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Watson M, Chaves AR, Gebara A, Desforges M, Broomfield A, Landry N, Lemoyne A, Shim S, Drodge J, Cuda J, Kiaee N, Nasr Y, Carleton C, Daskalakis ZJ, Taylor R, Tuominen L, Brender R, Antochi R, McMurray L, Tremblay S. A naturalistic study comparing the efficacy of unilateral and bilateral sequential theta burst stimulation in treating major depression - the U-B-D study protocol. BMC Psychiatry 2023; 23:739. [PMID: 37817124 PMCID: PMC10566125 DOI: 10.1186/s12888-023-05243-4] [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: 08/14/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent mental health condition affecting millions worldwide, leading to disability and reduced quality of life. MDD poses a global health priority due to its early onset and association with other disabling conditions. Available treatments for MDD exhibit varying effectiveness, and a substantial portion of individuals remain resistant to treatment. Repetitive transcranial magnetic stimulation (rTMS), applied to the left and/or right dorsolateral prefrontal cortex (DLPFC), is an alternative treatment strategy for those experiencing treatment-resistant MDD. The objective of this study is to investigate whether this newer form of rTMS, namely theta burst stimulation (TBS), when performed unilaterally or bilaterally, is efficacious in treatment-resistant MDD. METHODS In this naturalistic, randomized double-blinded non-inferiority trial, participants with a major depressive episode will be randomized to receive either unilateral (i.e., continuous TBS [cTBS] to the right and sham TBS to the left DLPFC) or bilateral sequential TBS (i.e., cTBS to the right and intermittent TBS [iTBS] to the left DLPFC) delivered 5 days a week for 4-6 weeks. Responders will move onto a 6-month flexible maintenance phase where TBS treatment will be delivered at a decreasing frequency depending on degree of symptom mitigation. Several clinical assessments and neuroimaging and neurophysiological biomarkers will be collected to investigate treatment response and potential associated biomarkers. A non-inferiority analysis will investigate whether bilateral sequential TBS is non-inferior to unilateral TBS and regression analyses will investigate biomarkers of treatment response. We expect to recruit a maximal of 256 participants. This trial is approved by the Research Ethics Board of The Royal's Institute of Mental Health Research (REB# 2,019,071) and will follow the Declaration of Helsinki. Findings will be published in peer-reviewed journals. DISCUSSION Comprehensive assessment of symptoms and neurophysiological biomarkers will contribute to understanding the differential efficacy of the tested treatment protocols, identifying biomarkers for treatment response, and shedding light into underlying mechanisms of TBS. Our findings will inform future clinical trials and aid in personalizing treatment selection and scheduling for individuals with MDD. TRIAL REGISTRATION The trial is registered on https://clinicaltrials.gov/ct2/home (#NCT04142996).
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Affiliation(s)
- Molly Watson
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Arthur R Chaves
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Faculty of Health Sciences, University of Ottawa, 125 University, Ottawa, ON, K1N6N5, Canada
| | - Abir Gebara
- School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Manon Desforges
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Antoinette Broomfield
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Noémie Landry
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Alexandra Lemoyne
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Stacey Shim
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Jessica Drodge
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Jennifer Cuda
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Nasim Kiaee
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Youssef Nasr
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Christophe Carleton
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Reggie Taylor
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Physics, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Lauri Tuominen
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Ram Brender
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Ruxandra Antochi
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Lisa McMurray
- Department of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada
| | - Sara Tremblay
- University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
- Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
- Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC, J8X 3X7, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
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Bourla A, Mouchabac S, Lorimy L, Crette B, Millet B, Ferreri F. Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications. Brain Sci 2023; 13:1246. [PMID: 37759847 PMCID: PMC10526536 DOI: 10.3390/brainsci13091246] [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: 08/02/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
The measurement of the motor threshold (MT) is an important element in determining stimulation intensity during Transcranial Magnetic Stimulation treatment (rTMS). The current recommendations propose its realization at least once a week. The variability in this motor threshold is an important factor to consider as it could translate certain neurophysiological specificities. We conducted a retrospective naturalistic study on data from 30 patients treated for treatment-resistant depression in an rTMS-specialized center. For each patient, weekly motor-evoked potential (MEP) was performed and several clinical elements were collected as part of our clinical interviews. Regarding response to treatment (Patient Health Questionnaire-9 (PHQ-9) before and after treatment), there was a mean difference of -8.88 (-21 to 0) in PHQ9 in the Theta Burst group, of -9.00 (-18 to -1) in the High-Frequency (10 Hz) group, and of -4.66 (-10 to +2) in the Low-Frequency (1 Hz) group. The mean improvement in depressive symptoms was 47% (p < 0.001, effect-size: 1.60). The motor threshold changed over the course of the treatment, with a minimum individual range of 1 point and a maximum of 19 points (total subset), and a greater concentration in the remission group (4 to 10) than in the other groups (3 to 10 in the response group, 1 to 8 in the partial response group, 3 to 19 in the stagnation group). We also note that the difference between MT at week 1 and week 6 was statistically significant only in the remission group, with a different evolutionary profile showing an upward trend in MT. Our findings suggest a potential predictive value of MT changes during treatment, particularly an increase in MT in patients who achieve remission and a distinct "break" in MT around the 4th week, which could predict nonresponse.
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Affiliation(s)
- Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France (F.F.)
- ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences-Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Clariane, Medical Strategy and Innovation Department, 75008 Paris, France
- NeuroStim Psychiatry Practice, 75005 Paris, France
| | - Stéphane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France (F.F.)
- ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences-Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | | | | | - Bruno Millet
- ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences-Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Institut du Cerveau, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, AP-HP, Sorbonne Université, ICM, 75013 Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France (F.F.)
- ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences-Psychiatry), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
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3
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Rothärmel M, Quesada P, Husson T, Harika-Germaneau G, Nathou C, Guehl J, Dalmont M, Opolczynski G, Miréa-Grivel I, Millet B, Gérardin E, Compère V, Dollfus S, Jaafari N, Bénichou J, Thill C, Guillin O, Moulier V. The priming effect of repetitive transcranial magnetic stimulation on clinical response to electroconvulsive therapy in treatment-resistant depression: a randomized, double-blind, sham-controlled study. Psychol Med 2023; 53:2060-2071. [PMID: 34579796 DOI: 10.1017/s0033291721003810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD. METHODS In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment. RESULTS After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests. CONCLUSIONS rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.
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Affiliation(s)
- Maud Rothärmel
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Pierre Quesada
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Thomas Husson
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Rouen University Hospital, Rouen, France
- INSERM U 1245 University of Rouen, Rouen, France
| | | | - Clément Nathou
- UNICAEN, ISTS, EA 7466, GIP Cyceron, Caen 14000, France
- CHU de Caen, Service de Psychiatrie adulte, Caen 14000, France
- UFR Santé UNICAEN, 2 rue des Rochambelles, Caen 14000, France
| | - Julien Guehl
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Marine Dalmont
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Rouen University Hospital, Rouen, France
| | - Gaëlle Opolczynski
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Iris Miréa-Grivel
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Bruno Millet
- Department of Adult Psychiatry, boulevard de l'Hôpital, Hôpital Universitaire de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de, Paris 75013, France
| | - Emmanuel Gérardin
- Department of Neuroradiology, Rouen University Hospital, Rouen, France
| | - Vincent Compère
- Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
| | - Sonia Dollfus
- UNICAEN, ISTS, EA 7466, GIP Cyceron, Caen 14000, France
- CHU de Caen, Service de Psychiatrie adulte, Caen 14000, France
- UFR Santé UNICAEN, 2 rue des Rochambelles, Caen 14000, France
| | | | - Jacques Bénichou
- Department of Biostatistics, Rouen University Hospital, Rouen, France
- INSERM U 1018, University of Rouen, Rouen, France
| | - Caroline Thill
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
- Rouen University Hospital, Rouen, France
- INSERM U 1245 University of Rouen, Rouen, France
- Faculté de Médecine, Normandie University, Rouen, France
| | - Virginie Moulier
- University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
- EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
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4
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Cotovio G, Rodrigues da Silva D, Real Lage E, Seybert C, Oliveira-Maia AJ. Hemispheric asymmetry of motor cortex excitability in mood disorders - Evidence from a systematic review and meta-analysis. Clin Neurophysiol 2022; 137:25-37. [PMID: 35240425 DOI: 10.1016/j.clinph.2022.01.137] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Mood disorders have been associated with lateralized brain dysfunction, on the left-side for depression and right-side for mania. Consistently, asymmetry of cortical excitability, as measured by transcranial magnetic stimulation (TMS) has been reported. Here, we reviewed and summarized work assessing such measures bilaterally in mood disorders. METHODS We performed a systematic review and extracted data to perform meta-analyses of interhemispheric asymmetry of motor cortex excitability, assessed with TMS, across different mood disorders and in healthy subjects. Additionally, potential predictors of interhemispheric asymmetry were explored. RESULTS Asymmetry of resting motor threshold (MT) among healthy volunteers was significant, favoring lower right relative to left-hemisphere excitability. MT was also significantly asymmetric in major depressive disorder (MDD), but with lower excitability of the left -hemisphere, when compared to the right, no longer observed in recovered patients. Findings on intracortical facilitation were similar. The few trials including bipolar depression revealed similar trends for imbalance, but with lower right hemisphere excitability, relative to the left. CONCLUSIONS There is interhemispheric asymmetry of motor cortical excitability in MDD, with lower excitability on left when compared to right-side. Interhemispheric asymmetry, with lower right relative to left-sided excitability, was found for bipolar depression and was also suggested for healthy volunteers, in a pattern that is clearly distinct from MDD. SIGNIFICANCE Mood disorders display asymmetric motor cortical excitability that is distinct from that found in healthy volunteers, supporting the presence of lateralized brain dysfunction in these disorders.
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Affiliation(s)
- Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal; NOVA Medical School, NMS , Universidade Nova de Lisboa, Lisboa, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Estela Real Lage
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal; NOVA Medical School, NMS , Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carolina Seybert
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal; NOVA Medical School, NMS , Universidade Nova de Lisboa, Lisboa, Portugal.
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Cotovio G, Oliveira-Maia AJ, Paul C, Faro Viana F, Rodrigues da Silva D, Seybert C, Stern AP, Pascual-Leone A, Press DZ. Day-to-day variability in motor threshold during rTMS treatment for depression: Clinical implications. Brain Stimul 2021; 14:1118-1125. [PMID: 34329797 DOI: 10.1016/j.brs.2021.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND When repetitive transcranial magnetic stimulation (rTMS) is used to treat medication refractory depression, the treatment pulse intensity is individualized according to motor threshold (MT). This measure is often acquired only on the first day of treatment, as per the protocol currently approved by Food and Drug Administration. OBJECTIVE Here, we aimed to assess daily MT variability across an rTMS treatment course and simulate the effects of different schedules of MT assessment on treatment intensity. METHODS We conducted a naturalistic retrospective study with 374 patients from a therapeutic rTMS program for depression that measures MT daily. RESULTS For each patient, in almost half the TMS sessions, MT varied on average more than 5% as compared to the baseline MT acquired in the first treatment day. Such variability was only minimally impacted by having different TMS technicians acquiring MT in different days. In a smaller cohort of healthy individuals, we confirmed that the motor hotspot localization method, a critical step for accurate MT assessment, was stable in different days, arguing that daily MT variability reflects physiological variability, rather than an artifact of measurement error. Finally, in simulations of the effect of one-time MT measurement, we found that half of sessions would have been 5% or more above or below target intensity, with almost 5% of sessions 25% above target intensity. The simulated effects of weekly MT measurements were significantly improved. CONCLUSIONS In conclusion, MT varies significantly across days, not fully dependent on methods of MT acquisition. This finding may have important implications for therapeutic rTMS practice regarding safety and suggests that regular MT assessments, daily or at least weekly, would ameliorate the effect.
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Affiliation(s)
- Gonçalo Cotovio
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA; Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carter Paul
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA
| | - Francisco Faro Viana
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Carolina Seybert
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Adam P Stern
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Institut Guttmann de Neurorehabilitación, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain
| | - Daniel Z Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, MA, USA.
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Cao KX, Ma ML, Wang CZ, Iqbal J, Si JJ, Xue YX, Yang JL. TMS-EEG: An emerging tool to study the neurophysiologic biomarkers of psychiatric disorders. Neuropharmacology 2021; 197:108574. [PMID: 33894219 DOI: 10.1016/j.neuropharm.2021.108574] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 01/02/2023]
Abstract
The etiology of psychiatric disorders remains largely unknown. The exploration of the neurobiological mechanisms of mental illness helps improve diagnostic efficacy and develop new therapies. This review focuses on the application of concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) in various mental diseases, including major depressive disorder, bipolar disorder, schizophrenia, autism spectrum disorder, attention-deficit/hyperactivity disorder, substance use disorder, and insomnia. First, we summarize the commonly used protocols and output measures of TMS-EEG; then, we review the literature exploring the alterations in neural patterns, particularly cortical excitability, plasticity, and connectivity alterations, and studies that predict treatment responses and clinical states in mental disorders using TMS-EEG. Finally, we discuss the potential mechanisms underlying TMS-EEG in establishing biomarkers for psychiatric disorders and future research directions.
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Affiliation(s)
- Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Mao-Liang Ma
- Department of Clinical Psychology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Cheng-Zhan Wang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Javed Iqbal
- School of Psychology, Shaanxi Normal University and Key Laboratory for Behavior and Cognitive Neuroscience of Shaanxi Province, Xi'an, China
| | - Ji-Jian Si
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; Key Laboratory for Neuroscience of Ministry of Education and Neuroscience, National Health and Family Planning Commission, Peking University, Beijing, China.
| | - Jian-Li Yang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China.
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Kaczmarczyk M, Regen F, Heuser I, Bajbouj M, Hellmann-Regen J. Inhibition of monoamine oxidase activity by repetitive transcranial magnetic stimulation: implications for inter-train interval and frequency. Eur Arch Psychiatry Clin Neurosci 2020; 270:119-126. [PMID: 30560291 DOI: 10.1007/s00406-018-0969-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulation technique that stimulates cortical regions via time-varying electromagnetic fields; in several countries this technique has been approved as a treatment for major depressive disorder. One empirically established target in antidepressant pharmacotherapy is the flavin-containing monoamine oxidoreductase (MAO). The function of MAO enzymes is based on oxidation processes that may be sensitive towards strong electromagnetic fields. Therefore, we hypothesized that rTMS-induced electromagnetic fields impact the activity of this enzyme. Using crude synaptosomal cell preparations from human SH-SY5Y neuroblastoma cells and rat cortex as well as viable cells, we assessed the effects of rTMS on MAO-A and -B activity in a well-controlled in vitro set up. In short, samples were stimulated at maximal intensity with an equal number of total stimuli at frequencies of 5, 20, and 100 Hz. Sham stimulation was performed in parallel. Treatment at frequencies of 5 and 20 Hz significantly decreased mainly MAO-B activity in all tissue preparations and species, whereas 100 Hz stimulation remained without effect on any MAO activity. Our results support the hypothesis, that rTMS-induced electromagnetic fields affect MAO activity and provide further evidence for intracellular effects possibly contributing to therapeutic effects of this neuromodulatory method. On a cautionary note, however, our findings are solely based on in vitro evidence.
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Affiliation(s)
- Michael Kaczmarczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Francesca Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Isabella Heuser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Malek Bajbouj
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian Hellmann-Regen
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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9
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Gellersen HM, Kedzior KK. Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:139. [PMID: 31064328 PMCID: PMC6505129 DOI: 10.1186/s12888-019-2106-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD). METHODS Electronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18-20 Hz using F8-coil (k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil (k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10. RESULTS Effects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80-110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies. CONCLUSION When matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy.
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Affiliation(s)
- Helena M. Gellersen
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK
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10
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Cortical motor threshold determination in dogs. Res Vet Sci 2019; 124:248-255. [PMID: 30953941 DOI: 10.1016/j.rvsc.2019.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 11/23/2022]
Abstract
In humans, determining the cortical motor threshold (CMT) is a critical step in successfully applying a transcranial magnetic stimulation (TMS) treatment. Stimulus intensity, safety and efficacy of a TMS treatment are dependent of the correct assessment of the CMT. Given that TMS in dogs could serve as a natural animal model, an accurate and reliable technique for the measurement of the CMT should be available for dogs. Using a visual descending staircase paradigm (Rossini paradigm), the CMT repeatability was assessed and compared to the electromyographic (EMG) variant. The influence of a HF-rTMS treatment on the CMT was examined. Subsequently, the CMT was measured under sedation and general anaesthesia. Finally, the coil-cortex distance was associated with the CMT, weight, age and gender. During one year the CMT was measured three times, during which it remained constant, although a higher CMT was measured (40% higher machine output) when using EMG (P-value < .001) and under general anaesthesia (P-value = .005). On average, a 40% and 12% higher machine output were registered. An aHF-rTMS protocol does not influence the CMT. Males have on average a 5.2 mm larger coil cortex distance and an 11.81% higher CMT. The CMT was positively linearly associated (P-value < .05) with the weight and age of the animals. Only within female subjects, a positive linear association was found between the CMT and the coil-cortex distance (P-value = .02). Using the visual Rossini paradigm, the CMT can be reliably used over time and during a TMS treatment. It has to be kept in mind that when using EMG or assessing the CMT under general anaesthesia, a higher CMT is to be expected. As in humans, every parameter that influences the coil-cortex distance may also influence the CMT.
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11
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Du X, Xu W, Li X, Zhou D, Han C. Sleep Disorder in Drug Addiction: Treatment With Transcranial Magnetic Stimulation. Front Psychiatry 2019; 10:848. [PMID: 31798482 PMCID: PMC6878723 DOI: 10.3389/fpsyt.2019.00848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Xiangju Du
- Psychiatry Department, Ningbo Kangning Hospital, Ningbo, China
| | - Weiqian Xu
- Center of Sleep Medicine, Taizhou 2nd People's Hospital, Taizhou, China
| | - Xingxing Li
- Psychiatry Department, Ningbo Kangning Hospital, Ningbo, China
| | - Dongsheng Zhou
- Psychiatry Department, Ningbo Kangning Hospital, Ningbo, China
| | - Cuilan Han
- Psychiatry Department, Ningbo Kangning Hospital, Ningbo, China
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12
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Poleszczyk A, Rakowicz M, Parnowski T, Antczak J, Święcicki Ł. Are there clinical and neurophysiologic predictive factors for a positive response to HF-rTMS in patients with treatment-resistant depression? Psychiatry Res 2018; 264:175-181. [PMID: 29649674 DOI: 10.1016/j.psychres.2018.03.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
Better selection of patients with treatment-resistant depression for high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) would make the procedure more efficient. The objective of this study was to search for clinical and neurophysiologic predictors of therapeutic response with a special focus on the bipolar population. Forty patients (30 bipolar) underwent 20 daily sessions of HF-rTMS. Clinical outcome measures included the 21-item Hamilton Depression Rating Scale, the Beck Depression Inventory, the Clinical Global Impression, and the Patient Global Impression. Neurophysiologic measurements included repeated estimation of the motor threshold and cortical silent period. Improvement was obtained in all psychometric scales, with no difference between unipolar and bipolar patients. Longer duration of the illness, higher number of prior hospitalizations, and more disturbed activity were associated with a worse response to rTMS, and somatic anxiety, sleep disorders, and health worries were positive predictors. In bipolar patients, longer disease duration and therapy with mirtazapine, mianserin, trazodone, hydroxyzine, and promethazine were associated with a worse response. Sleep disturbances, higher baseline motor threshold, and longer cortical silent period predicted a better response. In this study, we found several clinical and neurophysiologic predictors of better/worse responses to the standard HF-rTMS protocol. Our preliminary data need to be reproduced.
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Affiliation(s)
- Anna Poleszczyk
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Maria Rakowicz
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Tadeusz Parnowski
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Jakub Antczak
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Łukasz Święcicki
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
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Oliveira-Maia AJ, Press D, Pascual-Leone A. Modulation of motor cortex excitability predicts antidepressant response to prefrontal cortex repetitive transcranial magnetic stimulation. Brain Stimul 2017; 10:787-794. [PMID: 28438543 PMCID: PMC5576557 DOI: 10.1016/j.brs.2017.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is a treatment option for patients with medication-resistant major depressive disorder (MDD). However, antidepressant response is variable and there are currently no response predictors with sufficient accuracy for clinical use. OBJECTIVE We report on results of an observational open-label study to determine whether the modulatory effect of 10 Hz motor cortex (MC) rTMS is predictive of the antidepressant effect of 10 Hz DLPFC rTMS. METHODS Fifty-one medication-resistant MDD patients were enrolled for a 10-day treatment course of DLPFC rTMS and antidepressant response was assessed according to post-treatment reduction of the 17-item Hamilton Rating Scale for Depression score. Prior to treatment, we assessed the modulation of motor evoked potential (MEP) amplitude by MC rTMS. MEP's were induced with single TMS pulses and measured using surface electromyography. MEP modulation was calculated as the change of mean MEP amplitude after MC rTMS. RESULTS MEP modulation proved to be a robust predictor of reduction of clinician-rated depression severity following the course of DLPFC rTMS: larger MC rTMS-induced increase of corticospinal excitability anticipated a better antidepressant response. This was found both in univariate analyses (Spearman regression: rho = 0.43, p < 0.005) and a multivariable linear regression model (β = 0.25, p < 0.0001) controlling for baseline depression severity, age and resting motor threshold. CONCLUSIONS These findings suggest that MC rTMS-induced modulation of corticospinal excitability warrants further evaluation as a potential predictive biomarker of antidepressant response to left DLPFC 10 Hz rTMS.
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Affiliation(s)
- Albino J Oliveira-Maia
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215 MA, USA; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, 1349-019 Lisboa, Portugal; NOVA School of Medicine | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisboa, Portugal; Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, 1400-038 Lisboa, Portugal.
| | - Daniel Press
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215 MA, USA.
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215 MA, USA; Institut Guttmann de Neurorrehabilitación, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain.
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14
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Pathak Y, Salami O, Baillet S, Li Z, Butson CR. Longitudinal Changes in Depressive Circuitry in Response to Neuromodulation Therapy. Front Neural Circuits 2016; 10:50. [PMID: 27524960 PMCID: PMC4965463 DOI: 10.3389/fncir.2016.00050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 06/29/2016] [Indexed: 12/22/2022] Open
Abstract
Background: Major depressive disorder (MDD) is a public health problem worldwide. There is increasing interest in using non-invasive therapies such as repetitive transcranial magnetic stimulation (rTMS) to treat MDD. However, the changes induced by rTMS on neural circuits remain poorly characterized. The present study aims to test whether the brain regions previously targeted by deep brain stimulation (DBS) in the treatment of MDD respond to rTMS, and whether functional connectivity (FC) measures can predict clinical response. Methods: rTMS (20 sessions) was administered to five MDD patients at the left-dorsolateral prefrontal cortex (L-DLPFC) over 4 weeks. Magnetoencephalography (MEG) recordings and Montgomery-Asberg depression rating scale (MADRS) assessments were acquired before, during and after treatment. Our primary measures, obtained with MEG source imaging, were changes in power spectral density (PSD) and changes in FC as measured using coherence. Results: Of the five patients, four met the clinical response criterion (40% or greater decrease in MADRS) after 4 weeks of treatment. An increase in gamma power at the L-DLPFC was correlated with improvement in symptoms. We also found that increases in delta band connectivity between L-DLPFC/amygdala and L-DLPFC/pregenual anterior cingulate cortex (pACC), and decreases in gamma band connectivity between L-DLPFC/subgenual anterior cingulate cortex (sACC), were correlated with improvements in depressive symptoms. Conclusions: Our results suggest that non-invasive intervention techniques, such as rTMS, modulate the ongoing activity of depressive circuits targeted for DBS, and that MEG can capture these changes. Gamma oscillations may originate from GABA-mediated inhibition, which increases synchronization of large neuronal populations, possibly leading to increased long-range FC. We postulate that responses to rTMS could provide valuable insights into early evaluation of patient candidates for DBS surgery.
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Affiliation(s)
- Yagna Pathak
- Department of Biomedical Engineering, Marquette University Milwaukee, WI, USA
| | - Oludamilola Salami
- Department of Psychiatry, Medical College of Wisconsin Milwaukee, WI, USA
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University Montreal, QC, Canada
| | - Zhimin Li
- Department of Neurology, Medical College of Wisconsin Milwaukee, WI, USA
| | - Christopher R Butson
- Department of Biomedical Engineering, Marquette UniversityMilwaukee, WI, USA; Department of Psychiatry, Medical College of WisconsinMilwaukee, WI, USA; Department of Neurology, Medical College of WisconsinMilwaukee, WI, USA; Department of Bioengineering, Scientific Computing and Imaging (SCI) Institute, University of UtahSalt Lake City, UT, USA
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15
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Noda Y, Silverstein WK, Barr MS, Vila-Rodriguez F, Downar J, Rajji TK, Fitzgerald PB, Mulsant BH, Vigod SN, Daskalakis ZJ, Blumberger DM. Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review. Psychol Med 2015; 45:3411-3432. [PMID: 26349810 DOI: 10.1017/s0033291715001609] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996-2014), Embase (1980-2014) and PsycINFO (1806-2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.
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Affiliation(s)
- Y Noda
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - W K Silverstein
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - M S Barr
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - F Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory,Department of Psychiatry,Faculty of Medicine,University of British Columbia,Vancouver,British Columbia,Canada
| | - J Downar
- Department of Psychiatry,University of Toronto,Toronto,Ontario,Canada
| | - T K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre,The Alfred and Monash University Central Clinical School,Melbourne,Victoria,Australia
| | - B H Mulsant
- Department of Psychiatry,University of Toronto,Toronto,Ontario,Canada
| | - S N Vigod
- Department of Psychiatry,University of Toronto,Toronto,Ontario,Canada
| | - Z J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
| | - D M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health,Toronto,Ontario,Canada
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16
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Nordmann G, Azorina V, Langguth B, Schecklmann M. A systematic review of non-motor rTMS induced motor cortex plasticity. Front Hum Neurosci 2015; 9:416. [PMID: 26257632 PMCID: PMC4508515 DOI: 10.3389/fnhum.2015.00416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/06/2015] [Indexed: 11/29/2022] Open
Abstract
Motor cortex excitability can be measured by single- and paired-pulse transcranial magnetic stimulation (TMS). Repetitive transcranial magnetic stimulation (rTMS) can induce neuroplastic effects in stimulated and in functionally connected cortical regions. Due to its ability to non-invasively modulate cortical activity, rTMS has been investigated for the treatment of various neurological and psychiatric disorders. However, such studies revealed a high variability of both clinical and neuronal effects induced by rTMS. In order to better elucidate this meta-plasticity, rTMS-induced changes in motor cortex excitability have been monitored in various studies in a pre-post stimulation design. Here, we give a literature review of studies investigating motor cortex excitability changes as a neuronal marker for rTMS effects over non-motor cortical areas. A systematic literature review in April 2014 resulted in 29 articles in which motor cortex excitability was assessed before and after rTMS over non-motor areas. The majority of the studies focused on the stimulation of one of three separate cortical areas: the prefrontal area (17 studies), the cerebellum (8 studies), or the temporal cortex (3 studies). One study assessed the effects of multi-site rTMS. Most studies investigated healthy controls but some also stimulated patients with neuropsychiatric conditions (e.g., affective disorders, tinnitus). Methods and findings of the identified studies were highly variable showing no clear systematic pattern of interaction of non-motor rTMS with measures of motor cortex excitability. Based on the available literature, the measurement of motor cortex excitability changes before and after non-motor rTMS has only limited value in the investigation of rTMS related meta-plasticity as a neuronal state or as a trait marker for neuropsychiatric diseases. Our results do not suggest that there are systematic alterations of cortical excitability changes during rTMS treatment, which calls into question the practice of re-adjusting the stimulation intensity according to the motor threshold over the course of the treatment.
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Affiliation(s)
- Grégory Nordmann
- Experimental and Clinical Neuroscience, University of Regensburg Regensburg, Germany ; Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
| | - Valeriya Azorina
- Experimental and Clinical Neuroscience, University of Regensburg Regensburg, Germany ; Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
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17
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Lepping P, Schönfeldt-Lecuona C, Sambhi RS, Lanka SVN, Lane S, Whittington R, Leucht S, Poole R. A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation. Acta Psychiatr Scand 2014; 130:326-41. [PMID: 24724996 DOI: 10.1111/acps.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an approved treatment for depression. The clinical relevance of its efficacy is unclear. The clinical relevance of findings in the rTMS literature was assessed by translating Hamilton Depression Rating Scale (HAMD) data into Clinical Global Impression-Improvement scale (CGI-I) scores. METHOD We performed electronic searches of MEDLINE, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials for RCTs and non-RCT trials on rTMS using Hamilton Depression Rating Scale (HAMD). Articles were included if published in English before January 2014. We translated HAMD scores into nominal CGI-I scores for rTMS for depression and for treatment-resistant depression (TRD). RESULTS About 960 abstracts were retrieved. Sixty-three studies were included, yielding 130 study arms. For depression, the mean percentage change in HAMD scores in all sham-controlled rTMS treatment arms was 35.63 (SD 16.35) and for sham-rTMS 23.33 (SD 16.51). For TRD, active rTMS in sham-controlled studies showed a mean HAMD percentage reduction of 45.21 (SD 10.94) versus 25.04 (SD 17.55) for sham-rTMS. When aggregated scores were translated into notional CGI-I scores, for the treatment of depression, the notional CGI-I score difference between rTMS and sham-rTMS was 0.5 in favour of rTMS; for TRD, it was 0.75 in favour of rTMS. Differences between rTMS and sham-rTMS were bigger when all study arms were combined. CONCLUSION Whilst rTMS appears to be efficacious for both non-refractory and treatment-resistant depression, the clinical relevance of its efficacy is doubtful.
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Affiliation(s)
- P Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK; Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
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18
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Lefaucheur JP, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, Cantello RM, Cincotta M, de Carvalho M, De Ridder D, Devanne H, Di Lazzaro V, Filipović SR, Hummel FC, Jääskeläinen SK, Kimiskidis VK, Koch G, Langguth B, Nyffeler T, Oliviero A, Padberg F, Poulet E, Rossi S, Rossini PM, Rothwell JC, Schönfeldt-Lecuona C, Siebner HR, Slotema CW, Stagg CJ, Valls-Sole J, Ziemann U, Paulus W, Garcia-Larrea L. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014; 125:2150-2206. [PMID: 25034472 DOI: 10.1016/j.clinph.2014.05.021] [Citation(s) in RCA: 1267] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 12/11/2022]
Abstract
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain, movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic use of rTMS should be able to develop in the coming years.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France.
| | - Nathalie André-Obadia
- Neurophysiology and Epilepsy Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France; Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France
| | - Andrea Antal
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Samar S Ayache
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roberto M Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | | | - Mamede de Carvalho
- Institute of Physiology, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal
| | - Dirk De Ridder
- Brai(2)n, Tinnitus Research Initiative Clinic Antwerp, Belgium; Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Hospital, Lille, France; ULCO, Lille-Nord de France University, Lille, France
| | - Vincenzo Di Lazzaro
- Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Saša R Filipović
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, Beograd, Serbia
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giacomo Koch
- Non-Invasive Brain Stimulation Unit, Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - Emmanuel Poulet
- Department of Emergency Psychiatry, CHU Lyon, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; EAM 4615, Lyon-1 University, Bron, France
| | - Simone Rossi
- Brain Investigation & Neuromodulation Lab, Unit of Neurology and Clinical Neurophysiology, Department of Neuroscience, University of Siena, Siena, Italy
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, IRCCS San Raffaele Pisana, Rome, Italy; Institute of Neurology, Catholic University, Rome, Italy
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hartwig R Siebner
- Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Josep Valls-Sole
- EMG Unit, Neurology Service, Hospital Clinic, Department of Medicine, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August University, Göttingen, Germany
| | - Luis Garcia-Larrea
- Inserm U 1028, NeuroPain Team, Neuroscience Research Center of Lyon (CRNL), Lyon-1 University, Bron, France; Pain Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Bron, France
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Liu F, Guo W, Yu D, Gao Q, Gao K, Xue Z, Du H, Zhang J, Tan C, Liu Z, Zhao J, Chen H. Classification of different therapeutic responses of major depressive disorder with multivariate pattern analysis method based on structural MR scans. PLoS One 2012; 7:e40968. [PMID: 22815880 PMCID: PMC3398877 DOI: 10.1371/journal.pone.0040968] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 06/19/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies have found numerous brain changes in patients with major depressive disorder (MDD), but no neurological biomarker has been developed to diagnose depression or to predict responses to antidepressants. In the present study, we used multivariate pattern analysis (MVPA) to classify MDD patients with different therapeutic responses and healthy controls and to explore the diagnostic and prognostic value of structural neuroimaging data of MDD. METHODOLOGY/PRINCIPAL FINDINGS Eighteen patients with treatment-resistant depression (TRD), 17 patients with treatment-sensitive depression (TSD) and 17 matched healthy controls were scanned using structural MRI. Voxel-based morphometry, together with a modified MVPA technique which combined searchlight algorithm and principal component analysis (PCA), was used to classify the subjects with TRD, those with TSD and healthy controls. The results revealed that both gray matter (GM) and white matter (WM) of frontal, temporal, parietal and occipital brain regions as well as cerebellum structures had a high classification power in patients with MDD. The accuracy of the GM and WM that correctly discriminated TRD patients from TSD patients was both 82.9%. Meanwhile, the accuracy of the GM that correctly discriminated TRD or TSD patients from healthy controls were 85.7% and 82.4%, respectively; and the WM that correctly discriminated TRD or TSD patients from healthy controls were 85.7% and 91.2%, respectively. CONCLUSIONS/SIGNIFICANCE These results suggest that structural MRI with MVPA might be a useful and reliable method to study the neuroanatomical changes to differentiate patients with MDD from healthy controls and patients with TRD from those with TSD. This method might also be useful to study potential brain regions associated with treatment response in patients with MDD.
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Affiliation(s)
- Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wenbin Guo
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Center, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Dengmiao Yu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, China
| | - Keming Gao
- The Mood and Anxiety Clinic in the Mood Disorders Program of the Department of Psychiatry at Case Western Reserve University School of Medicine/University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Zhimin Xue
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Handan Du
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jianwei Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Changlian Tan
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhening Liu
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jingping Zhao
- Mental Health Institute, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Sun P, Wang F, Wang L, Zhang Y, Yamamoto R, Sugai T, Zhang Q, Wang Z, Kato N. Increase in cortical pyramidal cell excitability accompanies depression-like behavior in mice: a transcranial magnetic stimulation study. J Neurosci 2011; 31:16464-72. [PMID: 22072696 PMCID: PMC6633240 DOI: 10.1523/jneurosci.1542-11.2011] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/26/2011] [Accepted: 10/01/2011] [Indexed: 01/22/2023] Open
Abstract
Clinical evidence suggests that cortical excitability is increased in depressives. We investigated its cellular basis in a mouse model of depression. In a modified version of forced swimming (FS), mice were initially forced to swim for 5 consecutive days and then were treated daily with repetitive transcranial magnetic stimulation (rTMS) or sham treatment for the following 4 weeks without swimming. On day 2 through day 5, the mice manifested depression-like behaviors. The next and last FS was performed 4 weeks later, which revealed a 4 week maintenance of depression-like behavior in the sham mice. In slices from the sham controls, excitability in cingulate cortex pyramidal cells was elevated in terms of membrane potential and frequencies of spikes evoked by current injection. Depolarized resting potential was shown to depend on suppression of large conductance calcium-activated potassium (BK) channels. This BK channel suppression was confirmed by measuring spike width, which depends on BK channels. Chronic rTMS treatment during the 4 week period significantly reduced the depression-like behavior. In slices obtained from the rTMS mice, normal excitability and BK channel activity were recovered. Expression of a scaffold protein Homer1a was reduced by the FS and reversed by rTMS in the cingulate cortex. Similar recovery in the same behavioral, electrophysiological, and biochemical features was observed after chronic imipramine treatment. The present study demonstrated that manifestation and disappearance of depression-like behavior are in parallel with increase and decrease in cortical neuronal excitability in mice and suggested that regulation of BK channels by Homer1a is involved in this parallelism.
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Affiliation(s)
- Peng Sun
- Department of Physiology and
- Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Union Hospital and
| | - Furong Wang
- Department of Physiology and
- Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li Wang
- Department of Physiology and
- China-Japan Friendship Hospital, Beijing 100029, China, and
| | - Yu Zhang
- Department of Physiology and
- Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Medical College of Qinghai University, Xining 810001, China
| | | | | | - Qing Zhang
- Department of Physiology and
- Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
- Union Hospital and
| | | | - Nobuo Kato
- Department of Physiology and
- Medical Research Institute, Kanazawa Medical University, Ishikawa 920-0293, Japan
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The 'resting-state hypothesis' of major depressive disorder-a translational subcortical-cortical framework for a system disorder. Neurosci Biobehav Rev 2010; 35:1929-45. [PMID: 21192971 DOI: 10.1016/j.neubiorev.2010.12.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 12/14/2010] [Indexed: 01/25/2023]
Abstract
Major depressive disorder (MDD) has traditionally been characterized by various psychological symptoms, involvement of diverse functional systems (e.g., somatic, affect, cognition, reward, etc.), and with progress in neuroscience, an increasing number of brain regions. This has led to the general assumption that MDD is a stress-responsive brain 'system disorder' where either one or several alterations infiltrate a large number of functional systems in the brain that control the organism's somatic, affective, and cognitive life. However, while the effects or consequences of the abnormal changes in the functional systems of, for instance affect, cognition or reward have been investigated extensively, the underlying core mechanism(s) underlying MDD remain unknown. Hypotheses are proliferating rapidly, though. Based on recent findings, we will entertain an abnormality in the resting-state activity in MDD to be a core feature. Based on both animal and human data, we hypothesize that abnormal resting-state activity levels may impact stimulus-induced neural activity in medially situated core systems for self-representation as well as external stimulus (especially stress, specifically separation distress) interactions. Moreover, due to nested hierarchy between subcortical and cortical regions, we assume 'highjacking' of higher cortical affective and cognitive functions by lower subcortical primary-process emotional systems. This may account for the predominance of negative affect in somatic and cognitive functional system operations with the consecutive generation of the diverse symptoms in MDD. We will here focus on the neuroanatomical and biochemical basis of resting-state abnormalities in MDD including their linkage to the diverse psychopathological symptoms in depression. However, our 'resting-state hypothesis' may go well beyond that by being sufficiently precise to be linked to genetic, social, immunological, and endocrine dimensions and hypotheses as well as to clinical dimensions like endophenotypes and various diagnostic-prognostic biomarkers. Taken together, our 'resting-state hypothesis' may be considered a first tentative framework for MDD that integrates translational data, the various dimensions, and subcortical-cortical systems while at the same time providing the link to the clinical level of symptoms, endophenotypes and biomarkers.
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Zarkowski P, Navarro R, Pavlicova M, George MS, Avery D. The effect of daily prefrontal repetitive transcranial magnetic stimulation over several weeks on resting motor threshold. Brain Stimul 2010; 2:163-7. [PMID: 20161065 DOI: 10.1016/j.brs.2009.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The resting motor threshold (rMT) is an important factor in the selection of treatment intensity for patients receiving repetitive transcranial magnetic stimulation (rTMS). In many clinical studies to date, due to concerns about potential drift, the rMT has been routinely re-measured weekly or every fifth session. OBJECTIVE Our aim is to investigate whether ongoing treatment with rTMS affects the rMT, the degree of change, and whether frequent remeasurement is needed. METHODS Clinical data were drawn from 50 medication free patients receiving treatment for major depression with rTMS in a large U.S. NIH-sponsored multisite study. Four measurements of rMT were obtained including before and after the double blind phase, followed by weekly measurements during the open phase. Active treatment consisted of 75 four second trains of 10Hz stimulation applied over 37.5 minutes with the coil over the left DLPFC at 120% rMT. RESULTS For the group as a whole, there was no significant change in the rMT during a minimum of 2 weeks of treatment with prefrontal rTMS (p=0.911, one way ANOVA). The average within-subject coefficient of variation was 6.58%. On average the last rMT was 2.45% less than the baseline rMT (range 32.3% increase, 40.6% decrease). CONCLUSION Daily left prefrontal rTMS over several weeks as delivered in this trial does not cause systematic changes in rMT. While most subjects had <10% variance in rMT over time, 5 subjects had changes of approximately 20% from baseline, raising dosing and safety issues if undetected. We recommend that clinical trials of rTMS have periodic retesting of rMT, especially if the dose is at or near the edge of the TMS safety tables.
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Affiliation(s)
- Paul Zarkowski
- University of Washington, 325 Ninth Avenue, Seattle WA 98104-2499, USA.
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Szekely D, Polosan M, Grimaldi I, Buis C, Lhommée E, Bougerol T. Applications thérapeutiques actuelles de la stimulation magnétique transcrânienne répétée en psychiatrie. Rev Med Interne 2010; 31:508-14. [DOI: 10.1016/j.revmed.2009.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 07/15/2009] [Accepted: 08/17/2009] [Indexed: 01/18/2023]
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Grimm S, Bajbouj M. Efficacy of vagus nerve stimulation in the treatment of depression. Expert Rev Neurother 2010; 10:87-92. [PMID: 20021323 DOI: 10.1586/ern.09.138] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Major depressive disorder is a disease with prominent individual, medical and economic impacts. A relevant proportion of depressive patients suffering from a therapy-resistant course are increasingly being treated with antidepressant brain stimulation techniques. One of these interventions is the vagus nerve stimulation that has recently been tested in a number of clinical trials. To date, the acute and long-term efficacy of vagus nerve stimulation are still under debate. Thus further studies are required, especially since the exact mode of action of vagus nerve stimulation is still not well understood. In this paper we will review the results of existing clinical trials as well as the neurobiological effects measured with neuroimaging, biochemical and electrophysiology approaches.
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Affiliation(s)
- Simone Grimm
- Freie Universitaet Berlin, Cluster of Excellence Languages of Emotion and Dahlem Institute for Neuroscience of Emotion, Habelschwerdter Allee 45, 14195 Berlin, Germany. www.languages-of-emotion.de
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Padberg F, George MS. Repetitive transcranial magnetic stimulation of the prefrontal cortex in depression. Exp Neurol 2009; 219:2-13. [DOI: 10.1016/j.expneurol.2009.04.020] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 04/08/2009] [Accepted: 04/22/2009] [Indexed: 01/18/2023]
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Kato N. Neurophysiological mechanisms of electroconvulsive therapy for depression. Neurosci Res 2009; 64:3-11. [PMID: 19321135 DOI: 10.1016/j.neures.2009.01.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/15/2009] [Accepted: 01/26/2009] [Indexed: 11/18/2022]
Abstract
The neurobiological foundation of electroconvulsive therapy (ECT) remains fragile. How ECT affects neural activities in the brain of depressives is largely unknown. There has been accumulating knowledge on genes and molecules induced by the animal model of ECT. Exact functions of those molecules in the context of mood disorder remain unknown. Among the dozens of molecules highly expressed by ECT, one that shows an especially prominent induction (>6-fold) is Homer 1a, a member of the intracellular scaffold protein family Homer. We have examined effects of Homer 1a in ECT-subjected cortical pyramidal cells, on the basis of which two neurobiological consequences of ECT are proposed. First, Homer 1a either injected intracellularly or induced by ECT was shown to reduce neuronal excitability. This agrees with diverse lines of mutually consistent clinical investigations, which unanimously point to an enhanced excitability in the cerebral cortex of depressive patients. The GABAergic dysfunction hypothesis of depression was thus revitalized. Second, again by relying on Homer 1a, we have proposed a molecular mechanism by which ECT affects a form of long-term depression (LTD). The possibility is discussed that clinical effects of ECT are exerted at least partly by reducing neural excitability and modifying synaptic plasticity.
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Affiliation(s)
- Nobuo Kato
- Department of Physiology, Kanazawa Medical University, Ishikawa 920-0293, Japan.
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Lefaucheur JP, Lucas B, Andraud F, Hogrel JY, Bellivier F, Del Cul A, Rousseva A, Leboyer M, Paillère-Martinot ML. Inter-hemispheric asymmetry of motor corticospinal excitability in major depression studied by transcranial magnetic stimulation. J Psychiatr Res 2008; 42:389-98. [PMID: 17449060 DOI: 10.1016/j.jpsychires.2007.03.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Revised: 01/29/2007] [Accepted: 03/05/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Imaging and electroencephalographic studies have reported inter-hemispheric asymmetries in frontal cortical regions associated with depression. This study aimed at comparing motor corticospinal excitability assessed by methods of transcranial magnetic stimulation (TMS) between the right and left hemispheres in patients with major depression and healthy controls. METHOD Patients with major depression (n=35) and healthy controls (n=35) underwent a bilateral study of various motor corticospinal excitability parameters, including rest motor threshold (RMT), corticospinal silent period (CSP) duration and intra-cortical inhibition (ICI) and facilitation (ICF). Indexes of asymmetry were calculated, and the relationships between excitability parameters and clinical scores of depression were statistically analyzed. RESULTS Depressed patients showed a reduced excitability of both excitatory (RMT, ICF) and inhibitory (CSP, ICI) processes in the left hemisphere, compared to the right hemisphere and to healthy controls. CONCLUSION The present results confirmed the existence of inter-hemispheric asymmetries in frontal cortex activities of depressed patients in favor of a left-sided reduced excitability. This neurophysiological approach may help to guide repetitive TMS procedures in the treatment of depressive disorders.
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Affiliation(s)
- J P Lefaucheur
- Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94010 Creteil, France.
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Luborzewski A, Schubert F, Seifert F, Danker-Hopfe H, Brakemeier EL, Schlattmann P, Anghelescu I, Colla M, Bajbouj M. Metabolic alterations in the dorsolateral prefrontal cortex after treatment with high-frequency repetitive transcranial magnetic stimulation in patients with unipolar major depression. J Psychiatr Res 2007; 41:606-15. [PMID: 16600298 DOI: 10.1016/j.jpsychires.2006.02.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 01/19/2006] [Accepted: 02/10/2006] [Indexed: 11/24/2022]
Abstract
Neuroimaging studies suggest a specific role of anterior cingulate cortex (ACC) and left dorsolateral prefrontal cortex (DLPFC) in major depression. Stimulation of the latter by means of repetitive transcranial magnetic stimulation (rTMS) as an antidepressant intervention has increasingly been investigated in the past. The objective of the present study was to examine in vivo neurochemical alterations in both brain regions in 17 patients with unipolar major depression before and after 10 days of high-frequency (20Hz) rTMS of the left DLPFC using 3-tesla proton magnetic resonance spectroscopy. Six out of seventeen patients were treatment responders, defined as a 50% reduction of the Hamilton depression rating scale. No neurochemical alterations in the ACC were detected after rTMS. As compared to the non-responders, responders had lower baseline concentrations of DLPFC glutamate which increased after successful rTMS. Correspondingly, besides a correlation between clinical improvement and an increase in glutamate concentration, an interaction between glutamate concentration changes and stimulation intensity was observed. Our results indicate that metabolic, state-dependent changes within the left DLPFC in major depressive disorder involve the glutamate system and can be reversed in a dose-dependent manner by rTMS.
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Affiliation(s)
- Alexander Luborzewski
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, D-14050 Berlin, Germany.
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Brakemeier EL, Luborzewski A, Danker-Hopfe H, Kathmann N, Bajbouj M. Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS). J Psychiatr Res 2007; 41:395-403. [PMID: 16554071 DOI: 10.1016/j.jpsychires.2006.01.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 01/04/2006] [Accepted: 01/16/2006] [Indexed: 10/24/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique which had recently been investigated as a putative antidepressant intervention. However, there is little agreement about clinically useful predictors of rTMS outcome. Therefore, the objective of the present study was to determine whether specific biographical, clinical, and psychopathological parameters are associated with the antidepressant response to rTMS in a large sample of 70 depressive patients. We performed a logistic regression analysis in 70 patients with major depressive disorder treated with rTMS of the left dorsolateral prefrontal cortex testing the predictive value of various domains of the depression syndrome as well as the variables episode duration, degree of treatment resistance, and CORE criteria. Response was defined as a 50% reduction of the initial Hamilton score (HAMD). After two weeks of treatment, 21% of the patients showed a response to rTMS. The binary logistic regression model correctly assigned 86.7% of the responders and 96.4% of the non-responders to their final response group. In the model, a high level of sleep disturbances was a significant predictor for treatment response to rTMS. Also, a low score of treatment resistance and a short duration of episode were positive predictors. These findings provide new evidence that especially pronounced sleep disturbances may be a significant clinical predictor of a response to rTMS. Prospective rTMS studies are necessary to validate the predictive value of the derived model.
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Affiliation(s)
- Eva-Lotta Brakemeier
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany
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Langguth B, Kleinjung T, Marienhagen J, Binder H, Sand PG, Hajak G, Eichhammer P. Transcranial magnetic stimulation for the treatment of tinnitus: effects on cortical excitability. BMC Neurosci 2007; 8:45. [PMID: 17605764 PMCID: PMC1929114 DOI: 10.1186/1471-2202-8-45] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 07/02/2007] [Indexed: 11/29/2022] Open
Abstract
Background Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an innovative treatment for chronic tinnitus. The aim of the present study was to elucidate the underlying mechanism and to evaluate the relationship between clinical outcome and changes in cortical excitability. We investigated ten patients with chronic tinnitus who participated in a sham-controlled crossover treatment trial. Magnetic-resonance-imaging and positron-emission-tomography guided 1 Hz rTMS were performed over the auditory cortex on 5 consecutive days. Active and sham treatments were separated by one week. Parameters of cortical excitability (motor thresholds, intracortical inhibition, intracortical facilitation, cortical silent period) were measured serially before and after rTMS treatment by using single- and paired-pulse transcranial magnetic stimulation. Clinical improvement was assessed with a standardized tinnitus-questionnaire. Results We noted a significant interaction between treatment response and changes in motor cortex excitability during active rTMS. Specifically, clinical improvement was associated with an increase in intracortical inhibition, intracortical facilitation and a prolongation of the cortical silent period. These results indicate that intraindividual changes in cortical excitability may serve as a correlate of response to rTMS treatment. Conclusion The observed alterations of cortical excitability suggest that low frequency rTMS may evoke long-term-depression like effects resulting in an improvement of subcortical inhibitory function.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology and Audiology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Joerg Marienhagen
- Department of Nuclear Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Harald Binder
- Department of Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Strasse 26, 79104 Freiburg, Germany
| | - Philipp G Sand
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Peter Eichhammer
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
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Bajbouj M, Gallinat J, Lang UE, Hellen F, Vesper J, Lisanby SH, Danker-Hopfe H, Neu P. Motor cortex excitability after vagus nerve stimulation in major depression. J Clin Psychopharmacol 2007; 27:156-9. [PMID: 17414238 DOI: 10.1097/jcp.0b013e31803308f3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent data suggest that inhibitory pathways may be involved in the pathophysiology of depression and in the mode of action of some antidepressant interventions. The aim of the present study was to test whether vagus nerve stimulation (VNS) can affect motor cortex excitability. Measures of motor cortical excitability were probed by using single-pulse and paired-pulse transcranial magnetic stimulation at baseline, after 10 weeks of left VNS, and additionally, in an on-off paradigm in 10 patients with treatment-resistant unipolar depression. Ten weeks of VNS was associated with a selective and pronounced increase in intracortical inhibition, whereas no changes occurred in the on-off paradigm. These results suggest that VNS is capable of changing motor cortical excitability in patients with depression.
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Affiliation(s)
- Malek Bajbouj
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Germany.
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