of a dependence behavior. In recent years, VR has been applied in the treatment of ED because it triggers psychological and physiological responses through food exposure in place of real stimuli. Virtual reality-Cue exposure therapy has been proven as a valid technique for regulating anxiety and food craving in ED. More, TMS has been proven to modulate circuits and networks implicated in neuropsychiatric disorders and is effective in treating addiction such as nicotine craving and consumption and cocaine use disorder. The combination of a simulative technology and a neurostimulation would presumably provide better improvement compared to a single intervention because it implies the presence of both cognitive and neuropsychological techniques. The possible advantage of this approach will be discussed in the perspective.
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Affiliation(s)
- Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, E-Campus University, Novedrate, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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