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Vergallito A, Gesi C, Torriero S. Intermittent Theta Burst Stimulation Combined with Cognitive Training to Improve Negative Symptoms and Cognitive Impairment in Schizophrenia: A Pilot Study. Brain Sci 2024; 14:683. [PMID: 39061423 PMCID: PMC11274516 DOI: 10.3390/brainsci14070683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Schizophrenia is a chronic psychiatric disorder severely affecting patients' functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms cannot be treated pharmacologically and represent consistent predictors of the illness's prognosis. Cognitive remediation (CR) interventions have been applied to target these symptoms. Brain stimulation also provides promising yet preliminary results in reducing negative symptoms, whereas its effect on cognitive impairment remains heterogeneous. Here, we combined intermittent theta burst stimulation (iTBS) with CR to improve negative symptoms and cognitive impairment in schizophrenia spectrum patients. One hundred eligible patients were invited, and twenty-one participated. We randomized them into four groups, manipulating the stimulation condition (real vs. sham) and CR (no training vs. training). We delivered fifteen iTBS sessions over the left dorsolateral prefrontal cortex for three weeks, followed (or not) by 50 min of training. Consensus-based clinical and cognitive assessment was administered at baseline and after the treatment, plus at three follow-ups occurring one, three, and six months after the intervention. Mixed-model analyses were run on cognitive and negative symptom scores. The preliminary findings highlighted a marginal modulation of iTBS on negative symptoms, whereas CR improved isolated cognitive functions. We herein discuss the limitations and strengths of the methodological approach.
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Affiliation(s)
- Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milan, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy (S.T.)
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2
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Austelle CW, Seery E. Psychodynamically Informed Brain Stimulation: Building a Bridge from Brain to Mind. Am J Psychoanal 2024; 84:285-310. [PMID: 38871924 DOI: 10.1057/s11231-024-09444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Since its inception, psychiatry has undergone several periods of radical identity transformation. Initially limited to psychotherapy alone, the advent of medications stimulated an era of biological psychiatry. For years, medications served as the mainstay of biological treatments, paralleled by a rise in treatment resistance. Brain stimulation therapies are psychiatry's newest arm of intervention and represent an area ripe for exploration. These techniques offer new hope to treatment-resistant patients, but in a manner often dissociated from psychoanalytic conceptualization and the practice of psychotherapy. There is growing interest in bridging this divide. In this article, we continue the efforts at interweaving what may seem to be disparate approaches through the topic of treatment resistance. This article aims to engage interventional psychiatrists in considering psychosocial dimensions of their treatments and to provide education for psychoanalytic clinicians on the history, mechanism of action, and applications of brain stimulation technologies.
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Affiliation(s)
- Christopher W Austelle
- MD, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Erin Seery
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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3
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Sun L, Xiao K, Shen XY, Wang S. Impact of transcranial electrical stimulation on serum neurotrophic factors and language function in patients with speech disorders. World J Clin Cases 2024; 12:1742-1749. [PMID: 38660085 PMCID: PMC11036479 DOI: 10.12998/wjcc.v12.i10.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Speech disorders have a substantial impact on communication abilities and quality of life. Traditional treatments such as speech and psychological therapies frequently demonstrate limited effectiveness and patient compliance. Transcranial electrical stimulation (TES) has emerged as a promising non-invasive treatment to improve neurological functions. However, its effectiveness in enhancing language functions and serum neurofactor levels in individuals with speech disorders requires further investigation. AIM To investigate the impact of TES in conjunction with standard therapies on serum neurotrophic factor levels and language function in patients with speech disorders. METHODS In a controlled study spanning from March 2019 to November 2021, 81 patients with speech disorders were divided into a control group (n = 40) receiving standard speech stimulation and psychological intervention, and an observation group (n = 41) receiving additional TES. The study assessed serum levels of ciliary neurotrophic factor (CNTF), glial cell-derived neurotrophic factor (GDNF), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF), as well as evaluations of motor function, language function, and development quotient scores. RESULTS After 3 wk of intervention, the observation group exhibited significantly higher serum levels of CNTF, GDNF, BDNF, and NGF compared to the control group. Moreover, improvements were noted in motor function, cognitive function, language skills, physical abilities, and overall development quotient scores. It is worth mentioning that the observation group also displayed superior performance in language-specific tasks such as writing, reading comprehension, retelling, and fluency. CONCLUSION This retrospective study concluded that TES combined with traditional speech and psychotherapy can effectively increase the levels of neurokines in the blood and enhance language function in patients with speech disorders. These results provide a promising avenue for integrating TES into standard treatment methods for speech disorders.
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Affiliation(s)
- Li Sun
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Kai Xiao
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Xiao-Yan Shen
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
| | - Shu Wang
- Department of Rehabilitation Medicine, General Hospital of the Yangtze River Shipping, Wuhan 430010, Hubei Province, China
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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5
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Brown KA, Gould TD. Targeting metaplasticity mechanisms to promote sustained antidepressant actions. Mol Psychiatry 2024; 29:1114-1127. [PMID: 38177353 PMCID: PMC11176041 DOI: 10.1038/s41380-023-02397-1] [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: 06/22/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
The discovery that subanesthetic doses of (R, S)-ketamine (ketamine) and (S)-ketamine (esketamine) rapidly induce antidepressant effects and promote sustained actions following drug clearance in depressed patients who are treatment-resistant to other therapies has resulted in a paradigm shift in the conceptualization of how rapidly and effectively depression can be treated. Consequently, the mechanism(s) that next generation antidepressants may engage to improve pathophysiology and resultant symptomology are being reconceptualized. Impaired excitatory glutamatergic synapses in mood-regulating circuits are likely a substantial contributor to the pathophysiology of depression. Metaplasticity is the process of regulating future capacity for plasticity by priming neurons with a stimulation that alters later neuronal plasticity responses. Accordingly, the development of treatment modalities that specifically modulate the duration, direction, or magnitude of glutamatergic synaptic plasticity events such as long-term potentiation (LTP), defined here as metaplastogens, may be an effective approach to reverse the pathophysiology underlying depression and improve depression symptoms. We review evidence that the initiating mechanisms of pharmacologically diverse rapid-acting antidepressants (i.e., ketamine mimetics) converge on consistent downstream molecular mediators that facilitate the expression/maintenance of increased synaptic strength and resultant persisting antidepressant effects. Specifically, while the initiating mechanisms of these therapies may differ (e.g., cell type-specificity, N-methyl-D-aspartate receptor (NMDAR) subtype-selective inhibition vs activation, metabotropic glutamate receptor 2/3 antagonism, AMPA receptor potentiation, 5-HT receptor-activating psychedelics, etc.), the sustained therapeutic mechanisms of putative rapid-acting antidepressants will be mediated, in part, by metaplastic effects that converge on consistent molecular mediators to enhance excitatory neurotransmission and altered capacity for synaptic plasticity. We conclude that the convergence of these therapeutic mechanisms provides the opportunity for metaplasticity processes to be harnessed as a druggable plasticity mechanism by next-generation therapeutics. Further, targeting metaplastic mechanisms presents therapeutic advantages including decreased dosing frequency and associated diminished adverse responses by eliminating the requirement for the drug to be continuously present.
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Affiliation(s)
- Kyle A Brown
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Todd D Gould
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Department of Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Veterans Affairs Maryland Health Care System, Baltimore, MD, 21201, USA.
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6
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Liu Y, Luo Y, Zhang N, Zhang X, Liu S. A scientometric review of the growing trends in transcranial alternating current stimulation (tACS). Front Hum Neurosci 2024; 18:1362593. [PMID: 38510513 PMCID: PMC10950919 DOI: 10.3389/fnhum.2024.1362593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Objective The aim of the current study was to provide a comprehensive picture of tACS-related research in the last decade through a bibliometric approach in order to systematically analyze the current status and cutting-edge trends in this field. Methods Articles and review articles related to tACS from 2013 to 2022 were searched on the Web of Science platform. A bibliometric analysis of authors, journals, countries, institutions, references, and keywords was performed using CiteSpace (6.2.R2), VOSviewer (1.6.19), Scimago Graphica (1.0.30), and Bibliometrix (4.2.2). Results A total of 602 papers were included. There was an overall increase in annual relevant publications in the last decade. The most contributing author was Christoph S. Herrmann. Brain Stimulation was the most prolific journal. The most prolific countries and institutions were Germany and Harvard University, respectively. Conclusion The findings reveal the development prospects and future directions of tACS and provide valuable references for researchers in the field. In recent years, the keywords "gamma," "transcranial direct current simulation," and "Alzheimer's disease" that have erupted, as well as many references cited in the outbreak, have provided certain clues for the mining of research prefaces. This will act as a guide for future researchers in determining the path of tACS research.
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Affiliation(s)
- Yuanli Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Yulin Luo
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Na Zhang
- Department of Information Management, Anhui Vocational College of Police Officers, Hefei, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, China
- Hefei National Research Center for Physical Sciences at the Microscale, and Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, China
- Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, China
- Key Laboratory of Brain-Machine Intelligence for Information Behavior (Ministry of Education and Shanghai), School of Business and Management, Shanghai International Studies University, Shanghai, China
| | - Shen Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
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De Smet S, Razza LB, Pulopulos MM, De Raedt R, Baeken C, Brunoni AR, Vanderhasselt MA. Stress priming transcranial direct current stimulation (tDCS) enhances updating of emotional content in working memory. Brain Stimul 2024; 17:434-443. [PMID: 38565374 DOI: 10.1016/j.brs.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) targeting the prefrontal cortex has emerged as a valuable tool in psychiatric research. Understanding the impact of affective states, such as stress at the time of stimulation, on the efficacy of prefrontal tDCS is crucial for advancing tDCS interventions. Stress-primed tDCS, wherein stress is used as a priming agent, has the potential to modulate neural plasticity and enhance cognitive functions, particularly in emotional working memory. However, prior research using stress-primed tDCS focused solely on non-emotional working memory performance, yielding mixed results. In this sham-controlled study, we addressed this gap by investigating the effects of stress-primed bifrontal tDCS (active versus sham) on both non-emotional and emotional working memory performance. The study was conducted in 146 healthy individuals who were randomly assigned to four experimental groups. The Trier Social Stress Test (TSST) or a control variant of the test was used to induce a stress versus control state. The results showed that stress priming significantly enhanced the effects of tDCS on the updating of emotional content in working memory, as evidenced by improved accuracy. Notably, no significant effects of stress priming were found for non-emotional working memory performance. These findings highlight the importance of an individual's prior affective state in shaping their response to tDCS, especially in the context of emotional working memory.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium; Brain Stimulation and Cognition (BSC) Lab, Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Lais B Razza
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium
| | - Matias M Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000, São Paulo, Brazil; Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium
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Vergallito A, Gramano B, La Monica K, Giuliani L, Palumbo D, Gesi C, Torriero S. Combining transcranial magnetic stimulation with training to improve social cognition impairment in schizophrenia: a pilot randomized controlled trial. Front Psychol 2024; 15:1308971. [PMID: 38445059 PMCID: PMC10912559 DOI: 10.3389/fpsyg.2024.1308971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Schizophrenia is a severe, chronic mental disorder that profoundly impacts patients' everyday lives. The illness's core features include positive and negative symptoms and cognitive impairments. In particular, deficits in the social cognition domain showed a tighter connection to patients' everyday functioning than the other symptoms. Social remediation interventions have been developed, providing heterogeneous results considering the possibility of generalizing the acquired improvements in patients' daily activities. In this pilot randomized controlled trial, we investigated the feasibility of combining fifteen daily cognitive and social training sessions with non-invasive brain stimulation to boost the effectiveness of the two interventions. We delivered intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Twenty-one patients were randomized into four groups, varying for the assigned stimulation condition (real vs. sham iTBS) and the type of cognitive intervention (training vs. no training). Clinical symptoms and social cognition tests were administered at five time points, i.e., before and after the treatment, and at three follow-ups at one, three, and six months after the treatments' end. Preliminary data show a trend in improving the competence in managing emotion in participants performing the training. Conversely, no differences were found in pre and post-treatment scores for emotion recognition, theory of mind, and attribution of intentions scores. The iTBS intervention did not induce additional effects on individuals' performance. The methodological approach's novelty and limitations of the present study are discussed.
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Affiliation(s)
| | - Bianca Gramano
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Kevin La Monica
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luigi Giuliani
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Palumbo
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
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Xu X, Xu M, Su Y, Cao TV, Nikolin S, Moffa A, Loo C, Martin D. Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Psychological Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:1665. [PMID: 38137113 PMCID: PMC10741493 DOI: 10.3390/brainsci13121665] [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: 10/27/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Psychological interventions are effective in alleviating neuropsychiatric symptoms, though results can vary between patients. Repetitive transcranial magnetic stimulation (rTMS) has been proven to improve clinical symptoms and cognition. It remains unclear whether rTMS can augment the efficacy of psychological interventions. (2) Methods: We examined the effects of rTMS combined with psychological interventions on clinical, functional, and cognitive outcomes from randomized controlled trials conducted in healthy and clinical populations. We searched PubMed, EMBASE, Cochrane Library, and PsycINFO databases up to April 2023. (3) Results: Twenty-seven studies were ultimately included. Compared to sham rTMS combined with psychological interventions, active rTMS combined with psychological interventions significantly improved overall clinical symptoms (k = 16, SMD = 0.31, CIs 0.08 to 0.54, p < 0.01). We found that 10 or more sessions of rTMS combined with cognitive behavioural therapy significantly improved clinical outcomes overall (k = 3, SMD = 0.21, CIs 0.05 to 0.36, Z = 2.49, p < 0.01). RTMS combined with cognitive training (CT) significantly improved cognition overall compared to sham rTMS combined with CT (k = 13, SMD = 0.28, CIs 0.15 to 0.42, p < 0.01), with a significant effect on global cognition (k = 11, SMD = 0.45, CIs 0.21 to 0.68, p < 0.01), but not on the other cognitive domains. (4) Conclusion: The current results provide preliminary support for the augmentation effects of active rTMS on clinical and cognitive outcomes across diverse populations. Future clinical trials are required to confirm these augmentation effects for specific psychological interventions in specific clinical populations.
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Affiliation(s)
- Xiaomin Xu
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mei Xu
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Yon Su
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Thanh Vinh Cao
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Stevan Nikolin
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Adriano Moffa
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Colleen Loo
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Donel Martin
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
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10
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Vergallito A, Varoli E, Pisoni A, Mattavelli G, Del Mauro L, Feroldi S, Vallar G, Romero Lauro LJ. State-dependent effectiveness of cathodal transcranial direct current stimulation on cortical excitability. Neuroimage 2023; 277:120242. [PMID: 37348625 DOI: 10.1016/j.neuroimage.2023.120242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023] Open
Abstract
The extensive use of transcranial direct current stimulation (tDCS) in experimental and clinical settings does not correspond to an in-depth understanding of its underlying neurophysiological mechanisms. In previous studies, we employed an integrated system of Transcranial Magnetic Stimulation and Electroencephalography (TMS-EEG) to track the effect of tDCS on cortical excitability. At rest, anodal tDCS (a-tDCS) over the right Posterior Parietal Cortex (rPPC) elicits a widespread increase in cortical excitability. In contrast, cathodal tDCS (c-tDCS) fails to modulate cortical excitability, being indistinguishable from sham stimulation. Here we investigated whether an endogenous task-induced activation during stimulation might change this pattern, improving c-tDCS effectiveness in modulating cortical excitability. In Experiment 1, we tested whether performance in a Visuospatial Working Memory Task (VWMT) and a modified Posner Cueing Task (mPCT), involving rPPC, could be modulated by c-tDCS. Thirty-eight participants were involved in a two-session experiment receiving either c-tDCS or sham during tasks execution. In Experiment 2, we recruited sixteen novel participants who performed the same paradigm but underwent TMS-EEG recordings pre- and 10 min post- sham stimulation and c-tDCS. Behavioral results showed that c-tDCS significantly modulated mPCT performance compared to sham. At a neurophysiological level, c-tDCS significantly reduced cortical excitability in a frontoparietal network likely involved in task execution. Taken together, our results provide evidence of the state dependence of c-tDCS in modulating cortical excitability effectively. The conceptual and applicative implications are discussed.
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Affiliation(s)
- Alessandra Vergallito
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy.
| | - Erica Varoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alberto Pisoni
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy
| | - Giulia Mattavelli
- IUSS Cognitive Neuroscience (ICON) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, 27100, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Sarah Feroldi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy; MiBTec - Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Leonor J Romero Lauro
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy
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Del Mauro L, Vergallito A, Gattavara G, Juris L, Gallucci A, Vedani A, Cappelletti L, Farneti PM, Romero Lauro LJ. Betting on Non-Invasive Brain Stimulation to Treat Gambling Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:698. [PMID: 37190663 PMCID: PMC10136786 DOI: 10.3390/brainsci13040698] [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: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Gambling disorder (GD) is a behavioral addiction that severely impacts individuals' functioning, leading to high socioeconomic costs. Non-invasive brain stimulation (NiBS) has received attention for treating psychiatric and neurological conditions in recent decades, but there is no recommendation for its use for GD. Therefore, this study aimed to systematically review and analyze the available literature to determine the effectiveness of NiBS in treating GD. Following the PRISMA guidelines, we screened four electronic databases up to July 2022 and selected relevant English-written original articles. We included ten papers in the systematic review and seven in the meta-analysis. As only two studies employed a sham-controlled design, the pre-post standardized mean change (SMCC) was computed as effect size only for real stimulation. The results showed a significant effect of NiBS in reducing craving scores (SMCC = -0.69; 95% CI = [-1.2, -0.2], p = 0.010). Moreover, considering the GD's frequent comorbidity with mood disorders, we ran an exploratory analysis of the effects of NiBS on depressive symptoms, which showed significant decreases in post-treatment scores (SMCC = -0.71; 95% CI = [-1.1, -0.3], p < 0.001). These results provide initial evidence for developing NiBS as a feasible therapy for GD symptoms but further comprehensive research is needed to validate these findings. The limitations of the available literature are critically discussed.
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Affiliation(s)
- Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Fondazione Eris Onlus, 20134 Milano, Italy
| | - Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gaia Gattavara
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Anna Vedani
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
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Noël X. A critical perspective on updating drug memories through the integration of memory editing and brain stimulation. Front Psychiatry 2023; 14:1161879. [PMID: 37124256 PMCID: PMC10140428 DOI: 10.3389/fpsyt.2023.1161879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Addiction is a persistent, recurring condition characterized by repeated relapses despite the desire to control drug use or maintain sobriety. The attainment of abstinence is hindered by persistent maladaptive drug-associated memories, which drive drug-seeking and use behavior. This article examines the preliminary evidence supporting the combination of non-invasive brain stimulation (NIBS) techniques and memory editing (or reconsolidation) interventions as add-on forms of treatment for individuals with substance-related disorders (SUD). Studies have shown that NIBS can modestly reduce drug use and craving through improved cognitive control or other undetermined reasons. Memory reconsolidation, a process by which a previously consolidated memory trace can be made labile again, can potentially erase or significantly weaken SUD memories underpinning craving and the propensity for relapse. This approach conveys enthusiasm while also emphasizing the importance of managing boundary conditions and null results for interventions found on fear memory reconsolidation. Recent studies, which align with the state-dependency and activity-selectivity hypotheses, have shown that the combination of NIBS and behavioral interventions holds promise for treating SUD by reducing self-reported and physiological aspects of craving. Effective long-term outcomes for this procedure require better identification of critical memories, a deeper understanding of the brain mechanisms underlying SUD and memory reconsolidation and overcoming any boundary conditions of destabilized memories. This will enable the procedure to be personalized to the unique needs of individual patients.
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Affiliation(s)
- Xavier Noël
- Laboratoire de Psychologie Médicale et d’Addictologie, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Neuroscience Institute (UNI), Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Xavier Noël,
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Gersner R, Barnea-Ygael N, Tendler A. Moderators of the response to deep TMS for smoking addiction. Front Psychiatry 2022; 13:1079138. [PMID: 36699493 PMCID: PMC9869803 DOI: 10.3389/fpsyt.2022.1079138] [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: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Deep repetitive transcranial magnetic stimulation (Deep TMS™) was recently cleared by the FDA as a short-term treatment for smoking cessation. However, it is unknown which participants are more likely to benefit from the treatment. METHODS We evaluated the data from the published randomized controlled trial of 262 participants 22-70 years old that led to the FDA clearance to characterize demographic and smoking history factors that moderate Deep TMS treatment efficacy. The current analysis included 75 completers in the active TMS group and 94 completers in the sham TMS group. RESULTS We found that participants younger than 40 had four times the quit rate than those older than 40. Additionally, participants who quit following treatment smoked 10 years less than non-quitters. Moreover, Caucasian participants had two times the quit rate than African-American participants. Strikingly, participants with more than 12 years of education had 7 times the quit rate than participants with less education. CONCLUSION Three weeks of Deep TMS has a higher smoking addiction quit rate in participants who are younger, more educated, Caucasian and with less extensive smoking history. Participants who are older, with less education and more extensive smoking history may need a longer treatment course and/or combined treatment modalities. Potential reasons may be related to the challenges of inducing neuronal modifications in those with greater physical and psychological dependence. Further investigation is warranted.
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Affiliation(s)
| | - Noam Barnea-Ygael
- BrainsWay, Burlington, VT, United States.,Department of Life Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Aron Tendler
- BrainsWay, Burlington, VT, United States.,Department of Life Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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