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Di Rosa E, Masina F, Pastorino A, Galletti E, Gambarota F, Altoè G, Edelstyn N, Mapelli D. Mood moderates the effects of prefrontal tDCS on executive functions: A meta-analysis testing the affective state-dependency hypothesis. J Affect Disord 2024; 351:920-930. [PMID: 38341155 DOI: 10.1016/j.jad.2024.02.009] [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: 09/05/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In recent decades, numerous studies have investigated the effects of transcranial direct current stimulation (tDCS) on cognitive functioning. However, results of these studies frequently display inconsistency and pose challenges regarding replicability. The present work aimed at testing the hypothesis of mood as potential moderator of prefrontal tDCS effects on executive functions (EF). This hypothesis refers to the relationship between mood and EF, as well as to the association of mood with the dorsolateral prefrontal cortex (dlPFC) activity. METHODS We conducted a meta-analysis of 11 articles where the dlPFC was stimulated with anodal tDCS, EF were measured, and mood was assessed prior to the stimulation. We then conducted a meta-regression to examine whether mood moderated the tDCS effects on EF. RESULTS While no significant effect of tDCS on EF emerged from the meta-analysis, the meta-regression indicated that mood plays a significant role as moderator, with greater tDCS effects on EF in individuals with higher depressive symptoms. LIMITATIONS The limited number of studies included, the heterogeneous samples considered, and the limited generalizability to other non-invasive brain stimulation techniques and affective states. CONCLUSIONS Findings suggest that evaluating mood prior to stimulation could increase the sensitivity and specificity of tDCS application, and provide the first meta-analytic evidence in favor of the affective state-dependency hypothesis.
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Affiliation(s)
- Elisa Di Rosa
- Department of General Psychology, University of Padova, Italy.
| | | | | | | | - Filippo Gambarota
- Department of Developmental and Social Psychology - University of Padova, Italy
| | - Gianmarco Altoè
- Department of Developmental and Social Psychology - University of Padova, Italy
| | | | - Daniela Mapelli
- Department of General Psychology, University of Padova, Italy
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2
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Ellis CA, Sancho ML, Miller RL, Calhoun VD. Identifying EEG Biomarkers of Depression with Novel Explainable Deep Learning Architectures. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.19.585728. [PMID: 38562835 PMCID: PMC10983917 DOI: 10.1101/2024.03.19.585728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Deep learning methods are increasingly being applied to raw electroencephalogram (EEG) data. However, if these models are to be used in clinical or research contexts, methods to explain them must be developed, and if these models are to be used in research contexts, methods for combining explanations across large numbers of models must be developed to counteract the inherent randomness of existing training approaches. Model visualization-based explainability methods for EEG involve structuring a model architecture such that its extracted features can be characterized and have the potential to offer highly useful insights into the patterns that they uncover. Nevertheless, model visualization-based explainability methods have been underexplored within the context of multichannel EEG, and methods to combine their explanations across folds have not yet been developed. In this study, we present two novel convolutional neural network-based architectures and apply them for automated major depressive disorder diagnosis. Our models obtain slightly lower classification performance than a baseline architecture. However, across 50 training folds, they find that individuals with MDD exhibit higher β power, potentially higher δ power, and higher brain-wide correlation that is most strongly represented within the right hemisphere. This study provides multiple key insights into MDD and represents a significant step forward for the domain of explainable deep learning applied to raw EEG. We hope that it will inspire future efforts that will eventually enable the development of explainable EEG deep learning models that can contribute both to clinical care and novel medical research discoveries.
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Affiliation(s)
- Charles A Ellis
- Center for Translational Research in Neuroimaging and Data Science at Georgia State University, the Georgia Institute of Technology and Emory University, Atlanta GA 30303, USA
| | - Martina Lapera Sancho
- Center for Translational Research in Neuroimaging and Data Science at Georgia State University, the Georgia Institute of Technology and Emory University, Atlanta GA 30303, USA
| | - Robyn L Miller
- Center for Translational Research in Neuroimaging and Data Science at Georgia State University, the Georgia Institute of Technology and Emory University, Atlanta GA 30303, USA
| | - Vince D Calhoun
- Center for Translational Research in Neuroimaging and Data Science at Georgia State University, the Georgia Institute of Technology and Emory University, Atlanta GA 30303, USA
- Department of Computer Science, Georgia State University, Atlanta GA 30303, USA
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Guidali G, Zazio A, Lucarelli D, Marcantoni E, Stango A, Barchiesi G, Bortoletto M. Effects of transcranial magnetic stimulation (TMS) current direction and pulse waveform on cortico-cortical connectivity: A registered report TMS-EEG study. Eur J Neurosci 2023; 58:3785-3809. [PMID: 37649453 DOI: 10.1111/ejn.16127] [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: 04/30/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023]
Abstract
Transcranial magnetic stimulation (TMS)-evoked potentials (TEPs) are a promising proxy for measuring effective connectivity, that is, the directed transmission of physiological signals along cortico-cortical tracts, and for developing connectivity-based biomarkers. A crucial point is how stimulation parameters may affect TEPs, as they may contribute to the general variability of findings across studies. Here, we manipulated two TMS parameters (i.e. current direction and pulse waveform) while measuring (a) an early TEP component reflecting contralateral inhibition of motor areas, namely, M1-P15, as an operative model of interhemispheric cortico-cortical connectivity, and (b) motor-evoked potentials (MEP) for the corticospinal pathway. Our results showed that these two TMS parameters are crucial to evoke the M1-P15, influencing its amplitude, latency, and replicability. Specifically, (a) M1-P15 amplitude was strongly affected by current direction in monophasic stimulation; (b) M1-P15 latency was significantly modulated by current direction for monophasic and biphasic pulses. The replicability of M1-P15 was substantial for the same stimulation condition. At the same time, it was poor when stimulation parameters were changed, suggesting that these factors must be controlled to obtain stable single-subject measures. Finally, MEP latency was modulated by current direction, whereas non-statistically significant changes were evident for amplitude. Overall, our study highlights the importance of TMS parameters for early TEP responses recording and suggests controlling their impact in developing connectivity biomarkers from TEPs. Moreover, these results point out that the excitability of the corticospinal tract, which is commonly used as a reference to set TMS intensity, may not correspond to the excitability of cortico-cortical pathways.
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Affiliation(s)
- Giacomo Guidali
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agnese Zazio
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Delia Lucarelli
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Eleonora Marcantoni
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonietta Stango
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Guido Barchiesi
- Department of Philosophy, University of Milano, Milan, Italy
| | - Marta Bortoletto
- Neurophysiology Lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Tiba A, Drugaș M, Sârbu I, Simona T, Bora C, Miclăuș D, Voss L, Sanislav I, Ciurescu D. T-RAC: Study protocol of a randomised clinical trial for assessing the acceptability and preliminary efficacy of adding an exergame-augmented dynamic imagery intervention to the behavioural activation treatment of depression. PLoS One 2023; 18:e0288910. [PMID: 37523359 PMCID: PMC10389719 DOI: 10.1371/journal.pone.0288910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Improving the existent effective treatments of depression is a promising way to optimise the effects of psychological treatments. Here we examine the effects of adding a rehabilitation type of imagery based on exergames and dynamic simulations to a short behavioural activation treatment of depression. We investigate the acceptability and the efficacy of an exergame-augmented dynamic imagery intervention added to behavioural activation treatment and associated mechanisms of change. METHODS AND ANALYSES In a two-arm pilot randomised controlled trial, the acceptability and preliminary efficacy of an exergame-augmented dynamic imagery intervention added to behavioural activation treatment for depressed individuals will be assessed. Participants (age 18-65) meeting criteria for depression are recruited by media and local announcements. 110 participants will be randomly allocated to behavioural activation plus imagery group or to standard behavioural activation group. The primary outcome is depressive symptom severity (Beck Depression Inventory II) and secondary outcomes are anhedonia, apathy and behavioural activation and avoidance. The outcomes are assessed at baseline, mid treatment, posttreatment and 3-month follow-up. Moderation and mediation analyses will be explored. An intention-to-treat approach with additional per-protocol analysis will be used for data analysis.
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Affiliation(s)
- Alexandru Tiba
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Marius Drugaș
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Ioana Sârbu
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Trip Simona
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Carmen Bora
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Daiana Miclăuș
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Laura Voss
- The Hull York Medical School, University of York, York, United Kingdom
| | - Ioana Sanislav
- Department of Psychology, University of Oradea, Oradea, Romania
| | - Daniel Ciurescu
- Faculty of Medicine, Transilvania University, Brașov, Romania
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5
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Páscoa Dos Santos F, Vohryzek J, Verschure PFMJ. Multiscale effects of excitatory-inhibitory homeostasis in lesioned cortical networks: A computational study. PLoS Comput Biol 2023; 19:e1011279. [PMID: 37418506 DOI: 10.1371/journal.pcbi.1011279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/18/2023] [Indexed: 07/09/2023] Open
Abstract
Stroke-related disruptions in functional connectivity (FC) often spread beyond lesioned areas and, given the localized nature of lesions, it is unclear how the recovery of FC is orchestrated on a global scale. Since recovery is accompanied by long-term changes in excitability, we propose excitatory-inhibitory (E-I) homeostasis as a driving mechanism. We present a large-scale model of the neocortex, with synaptic scaling of local inhibition, showing how E-I homeostasis can drive the post-lesion restoration of FC and linking it to changes in excitability. We show that functional networks could reorganize to recover disrupted modularity and small-worldness, but not network dynamics, suggesting the need to consider forms of plasticity beyond synaptic scaling of inhibition. On average, we observed widespread increases in excitability, with the emergence of complex lesion-dependent patterns related to biomarkers of relevant side effects of stroke, such as epilepsy, depression and chronic pain. In summary, our results show that the effects of E-I homeostasis extend beyond local E-I balance, driving the restoration of global properties of FC, and relating to post-stroke symptomatology. Therefore, we suggest the framework of E-I homeostasis as a relevant theoretical foundation for the study of stroke recovery and for understanding the emergence of meaningful features of FC from local dynamics.
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Affiliation(s)
- Francisco Páscoa Dos Santos
- Eodyne Systems SL, Barcelona, Spain
- Department of Information and Communication Technologies, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Jakub Vohryzek
- Centre for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, United Kingdom
| | - Paul F M J Verschure
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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Cotovio G, Ventura F, Rodrigues da Silva D, Pereira P, Oliveira-Maia AJ. Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders. Brain Sci 2023; 13:1029. [PMID: 37508962 PMCID: PMC10377201 DOI: 10.3390/brainsci13071029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Non-invasive brain stimulation techniques (NIBS) have been widely used in both clinical and research contexts in neuropsychiatry. They are safe and well-tolerated, making NIBS an interesting option for application in different settings. Transcranial magnetic stimulation (TMS) is one of these strategies. It uses electromagnetic pulses for focal modulate ion of neuronal activity in brain cortical regions. When pulses are applied repeatedly (repetitive transcranial magnetic stimulation-rTMS), they are thought to induce long-lasting neuroplastic effects, proposed to be a therapeutic mechanism for rTMS, with efficacy and safety initially demonstrated for treatment-resistant depression (TRD). Since then, many rTMS treatment protocols emerged for other difficult to treat psychiatric conditions. Moreover, multiple clinical studies, including large multi-center trials and several meta-analyses, have confirmed its clinical efficacy in different neuropsychiatric disorders, resulting in evidence-based guidelines and recommendations. Currently, rTMS is cleared by multiple regulatory agencies for the treatment of TRD, depression with comorbid anxiety disorders, obsessive compulsive disorder, and substance use disorders, such as smoking cessation. Importantly, current research supports the potential future use of rTMS for other psychiatric syndromes, including the negative symptoms of schizophrenia and post-traumatic stress disorder. More precise knowledge of formal indications for rTMS therapeutic use in psychiatry is critical to enhance clinical decision making in this area.
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Affiliation(s)
- Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal; (G.C.)
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, 1449-005 Lisbon, Portugal
| | - Fabiana Ventura
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal; (G.C.)
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Daniel Rodrigues da Silva
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal; (G.C.)
| | - Patrícia Pereira
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal; (G.C.)
- Portuguese Red Cross Health School, 1300-125 Lisbon, Portugal
| | - Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, 1400-038 Lisbon, Portugal; (G.C.)
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
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7
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Pinto D, Martins R, Macedo A, Castelo Branco M, Valente Duarte J, Madeira N. Brain Hemispheric Asymmetry in Schizophrenia and Bipolar Disorder. J Clin Med 2023; 12:jcm12103421. [PMID: 37240527 DOI: 10.3390/jcm12103421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This study aimed to compare brain asymmetry in patients with schizophrenia (SCZ), bipolar disorder (BPD), and healthy controls to test whether asymmetry patterns could discriminate and set boundaries between two partially overlapping severe mental disorders. METHODS We applied a fully automated voxel-based morphometry (VBM) approach to assess structural brain hemispheric asymmetry in magnetic resonance imaging (MRI) anatomical scans in 60 participants (SCZ = 20; BP = 20; healthy controls = 20), all right-handed and matched for gender, age, and education. RESULTS Significant differences in gray matter asymmetry were found between patients with SCZ and BPD, between SCZ patients and healthy controls (HC), and between BPD patients and HC. We found a higher asymmetry index (AI) in BPD patients when compared to SCZ in Brodmann areas 6, 11, and 37 and anterior cingulate cortex and an AI higher in SCZ patients when compared to BPD in the cerebellum. CONCLUSION Our study found significant differences in brain asymmetry between patients with SCZ and BPD. These promising results could be translated to clinical practice, given that structural brain changes detected by MRI are good candidates for exploration as biological markers for differential diagnosis, besides helping to understand disease-specific abnormalities.
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Affiliation(s)
- Diogo Pinto
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
| | - Ricardo Martins
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - António Macedo
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - Miguel Castelo Branco
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - João Valente Duarte
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Nuno Madeira
- Faculty of Medicine, University of Coimbra (UC), 3004-504 Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, 3000-548 Coimbra, Portugal
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
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Sharpley CF, Bitsika V, Shadli SM, Jesulola E, Agnew LL. EEG frontal lobe asymmetry as a function of sex, depression severity, and depression subtype. Behav Brain Res 2023; 443:114354. [PMID: 36801473 DOI: 10.1016/j.bbr.2023.114354] [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: 12/03/2022] [Revised: 01/29/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
To investigate possible contributors to the inconsistent association between frontal lobe asymmetry (FLA) and depression, EEG data were collected across five frontal sites, and examined for their associations with four subtypes of depression (Depressed mood, Anhedonia, Cognitive depression, Somatic depression). One hundred community volunteers (54 males, 46 females) aged at least 18 yr completed standardized scales for depression and anxiety, and gave EEG data under Eyes Open and Eyes Closed conditions. Results indicated that, although there was no significant correlation between the differences in EEG power across each of the five pairs of frontal sites and total depression scores, there were several meaningful correlations (accounting for at least 10% of the variance) between specific EEG site differences data and each of the four depression subtypes. There were also different patterns of association between FLA and the depression subtypes according to sex, and total depression severity. These findings help to explain the apparent inconsistency in previous FLA-depression results, and argue for a more nuanced approach to this hypothesis.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale 2350, New South Wales, Australia.
| | - Vicki Bitsika
- Brain-Behaviour Research Group, University of New England, Armidale 2350, New South Wales, Australia
| | - Shabah M Shadli
- Brain-Behaviour Research Group, University of New England, Armidale 2350, New South Wales, Australia
| | - Emmanuel Jesulola
- Brain-Behaviour Research Group, University of New England, Armidale 2350, New South Wales, Australia; Emmanuel Jesulola is now at Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, Armidale 2350, New South Wales, Australia; Linda Agnew is now at Griffith University, Qld, Australia
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Sá KN, Baptista RF, Shirahige L, Razza LB, Nogueira M, Coura MHF, Afonso-Santos L, Tanaka C, Baptista AF, Monte-Silva K, Brunoni AR. Evidence-based umbrella review of non-invasive brain stimulation in anxiety disorders. THE EUROPEAN JOURNAL OF PSYCHIATRY 2023. [DOI: 10.1016/j.ejpsy.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Beydler EM, Katzell L, Schmidt L, Carr BR, Holbert RC. Case report: Rapid symptom resolution of a mixed affective state with high-frequency repetitive transcranial magnetic stimulation. Front Psychiatry 2023; 14:1137055. [PMID: 36846231 PMCID: PMC9947494 DOI: 10.3389/fpsyt.2023.1137055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Bipolar major depressive episodes with mixed features are diagnosed in patients who meet the full criteria for a major depressive episode exhibiting three additional concurrent symptoms of hypomania or mania. Up to half of patients with bipolar disorder experience mixed episodes, which are more likely to be treatment-refractory than pure depression or mania/hypomania alone. CASE We present a 68-year-old female with Bipolar Type II Disorder with a four-month medication-refractory major depressive episode with mixed features referred for neuromodulation consultation. Previous failed medication trials over several years included lithium, valproate, lamotrigine, topiramate, and quetiapine. She had no history of treatment with neuromodulation. At the initial consultation, her baseline Montgomery-Asberg Depression Rating Scale (MADRS) was moderate in severity at 32. Her Young Mania Rating Scale (YMRS) was 22, with dysphoric hypomanic symptoms consisting of heightened irritability, verbosity and increased rate of speech, and decreased sleep. She declined electroconvulsive therapy but elected to receive repetitive transcranial magnetic stimulation (rTMS). INTERVENTIONS The patient underwent repetitive transcranial magnetic stimulation (rTMS) with a Neuronetics NeuroStar system, receiving nine daily sessions over the left dorsolateral prefrontal cortex (DLPFC). Standard settings of 120% MT, 10 Hz (4 sec on, 26 sec off), and 3,000 pulses/session were used. Her acute symptoms showed a brisk response, and at the final treatment, her repeat MADRS was 2, and YMRS was 0. The patient reported feeling "great," which she defined as feeling stable with minimal depression and hypomania for the first time in years. CONCLUSION Mixed episodes present a treatment challenge given their limited treatment options and diminished responses. Previous research has shown decreased efficacy of lithium and antipsychotics in mixed episodes with dysphoric mood such as the episode our patient experienced. One open-label study of low-frequency right-sided rTMS showed promising results in patients with treatment-refractory depression with mixed features, but the role of rTMS in the management of these episodes is largely unexplored. Given the concern for potential manic mood switches, further investigation into the laterality, frequency, anatomical target, and efficacy of rTMS for bipolar major depressive episodes with mixed features is warranted.
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Affiliation(s)
- Emily M Beydler
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lauren Katzell
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lauren Schmidt
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Brent R Carr
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Richard C Holbert
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
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Keeratitanont K, Theerakulpisut D, Auvichayapat N, Suphakunpinyo C, Patjanasoontorn N, Tiamkao S, Tepmongkol S, Khiewvan B, Raruenrom Y, Srisuruk P, Paholpak S, Auvichayapat P. Brain laterality evaluated by F-18 fluorodeoxyglucose positron emission computed tomography in autism spectrum disorders. Front Mol Neurosci 2022; 15:901016. [PMID: 36034502 PMCID: PMC9399910 DOI: 10.3389/fnmol.2022.901016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background and rationale Autism spectrum disorder (ASD) is a neuropsychiatric disorder that has no curative treatment. Little is known about the brain laterality in patients with ASD. F-18 fluorodeoxyglucose positron emission computed tomography (F-18 FDG PET/CT) is a neuroimaging technique that is suitable for ASD owing to its ability to detect whole brain functional abnormalities in a short time and is feasible in ASD patients. The purpose of this study was to evaluate brain laterality using F-18 FDG PET/CT in patients with high-functioning ASD. Materials and methods This case-control study recruited eight ASD patients who met the DSM-5 criteria, the recorded data of eight controls matched for age, sex, and handedness were also enrolled. The resting state of brain glucose metabolism in the regions of interest (ROIs) was analyzed using the Q.Brain software. Brain glucose metabolism and laterality index in each ROI of ASD patients were compared with those of the controls. The pattern of brain metabolism was analyzed using visual analysis and is reported in the data description. Results The ASD group’s overall brain glucose metabolism was lower than that of the control group in both the left and right hemispheres, with mean differences of 1.54 and 1.21, respectively. We found statistically lower mean glucose metabolism for ASD patients than controls in the left prefrontal lateral (Z = 1.96, p = 0.049). The left laterality index was found in nine ROIs for ASD and 11 ROIs for the control. The left laterality index in the ASD group was significantly lower than that in the control group in the prefrontal lateral (Z = 2.52, p = 0.012), precuneus (Z = 2.10, p = 0.036), and parietal inferior (Z = 1.96, p = 0.049) regions. Conclusion Individuals with ASD have lower brain glucose metabolism than control. In addition, the number of ROIs for left laterality index in the ASD group was lower than control. Left laterality defects may be one of the causes of ASD. This knowledge can be useful in the treatment of ASD by increasing the left-brain metabolism. This trial was registered in the Thai Clinical Trials Registry (TCTR20210705005).
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Affiliation(s)
- Keattichai Keeratitanont
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narong Auvichayapat
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chanyut Suphakunpinyo
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Niramol Patjanasoontorn
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supatporn Tepmongkol
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn University Biomedical Imaging Group (CUBIG), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Benjapa Khiewvan
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yutapong Raruenrom
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piyawan Srisuruk
- Department of Educational Psychology and Counseling, Faculty of Education, Khon Kaen University, Khon Kaen, Thailand
- Research and Service Institute for Autism, Khon Kaen University, Khon Kaen, Thailand
| | - Suchat Paholpak
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Service Institute for Autism, Khon Kaen University, Khon Kaen, Thailand
| | - Paradee Auvichayapat
- Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Service Institute for Autism, Khon Kaen University, Khon Kaen, Thailand
- *Correspondence: Paradee Auvichayapat,
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