1
|
Bellini BB, Scholz JR, Abe TO, Arnaut D, Tonstad S, Alberto RL, Gaya PV, de Moraes IRA, Teixeira MJ, Marcolin MA. Does deep TMS really works for smoking cessation? A prospective, double blind, randomized, sham controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110997. [PMID: 38531486 DOI: 10.1016/j.pnpbp.2024.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION A substantial proportion of smokers wishing to quit do not stop smoking when using current therapies to aid cessation. Magnetic pulses to specific brain areas designated as transcranial magnetic stimulation may modulate brain activity and thereby change chemical dependencies. Deep transcranial magnetic stimulation (dTMS) with the H4 coil stimulates neuronal pathways in the lateral prefrontal cortex and insula bilaterally, areas involved in tobacco addiction. OBJECTIVE To evaluate the efficacy and safety of dTMS with T4 coil in smoking cessation. METHODS In a double blind, controlled clinical trial, adult smokers of at least 10 cigarettes/day were randomized to active (n = 50) versus sham dTMS (n = 50). The protocol involved up to 21 sessions administered over up to 12 weeks. Tobacco use was monitored by self-report and confirmed by expired air monoximetry (at each dTMS visit) and blood cotinine (at the screening visit and at the end of sessions). Participants completed abstinence, mood and cognition scales at determined timepoints during follow-up. RESULTS In the intention to-treat-analysis, the cessation rate of the intervention and control groups was 14.0%. The reported side effects were as expected for this procedure. Although there were no serious adverse events, three participants were withdrawn according to safety criteria. CONCLUSION Active treatment with dTMS H4 coil was safe but not effective for smoking cessation.
Collapse
Affiliation(s)
- Bianca B Bellini
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil; Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil.
| | - Jaqueline R Scholz
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Debora Arnaut
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Rodrigo L Alberto
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco A Marcolin
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
2
|
Mo Y, Shi ZM, Yang XH, Lan XJ, Deng CJ, Huang XB, Tan XL, Pridmore S, Ungvari GS, Xiang YT, Zheng W. Deep transcranial magnetic stimulation for schizophrenia: a systematic review. Front Psychiatry 2024; 15:1390913. [PMID: 38881546 PMCID: PMC11176548 DOI: 10.3389/fpsyt.2024.1390913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background The efficacy and safety of deep transcranial magnetic stimulation (dTMS) as an intervention for schizophrenia remain unclear. This systematic review examined the efficacy and safety of dTMS for schizophrenia. Methods A systematic search of Chinese (WanFang and Chinese Journal Net) and English databases (PubMed, EMBASE, PsycINFO, and Cochrane Library) were conducted. Results Three randomized clinical trials (RCTs) comprising 80 patients were included in the analyses. Active dTMS was comparable to the sham treatment in improving total psychopathology, positive symptoms, negative symptoms, and auditory hallucinations measured by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Auditory Hallucinations Rating Scale (AHRS), respectively. Only one RCT reported the effects on neurocognitive function measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB), suggesting that dTMS may only improve one Stockings of Cambridge measure (i.e., subsequent times for five move problems). All three studies reported overall discontinuation rates, which ranged from 16.7% to 44.4%. Adverse events were reported in only one RCT, the most common being tingling/twitching (30.0%, 3/10), head/facial discomfort (30.0%, 3/10), and back pain (20.0%, 2/10). Conclusion This systematic review suggests that dTMS does not reduce psychotic symptoms in schizophrenia, but it shows potential for improving executive functions. Future RCTs with larger sample sizes focusing on the effects of dTMS on psychotic symptoms and neurocognitive function in schizophrenia are warranted to further explore these findings.
Collapse
Affiliation(s)
- Yu Mo
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhan-Ming Shi
- Department of Psychiatry, Chongqing Jiangbei Second Hospital, Chongqing, China
| | - Xin-Hu Yang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xian-Jun Lan
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Can-Jin Deng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiao-Lin Tan
- Department of Psychiatry, Chongqing mental health center, Chongqing, China
| | - Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Gabor S Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Wei Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
3
|
Effects of deep transcranial magnetic stimulation (dTMS) on cognition. Neurosci Lett 2021; 755:135906. [PMID: 33892000 DOI: 10.1016/j.neulet.2021.135906] [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: 01/28/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022]
Abstract
Deep transcranial magnetic stimulation (dTMS) is a modern non-invasive brain stimulation method demonstrated as effective in the treatment of major depression and obsessive-compulsive disorder (OCD). This review aims to survey present knowledge concerning the cognitive function changes identified in dTMS research. A systematic literature search in PubMed and Google Scholar was performed and 23 out of 64 studies on dTMS and cognitive functioning were included in the review. Ten studies were conducted with patients with affective disorders, six with healthy participants, two with schizophrenia patients, two with OCD patients, and one study each with patients suffering from central neuropathic pain, autistic disorder, and attention deficit hyperactivity disorder. The best outcomes were obtained after 20 sessions of high-frequency dTMS with OCD patients, where, in addition to clinical improvement, patients showed amelioration of cognitive functions, specifically in cognitive control domains. The studies on patients with depression appear to show inconsistent results, from cognitive improvement in open-label studies to no improvement versus sham dTMS in controlled trials. Experimental research in healthy volunteers suggests an influence of dTMS on memory and self-agency, and also contain contradictory results. Most studies did not demonstrate a significant improvement in cognitive functioning. However, randomized sham-controlled trials with larger groups of medication-free patients and inclusion of functional imaging or electrophysiological recording connected with dTMS application are necessary for more detailed and confident conclusions concerning the effect of dTMS on cognitive functions.
Collapse
|
4
|
Application of transcranial magnetic stimulation for major depression: Coil design and neuroanatomical variability considerations. Eur Neuropsychopharmacol 2021; 45:73-88. [PMID: 31285123 DOI: 10.1016/j.euroneuro.2019.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 04/22/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022]
Abstract
High-frequency repeated transcranial magnetic stimulation (rTMS) as a treatment for major depressive disorder (MDD) has received FDA clearance for both the figure-of-8 coil (figure-8 coil) and the H1 coil. The FDA-cleared MDD protocols for both coils include high frequency (10-18 Hz) stimulation targeting the dorsolateral prefrontal cortex (dlPFC) at an intensity that is 120% of the right-hand resting motor threshold. Despite these similar parameters, the two coils generate distinct electrical fields (e-fields) which result in differences in the cortical stimulation they produce. Due to the differences in coil designs, the H1 coil induces a stimulation e-field that is broader and deeper than the one induced by the figure-8 coil. In this paper we review theoretical and clinical implications of these differences between the two coils and compare evidence of their safety and efficacy in treating MDD. We present the design principles of the coils, the challenges of identifying, finding, and stimulating the optimal brain target of each individual (both from functional and connectivity perspectives), and the possible implication of stimulating outside that target. There is only one study that performed a direct comparison between clinical effectiveness of the two coils, using the standard FDA-approved protocols in MDD patients. This study indicated clinical superiority of the H1 coil but did not measure long-term effects. Post-marketing data suggest that both coils have a similar safety profile in clinical practice, whereas effect size comparisons of the two respective FDA pivotal trials suggests that the H1 coil may have an advantage in efficacy. We conclude that further head-to-head experiments are needed, especially ones that will compare long-term effects and usage of similar temporal stimulation parameters and similar number of pulses.
Collapse
|
5
|
Factors associated with response after deep transcranial magnetic stimulation in a real-world clinical setting: Results from the first 40 cases of treatment-resistant depression. Eur Psychiatry 2020; 44:61-67. [DOI: 10.1016/j.eurpsy.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 01/04/2023] Open
Abstract
AbstractBackground:Deep transcranial magnetic stimulation (dTMS) has been sanctioned by the United States Food and Drug Administration for treatment-resistant depression. In a retrospective cohort study, we evaluated response and effectiveness of dTMS in real-world practice, as an add-on treatment for resistant depression.Methods:Forty adult outpatients suffering from depression, all taking psychiatric medications, underwent 20 dTMS treatments over a 4–6 week period. At baseline (T0), visit 10 (T1), and visit 20 (T2), the Clinical Global Impression-Severity (CGI-S) scale was administered, and the Clinical Global Impression Improvement (CGI-I) scale was completed at T1 and T2; the Hamilton Depression Rating Scale (HDRS-21) was administrated at T0 and T2 only. The patients also completed the Quick Inventory of Depressive Symptoms–Self-Report (QIDS-SR) at T0, T1, and T2.Results:Depressive symptoms (HDRS-21 total score) decreased significantly following treatment. The HDRS total score decreased from an average of 21.22 (± 6.09) at T0, to 13.95 (± 7.24) at T2. Correspondingly, at T2, 32.5% were responders to the treatment and 20% were in remission, based on the HDRS-21. Treatment was well tolerated, with a discontinuation rate of 7.5%. While depressive symptoms at baseline did not predict remission/response at T2, higher HDRS scores at T0 were associated with a larger decrease in depressive symptoms during the study.Conclusions:Significant antidepressant effects were seen following 20 dTMS treatments, given as augmentation to ongoing medications in treatment-resistant depression. The findings suggest that among patients with TRD, the severity of the depressive episode (and not necessarily the number of failed antidepressant medication trials) is associated with a positive therapeutic effect of dTMS. Hence, the initial severity of the depressive episode may guide clinicians in referring patients for dTMS.
Collapse
|
6
|
Popa T, Morris LS, Hunt R, Deng ZD, Horovitz S, Mente K, Shitara H, Baek K, Hallett M, Voon V. Modulation of Resting Connectivity Between the Mesial Frontal Cortex and Basal Ganglia. Front Neurol 2019; 10:587. [PMID: 31275221 PMCID: PMC6593304 DOI: 10.3389/fneur.2019.00587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The mesial prefrontal cortex, cingulate cortex, and the ventral striatum are key nodes of the human mesial fronto-striatal circuit involved in decision-making and executive function and pathological disorders. Here we ask whether deep wide-field repetitive transcranial magnetic stimulation (rTMS) targeting the mesial prefrontal cortex (MPFC) influences resting state functional connectivity. Methods: In Study 1, we examined functional connectivity using resting state multi-echo and independent components analysis in 154 healthy subjects to characterize default connectivity in the MPFC and mid-cingulate cortex (MCC). In Study 2, we used inhibitory, 1 Hz deep rTMS with the H7-coil targeting MPFC and dorsal anterior cingulate (dACC) in a separate group of 20 healthy volunteers and examined pre- and post-TMS functional connectivity using seed-based and independent components analysis. Results: In Study 1, we show that MPFC and MCC have distinct patterns of functional connectivity with MPFC-ventral striatum showing negative, whereas MCC-ventral striatum showing positive functional connectivity. Low-frequency rTMS decreased functional connectivity of MPFC and dACC with the ventral striatum. We further showed enhanced connectivity between MCC and ventral striatum. Conclusions: These findings emphasize how deep inhibitory rTMS using the H7-coil can influence underlying network functional connectivity by decreasing connectivity of the targeted MPFC regions, thus potentially enhancing response inhibition and decreasing drug-cue reactivity processes relevant to addictions. The unexpected finding of enhanced default connectivity between MCC and ventral striatum may be related to the decreased influence and connectivity between the MPFC and MCC. These findings are highly relevant to the treatment of disorders relying on the mesio-prefrontal-cingulo-striatal circuit.
Collapse
Affiliation(s)
- Traian Popa
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Laurel S. Morris
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Hunt
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Zhi-De Deng
- Non-Invasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Silvina Horovitz
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Karin Mente
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Hitoshi Shitara
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kwangyeol Baek
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Valerie Voon
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Helena M. Gellersen
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
8
|
Kedzior KK, Gerkensmeier I, Schuchinsky M. Can deep transcranial magnetic stimulation (DTMS) be used to treat substance use disorders (SUD)? A systematic review. BMC Psychiatry 2018; 18:137. [PMID: 29776355 PMCID: PMC5960210 DOI: 10.1186/s12888-018-1704-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Deep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks. The current study assessed the effects of DTMS in the treatment of substance use disorders (SUD) using a systematic review. METHODS Electronic literature search (PsycInfo, Medline until April 2017) identified k = 9 studies (k = 4 randomized-controlled trials, RCTs, with inactive sham and k = 5 open-label studies). DTMS was most commonly applied using high frequency/intensity (10-20 Hz/100-120% of the resting motor threshold, MT) protocols for 10-20 daily sessions in cases with alcohol, nicotine or cocaine use disorders. The outcome measures were craving and dependence (according to standardized scales) or consumption (frequency, abstinence or results of biological assays) at the end of the daily treatment phases and at the last follow-up. RESULTS Acute and longer-term (6-12 months) reductions in alcohol craving were observed after 20 sessions (20 Hz, 120% MT) relative to baseline in k = 4 open-label studies with comorbid SUD and major depressive disorder (MDD). In k = 2 RCTs without MDD, alcohol consumption acutely decreased after 10-12 sessions (10-20 Hz, 100-120% MT) relative to baseline or to sham. Alcohol craving was reduced only after higher frequency/intensity DTMS (20 Hz, 120% MT) relative to sham in k = 1 RCT. Nicotine consumption was reduced and abstinence was increased after 13 sessions (10 Hz, 120% MT) and at the 6-month follow-up relative to sham in k = 1 RCT. Cocaine craving was reduced after 12 sessions (15 Hz, 100% MT) and at the 2-month follow-up relative to baseline in k = 1 open-label study while consumption was reduced after 12 sessions (10 Hz, 100% MT) relative to baseline but not to sham in k = 1 RCT. CONCLUSIONS High-frequency DTMS may be effective at treating some SUD both acutely and in the longer-term. Large RCTs with inactive sham are required to determine the efficacy and the optimal stimulation parameters of DTMS for the treatment of SUD.
Collapse
Affiliation(s)
| | - Imke Gerkensmeier
- 0000 0001 2297 4381grid.7704.4Institute of Psychology and Transfer, University of Bremen, Bremen, Germany
| | - Maria Schuchinsky
- 0000 0004 1936 9692grid.10049.3cUniversity of Limerick, Limerick, Ireland
| |
Collapse
|
9
|
Gellersen HM, Kedzior KK. An Update of a Meta-Analysis on the Clinical Outcomes of Deep Transcranial Magnetic Stimulation (DTMS) in Major Depressive Disorder (MDD). ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract. Deep transcranial magnetic stimulation (DTMS) is a noninvasive therapy for treatment-resistant major depressive disorder (MDD). The current study aimed to update a previous meta-analysis by investigating the acute and longer-term clinical outcomes of DTMS and their possible predictors (patient characteristics and stimulation parameters) in unipolar MDD. A systematic literature search identified 11 studies with 282 treatment-resistant, unipolar MDD patients. The clinical outcomes (depression severity, response and remission rates) were evaluated using random-effects meta-analyses. High frequency and intensity DTMS protocol with H1-coil had significant acute antidepressant outcomes and improved some cognitive functions after 20 daily sessions in unipolar MDD. Response rates tended to increase with lower severity of illness. Antidepressant effects were prolonged if maintenance DTMS was used after daily stimulation phases. DTMS consistently improves various symptom domains (antidepressant, cognitive) in treatment-resistant unipolar MDD.
Collapse
Affiliation(s)
- Helena M. Gellersen
- Behavioural and Clinical Neuroscience Institute (BCNI), Department of Psychology, University of Cambridge, UK
| | | |
Collapse
|
10
|
Chae KS, Kim YH. Potential Impact of Geomagnetic Field in Transcranial Magnetic Stimulation for the Treatment of Neurodegenerative Diseases. Front Hum Neurosci 2017; 11:478. [PMID: 29021752 PMCID: PMC5623677 DOI: 10.3389/fnhum.2017.00478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/15/2017] [Indexed: 01/08/2023] Open
Abstract
Throughout the long history of various therapeutic trials of transcranial magnetic stimulation (TMS), some TMS protocols have been reported to be clearly effective in the treatment of neurodegenerative diseases. Despite promising results from repetitive TMS (rTMS) using low frequency electromagnetic fields (EMFs) for neurodegenerative diseases, the low reproducibility has hampered the clinical applications of rTMS. Here, based on the notion of radical pair mechanism explaining magnetoreception in living organisms, we propose a new perspective that rTMS with controlled geomagnetic field (rTMS-GMF) can be an efficient and reproducible therapeutic approach for neurodegenerative diseases. In addition, combined consideration of imprinted GMF and/or EMFs in patients’ earlier life may augment the potential efficacy of the rTMS-GMF. The investigation of this approach is intriguing and may have a high impact on the technical suitability and clinical application of the rTMS-GMF in the near future.
Collapse
Affiliation(s)
- Kwon-Seok Chae
- Department of Biology Education, Kyungpook National University, Daegu, South Korea.,Department of Nanoscience & Nanotechnology, Kyungpook National University, Daegu, South Korea.,Brain Science and Engineering Institute, Kyungpook National University, Daegu, South Korea
| | - Yong-Hwan Kim
- Department of Biological Sciences, Neuroscience Program, Delaware State University, Dover, DE, United States
| |
Collapse
|
11
|
Hu SH, Lai JB, Xu DR, Qi HL, Peterson BS, Bao AM, Hu CC, Huang ML, Chen JK, Wei N, Hu JB, Li SL, Zhou WH, Xu WJ, Xu Y. Efficacy of repetitive transcranial magnetic stimulation with quetiapine in treating bipolar II depression: a randomized, double-blinded, control study. Sci Rep 2016; 6:30537. [PMID: 27460201 PMCID: PMC4962310 DOI: 10.1038/srep30537] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/06/2016] [Indexed: 01/15/2023] Open
Abstract
The clinical and cognitive responses to repetitive transcranial magnetic stimulation (rTMS) in bipolar II depressed patients remain unclear. In this study, thirty-eight bipolar II depressed patients were randomly assigned into three groups: (i) left high-frequency (n = 12), (ii) right low-frequency (n = 13), (iii) sham stimulation (n = 13), and underwent four-week rTMS with quetiapine concomitantly. Clinical efficacy was evaluated at baseline and weekly intervals using the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive functioning was assessed before and after the study with the Wisconsin Card Sorting Test (WCST), Stroop Word-Color Interference Test (Stroop), and Trail Making Test (TMT). Thirty-five patients were included in the final analysis. Overall, the mean scores of both the HDRS-17 and the MADRS significantly decreased over the 4-week trial, which did not differ among the three groups. Exploratory analyses revealed no differences in factor scores of HDRS-17s, or in response or remission rates. Scores of WCST, Stroop, or TMT did not differ across the three groups. These findings indicated active rTMS combined with quetiapine was not superior to quetiapine monotherapy in improving depressive symptoms or cognitive performance in patients with bipolar II depression.
Collapse
Affiliation(s)
- Shao-Hua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Jian-Bo Lai
- Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Dong-Rong Xu
- Epidemiology Division &MRI Unit, Department of Psychiatry, Columbia University &New York State Psychiatric Institute, New York 10032, USA
| | - Hong-Li Qi
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Bradley S Peterson
- Institute of the Developing Mind, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California 90027, USA
| | - Ai-Min Bao
- The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China.,Department of Neurobiology; Key Laboratory of Medical Neurobiology of Ministry of Health of China; Zhejiang Province Key Laboratory of Neurobiology, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Chan-Chan Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Man-Li Huang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Jing-Kai Chen
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Ning Wei
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Jian-Bo Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Shu-Lan Li
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Wei-Hua Zhou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Wei-Juan Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou 310003, China
| |
Collapse
|
12
|
Bruchim-Samuel M, Lax E, Gazit T, Friedman A, Ahdoot H, Bairachnaya M, Pinhasov A, Yadid G. Electrical stimulation of the vmPFC serves as a remote control to affect VTA activity and improve depressive-like behavior. Exp Neurol 2016; 283:255-63. [PMID: 27181412 DOI: 10.1016/j.expneurol.2016.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022]
Abstract
Despite progress in elucidating mechanisms of depression, the efficacy of different treatments remains inadequate. Recent small-scale clinical studies suggested anti-depressant treatment using deep brain stimulation (DBS) of the ventral capsule/ventral striatum or subgenual cingulate cortex (SCC), yet controlled, multi-center trials were unsuccessful. We recently suggested the ventral tegmental area (VTA) as an important intersection for treating depression. We also found that stimulation of the VTA of a genetic rat model of depression (Flinders Sensitive Line (FSL) rats) with a programmed pattern designed to mimic the burst firing of normal rats decreases depressive-like behavior. Herein, we examined the possibility of reaching the VTA - located deep in the brain stem - through its direct connection to the ventro-medial prefrontal cortex (vmPFC), which parallels the human SCC. Thus, we compared treatment of FSLs with modified versions of DBS - either chronic-intermittent low-frequency electrical stimulation of the vmPFC, or patterned acute electrical stimulation (pAES), which integrates transcranial magnetic stimulation properties, namely, bursts of pulse trains and low frequency stimulation, applied to the VTA. We found that stimulation of the vmPFC (20Hz, 15min/day, 10days) improved depressive-like behavior and VTA local field potential (LFP) activity of FSLs, yet it had only a partial long-term effect on behavior. In particular, vmPFC stimulation decreased theta band activity, which correlated with the improvement in depressive-like behavior of all treated FSLs at day 1, and in ~50% of treated FSLs at day 28 post treatment. pAES of the VTA (10Hz, 20min) caused significant, long-term improvement of depressive-like behavior of FSLs, concurrently with normalizing intra-VTA LFP activity, and increasing VTA LFP synchronicity and hippocampal BDNF mRNA levels. Thus, although low-frequency electrical stimulation of the PFC alters VTA activity, leading to attenuation of depressive-like manifestations, a specific stimulation pattern affecting VTA cell programming is important for long-term efficacy.
Collapse
Affiliation(s)
| | - Elad Lax
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Tomer Gazit
- Leslie and Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Hadas Ahdoot
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | | | - Gal Yadid
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel; Leslie and Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, Israel.
| |
Collapse
|