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Kataria M, Gupta N, Kumar A, Bhoriwal S, Singh A, Shekhar V, Bhatia R. Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial. Breast Cancer 2024; 31:841-850. [PMID: 38796817 DOI: 10.1007/s12282-024-01598-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] [Received: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. METHODS We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). RESULTS Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). CONCLUSION The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
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Affiliation(s)
- Monika Kataria
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Aasheesh Kumar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Akanksha Singh
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Varun Shekhar
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Renu Bhatia
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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2
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Ahmadpanah M, Amini S, Mazdeh M, Haghighi M, Soltanian A, Jahangard L, Keshavarzi A, Brand S. Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) Add-On Therapy to a Standard Treatment in Individuals with Multiple Sclerosis and Concomitant Symptoms of Depression—Results from a Randomized Clinical Trial and Pilot Study. J Clin Med 2023; 12:jcm12072525. [PMID: 37048608 PMCID: PMC10095476 DOI: 10.3390/jcm12072525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Compared to the general population, persons with multiple sclerosis (MS) are at increased risk of suffering from major depressive disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) was used successfully to treat individuals with MDD. Here, we conducted a randomized clinical trial and pilot study, and tested the effectiveness of rTMS adjuvant to a standard pharmacological treatment among persons with MS, compared to a sham condition. Materials and Methods: A total of 40 persons with MS (mean age: 32 years; 42.5% females; median EDSS score: 4) and with moderate to severe symptoms of depression were randomly assigned to the rTMS or to the rTMS sham condition, always as adjuvant intervention to the standard treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI). rTMS consisted of 10 sessions each of 37.5 min; the sham condition was identical to the active condition except for the absence of rTMS stimuli. At the beginning and two weeks after the end of the study, participants reported on their fatigue, while experts rated the severity of participants’ depressive symptoms (Montgomery–Asberg Depression Rating Scale; MADRS), cognitive performance (Montreal Cognitive Assessment; MoCA), and degree of disability (Expanded Disability Status Scale; EDSS). Results: Data were analyzed per intent-to-treat. Scores for depression, fatigue, and EDSS declined significantly over time (large effect sizes), but more so in the rTMS condition than in the sham condition (large effect sizes for the time by group-interactions). Compared to the sham condition, scores for depression were significantly lower in the rTMS condition. Scores for cognition improved over time in both study conditions (large effect size). Conclusion: Compared to a sham condition, adjuvant rTMS to a standard pharmacological treatment ameliorated typical MS-related symptoms (depression; fatigue; EDSS scores). Results from this pilot study suggested that rTMS might be routinely applied in persons with MS displaying symptoms of depression and fatigue.
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3
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Bhattacharyya P, Anand A, Lin J, Altinay M. Left Dorsolateral Prefrontal Cortex Glx/tCr Predicts Efficacy of High Frequency 4- to 6-Week rTMS Treatment and Is Associated With Symptom Improvement in Adults With Major Depressive Disorder: Findings From a Pilot Study. Front Psychiatry 2021; 12:665347. [PMID: 34925079 PMCID: PMC8677827 DOI: 10.3389/fpsyt.2021.665347] [Citation(s) in RCA: 6] [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: 02/07/2021] [Accepted: 11/08/2021] [Indexed: 12/05/2022] Open
Abstract
About 20-40% of estimated 121 million patients with major depressive disorder (MDD) are not adequately responsive to medication treatment. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive, non-convulsive neuromodulation/neurostimulation method, has gained popularity in treatment of MDD. Because of the high cost involved in rTMS therapy, ability to predict the therapy effectiveness is both clinically and cost wise significant. This study seeks an imaging biomarker to predict efficacy of rTMS treatment using a standard high frequency 10-Hz 4- to 6-week protocol in adult population. Given the significance of excitatory and inhibitory neurotransmitters glutamate (Glu) and gamma aminobutyric acid (GABA) in the pathophysiology of MDD, and the involvement of the site of rTMS application, left dorsolateral prefrontal cortex (lDLPFC), in MDD, we explored lDLPFC Glx (Glu + glutamine) and GABA levels, measured by single voxel magnetic resonance spectroscopy (MRS) with total creatine (tCr; sum of creatine and phosphocreatine) as reference, as possible biomarkers of rTMS response prediction. Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) MRS data from 7 patients (40-74 y) were used in the study; 6 of these patients were scanned before and after 6 weeks of rTMS therapy. Findings from this study show inverse correlation between pretreatment lDLPFC Glx/tCr and (i) posttreatment depression score and (ii) change in depression score, suggesting higher Glx/tCr as a predictor of treatment efficacy. In addition association was observed between changes in depression scores and changes in Glx/tCr ratio. The preliminary findings did not show any such association between GABA/tCr and depression score.
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Affiliation(s)
- Pallab Bhattacharyya
- Cleveland Clinic, Imaging Institute, Cleveland, OH, United States.,Department of Radiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
| | - Amit Anand
- Cleveland Clinic, Neurological Institute, Cleveland, OH, United States
| | - Jian Lin
- Cleveland Clinic, Imaging Institute, Cleveland, OH, United States
| | - Murat Altinay
- Cleveland Clinic, Neurological Institute, Cleveland, OH, United States
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4
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Buhagiar F, Fitzgerald M, Bell J, Allanson F, Pestell C. Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review. Front Hum Neurosci 2020; 14:598208. [PMID: 33362494 PMCID: PMC7759622 DOI: 10.3389/fnhum.2020.598208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population. Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.
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Affiliation(s)
- Francesca Buhagiar
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Sarich Neuroscience Research Institute, Nedlands, WA, Australia
- Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Carmela Pestell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- Curtin University, Perth, WA, Australia
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5
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Pan F, Shen Z, Jiao J, Chen J, Li S, Lu J, Duan J, Wei N, Shang D, Hu S, Xu Y, Huang M. Neuronavigation‐Guided rTMS for the Treatment of Depressive Patients With Suicidal Ideation: A Double‐Blind, Randomized, Sham‐Controlled Trial. Clin Pharmacol Ther 2020; 108:826-832. [PMID: 32319673 DOI: 10.1002/cpt.1858] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Fen Pan
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Zhe Shen
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - JianPing Jiao
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Jinkai Chen
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Shangda Li
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Jing Lu
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Jinfeng Duan
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Ning Wei
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Desheng Shang
- Department of Radiology First Affiliated Hospital College of Medicine The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Zhejiang University Hangzhou China
| | - Shaohua Hu
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
| | - Yi Xu
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
- Department of Neurobiology NHC and CAMS Key Laboratory of Medical Neurobiology Zhejiang University School of Medicine Hangzhou Zhejiang China
| | - Manli Huang
- Department of Psychiatry First Affiliated Hospital College of Medicine Zhejiang University Hangzhou China
- The Key Laboratory of Mental Disorder’s Management of Zhejiang Province Hangzhou China
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Abstract
Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Michael Michaelides
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Ruben Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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7
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Neurophysiological examination combined with functional intraoperative navigation using TMS in patients with brain tumor near the central region-a pilot study. Acta Neurochir (Wien) 2019; 161:1853-1864. [PMID: 31297597 DOI: 10.1007/s00701-019-04004-1] [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: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Feasibility and value of non-invasive transcranial magnetic brain stimulation (TMS MAGVENTURE® MagPro R30 Denmark) for preoperative diagnosis and surgical planning of brain tumor operations in everyday clinical practice. METHODS A prospective monocentric study was conducted, which included preoperative neurological and electrophysiological examination, TMS, and display of functional data in the navigation system (LOCALITE® TMS Navigator Germany). During surgery, the TMS data were correlated with the intraoperative monitoring (IOM). Twenty-four hours to 96 h and after at least 3 months, follow-ups with neurological, electrophysiological examinations and TMS stimulation were performed. RESULTS Twenty-five patients with tumors in or near by the primary motor cortex region were included in the study. Twenty-one patients completed preoperative and first postoperative TMS and the neurological examination. Eight of 21 patients showed slight worsening of primary motor cortex function, 8 patients had an unchanged state, and 4 patients showed an improvement early after surgery. The changes of the electrophysiological examination like significant delay of the latency and/or reduced amplitudes matched well with the postoperative neurological outcome: if patients showed a worsening of the SEP's and MEP's, the postoperative results revealed deterioration. CONCLUSION A preoperatively performed TMS using the MAGVENTURE® MagPro R30 and the LOCALITE® TMS Navigator could be established in our clinical daily practice and allowed a safe and reliable mapping of the primary motor cortex in order to minimize the risk of postoperative neurological deficits and improve the neurological outcome of the patients.
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8
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Zhou L, Guo Z, Xing G, Peng H, Cai M, Chen H, McClure MA, He L, Xiong L, He B, Du F, Mu Q. Antidepressant Effects of Repetitive Transcranial Magnetic Stimulation Over Prefrontal Cortex of Parkinson's Disease Patients With Depression: A Meta-Analysis. Front Psychiatry 2019; 9:769. [PMID: 30761029 PMCID: PMC6362497 DOI: 10.3389/fpsyt.2018.00769] [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: 05/15/2018] [Accepted: 12/21/2018] [Indexed: 01/05/2023] Open
Abstract
Objective: The purpose of this meta-analysis was to investigate the antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) over the prefrontal cortex (PFC) of patients with Parkinson's disease (PD) and to determine the optimal rTMS parameters, such as the intensity, frequency and the delivered pattern of rTMS stimulation. Methods: EMBASE, PubMed, Web of Science, MEDLINE, and Cochrane data bases were researched for papers published before March 12, 2018. Studies investigating the anti-depression effects of rTMS over PFC in patients with PD were considered. The main outcomes of pre- and post-rTMS treatment as well as score changes were all extracted. The mean effect size was estimated by calculating the standardized mean difference (SMD) with 95% confidence interval (CI) by using fixed or random effect models as appropriate. Results: Nine studies containing 137 PD patients with depression were included. The pooled results showed significant pre-post anti-depressive effects of rTMS over PFC in PD patients with depression (SMD = -0.80, P < 0.00001). The subgroup analyses of stimulation intensity, frequencies, and models also revealed significant effects (Intensities: 90% RMT: SMD = -1.16, P = 0.0006; >100% RMT: SMD = -0.82, P < 0.0001. Frequencies: < 1.0 Hz: SMD = -0.83, P = 0.03; 5.0 Hz: SMD = -1.10, P < 0.0001; ≥10.0 Hz: SMD = -0.55, P = 0.02. Models: Continuous: SMD = -0.79, P < 0.0001; Discontinuous: SMD = -0.84, P = 0.02). But the results of the studies with place-controlled designs were not significant (Overall: SMD = -0.27, P = 0.54. Intensities: 90% RMT: SMD = 0.27, P = 0.68; 100% RMT: SMD = -0.32, P = 0.33. Frequencies: 5.0 Hz: SMD = -0.87, P = 0.10; ≥10.0 Hz: SMD = 0.27, P = 0.66. Models: Continuous: SMD = -0.28, P = 0.68; Discontinuous: SMD = -0.32, P = 0.33). The greater effect sizes of rTMS with 90% RMT, 5.0 Hz in discontinuous days can be observed rather than the other parameters in both kinds of analyses across study design. Conclusions: rTMS may have a significant positive pre-post anti-depressive effect over PFC on patients with depression, especially by using 5.0 Hz frequency with 90% RMT intensity in discontinuous days, which may produce better effects than other parameters. The real effect, though, was not different from that of the placebo. Future studies with larger sample sizes and high-quality studies are needed to further corroborate our results and to identify the optimal rTMS protocols.
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Affiliation(s)
- Liang Zhou
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
- School of Clinical Medicine,The Clinical Medical College of Southwest Medical University, Luzhou, China
| | - Zhiwei Guo
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Guoqiang Xing
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
- Lotus Biotech.com LLC., John Hopkins University-MCC, Rockville, MD, United States
| | - Haitao Peng
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Mengjie Cai
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Huaping Chen
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Morgan A. McClure
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Lin He
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Liangwen Xiong
- Department of Genitourinary, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bin He
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
| | - Fei Du
- Department of Psychiatry, Harvard Medical School, Belmont, CA, United States
| | - Qiwen Mu
- Department of Radiology and Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, Nanchong, China
- Department of Radiology, Peking University Third Hospital, Beijing, China
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9
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Abdelnaim MA, Langguth B, Deppe M, Mohonko A, Kreuzer PM, Poeppl TB, Hebel T, Schecklmann M. Anti-Suicidal Efficacy of Repetitive Transcranial Magnetic Stimulation in Depressive Patients: A Retrospective Analysis of a Large Sample. Front Psychiatry 2019; 10:929. [PMID: 31969842 PMCID: PMC6960193 DOI: 10.3389/fpsyt.2019.00929] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Suicide is a major public health problem. About 90% of suicide victims have one or more major psychiatric disorder, with a reported 20-fold increased risk for suicide in patients with affective disorders in comparison with healthy subjects. Repetitive transcranial magnetic stimulation (rTMS) has been established as an effective alternative or adjunctive treatment option for patients with depressive disorders, but little is known about its effects on suicide risk. Objective: For the assessment of the effectiveness of rTMS on suicidal ideation and behaviors, we performed a retrospective analysis of a large sample of patients with depressive disorders, who were treated with rTMS. Methods: We analyzed the records of 711 TMS in- and out-patients with depressive affective disorders in a tertiary referral hospital between 2002 and 2017. Out of these patients we were able to collect Hamilton depression rating scale (HAMD) data of 332 patients (180 females, 152 males; age range 20 to 79 years; mean age 47.3 ± 12.3) for which we analyzed the change of suicidal ideation by using item 3 (suicidality) of HAMD. Results: Out of all 711 patients treated with rTMS for their depression, one patient (0.1%) committed suicide during the TMS treatment. In the statistical analysis of the subsample with 332 patients there was an overall amelioration of depressive symptoms accompanied by a significant decrease in the suicidality item with a medium effect size. Decrease in suicidality was not inferior to changes in other items as indicated by effect sizes. Forty-seven percent of patients showed an amelioration in suicidality, 41.3% of patients did not show a change in their suicidality's scores, and 11.7% of patients showed an increase in suicidality's scores from baseline to final rating. Correlation of item 3 (suicidality) and item 7 (drive) demonstrated a significant positive association, revealing improved drive with a parallel decreased suicidality. Conclusion: Based on the proposed data, there is no evidence that rTMS increases the risk for suicide during the course of the treatment. Conversely, rTMS tends to reduce suicidal ideation. Our findings call for further rTMS controlled studies using large sample sizes and specific suicidality assessment measures to obtain more conclusive results.
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Affiliation(s)
- Mohamed A Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Markus Deppe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alexey Mohonko
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Tobias Hebel
- 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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10
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Jang KI, Shim M, Lee S, Hwang HJ, Chae JH. Changes in Global and Nodal Networks in Patients With Unipolar Depression After 3-Week Repeated Transcranial Magnetic Stimulation Treatment. Front Psychiatry 2019; 10:686. [PMID: 31649561 PMCID: PMC6794380 DOI: 10.3389/fpsyt.2019.00686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: Repeated transcranial magnetic stimulation (rTMS) therapy has been applied in depressive disorders, but its neurobiological effect has not been well understood. Changes in cortical source network after treatment need to be confirmed. The present study investigated the effect of 3-week rTMS therapy on the symptom severity and cortical source network in patients with unipolar depression. Methods: Thirty-five patients with unipolar major depressive disorder participated in the study. High-frequency (10 Hz) rTMS was applied at the left dorsolateral prefrontal cortex during 3 weeks (five consecutive weekdays every week). Clinical symptoms were examined using the Hamilton Rating Scale for Depression and Anxiety. The resting state electroencephalography was recorded with 62 scalp channels before and after rTMS treatment. Results: Clinical symptoms significantly improved after rTMS treatment in both the active (p = 0.001) and sham groups (p = 0.002). However, an increased cortical source network in global and nodal levels was observed only in the active group after a 3-week treatment. Conclusions: The present study indicates that rTMS treatment leads to improved symptoms in patients with unipolar depression. Furthermore, treatment outcome of real effect was assured in changes of cortical source network.
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Affiliation(s)
- Kuk-In Jang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Miseon Shim
- Department of Psychiatry, University of Missouri-Kansas City, Center for Behavioral Medicine, Kansas, MO, United States.,Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Sangmin Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han-Jeong Hwang
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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11
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Hodaj H, Payen JF, Lefaucheur JP. Therapeutic impact of motor cortex rTMS in patients with chronic neuropathic pain even in the absence of an analgesic response. A case report. Neurophysiol Clin 2018; 48:303-308. [DOI: 10.1016/j.neucli.2018.05.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022] Open
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12
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Kobayashi B, Cook IA, Hunter AM, Minzenberg MJ, Krantz DE, Leuchter AF. Can neurophysiologic measures serve as biomarkers for the efficacy of repetitive transcranial magnetic stimulation treatment of major depressive disorder? Int Rev Psychiatry 2017; 29:98-114. [PMID: 28362541 DOI: 10.1080/09540261.2017.1297697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD). There are clinical data that support the efficacy of many different approaches to rTMS treatment, and it remains unclear what combination of stimulation parameters is optimal to relieve depressive symptoms. Because of the costs and complexity of studies that would be necessary to explore and compare the large number of combinations of rTMS treatment parameters, it would be useful to establish reliable surrogate biomarkers of treatment efficacy that could be used to compare different approaches to treatment. This study reviews the evidence that neurophysiologic measures of cortical excitability could be used as biomarkers for screening different rTMS treatment paradigms. It examines evidence that: (1) changes in excitability are related to the mechanism of action of rTMS; (2) rTMS has consistent effects on measures of excitability that could constitute reliable biomarkers; and (3) changes in excitability are related to the outcomes of rTMS treatment of MDD. An increasing body of evidence indicates that these neurophysiologic measures have the potential to serve as reliable biomarkers for screening different approaches to rTMS treatment of MDD.
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Affiliation(s)
- Brian Kobayashi
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA
| | - Ian A Cook
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA.,d Department of Bioengineering , University of California Los Angeles , Los Angeles , CA , USA
| | - Aimee M Hunter
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA
| | - Michael J Minzenberg
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA
| | - David E Krantz
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA
| | - Andrew F Leuchter
- a David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA.,c Neuromodulation Division , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles , CA , USA
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13
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Transcranial Direct Current Stimulation for the Treatment of Depression: a Comprehensive Review of the Recent Advances. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9741-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Beuzon G, Timour Q, Saoud M. Predictors of response to repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder. Encephale 2016; 43:3-9. [PMID: 28034451 DOI: 10.1016/j.encep.2016.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/28/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), based on the principle of electromagnetic induction, consists of applying series of magnetic impulses to the cerebral cortex so as to modulate neurone activity in a target zone. This technique, still experimental, could prove promising in the field of psychiatry, in particular for the treatment of major depressive disorder. It is important for the clinician to be able to assess the response potential of a given patient to rTMS, and this among other things requires relevant predictive factors to be available. This review of the literature aims to determine and analyse reported predictive factors for therapeutic response to rTMS treatment in major depressive disorder. Different parameters are studied, in particular age, the severity of the depressive episode, psychological dimensions, genetic factors, cerebral blood flows via cerebral imagery, and neuronavigation. The factors found to be associated with better therapeutic response were young age, low level of severity of the depressive episode, motor threshold intensity over 100%, more than 1000 stimulations per session, more than 10 days treatment, L/L genotype on the 5-HTTLPR transporter gene, C/C homozygosity on the promotor regions of the 5-HT1A receptor gene, Val/Val homozygosity on the BDNF gene, cordance analyses by EEG, and finally the accurate localisation provided by neuronavigation. The authors conclude that investigations in larger patient samples are required in the future, and that the work already achieved should provide lines of approach for the coming experimental studies.
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Affiliation(s)
- G Beuzon
- Pharmacologie médicale, EA 4312 neurocardiologie, physiopathologie des troubles du rythme cardiaque, hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
| | - Q Timour
- Pharmacologie médicale, EA 4612 neurocardiologie, physiopathologie des troubles du rythme cardiaque hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
| | - M Saoud
- Unité de recherche EA4615, PsyR, université Claude-Bernard-Lyon 1, 27-29, boulevard du 11-Novembre-1918, 69622 Lyon, France; Service de psychiatrie adultes liaison consultation, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France.
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15
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Leung A, Shukla S, Fallah A, Song D, Lin L, Golshan S, Tsai A, Jak A, Polston G, Lee R. Repetitive Transcranial Magnetic Stimulation in Managing Mild Traumatic Brain Injury-Related Headaches. Neuromodulation 2015; 19:133-41. [DOI: 10.1111/ner.12364] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Albert Leung
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shivshil Shukla
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amir Fallah
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - David Song
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Lisa Lin
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shahrokh Golshan
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
- Biostatistics Core; Veterans Medical Research Foundation; San Diego CA USA
| | - Alice Tsai
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amy Jak
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Greg Polston
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Roland Lee
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
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Baeken C, Desmyter S, Duprat R, De Raedt R, Van Denabbeele D, Tandt H, Lemmens GMD, Vervaet M, van Heeringen K. Self-directedness: an indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression. Psychiatry Res 2014; 220:269-74. [PMID: 25175912 DOI: 10.1016/j.psychres.2014.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/27/2014] [Accepted: 07/31/2014] [Indexed: 12/26/2022]
Abstract
Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
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Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Psychiatry University Hospital (UZBrussel), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Stefanie Desmyter
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dirk Van Denabbeele
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Myriam Vervaet
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
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Brunelin J, Jalenques I, Trojak B, Attal J, Szekely D, Gay A, Januel D, Haffen E, Schott-Pethelaz AM, Brault C, Poulet E. The Efficacy and Safety of Low Frequency Repetitive Transcranial Magnetic Stimulation for Treatment-resistant Depression: The Results From a Large Multicenter French RCT. Brain Stimul 2014; 7:855-63. [DOI: 10.1016/j.brs.2014.07.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/18/2014] [Accepted: 07/31/2014] [Indexed: 02/07/2023] Open
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Micoulaud-Franchi JA, Richieri R, Lancon C, Vion-Dury J. Protocoles de rTMS interactives en psychiatrie. Encephale 2013; 39:426-31. [DOI: 10.1016/j.encep.2013.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 02/07/2013] [Indexed: 11/28/2022]
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Li CT, Su TP, Hsieh JC, Ho ST. Efficacy and practical issues of repetitive transcranial magnetic stimulation on chronic medically unexplained symptoms of pain. ACTA ACUST UNITED AC 2013; 51:81-7. [DOI: 10.1016/j.aat.2013.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/01/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Moreno-Duarte I, Morse LR, Alam M, Bikson M, Zafonte R, Fregni F. Targeted therapies using electrical and magnetic neural stimulation for the treatment of chronic pain in spinal cord injury. Neuroimage 2013; 85 Pt 3:1003-13. [PMID: 23727533 DOI: 10.1016/j.neuroimage.2013.05.097] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/17/2013] [Accepted: 05/23/2013] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chronic neuropathic pain is one of the most common and disabling symptoms in individuals with spinal cord injury (SCI). Over two-thirds of subjects with SCI suffer from chronic pain influencing quality of life, rehabilitation, and recovery. Given the refractoriness of chronic pain to most pharmacological treatments, the majority of individuals with SCI report worsening of this condition over time. Moreover, only 4-6% of patients in this cohort report improvement. Novel treatments targeting mechanisms associated with pain-maladaptive plasticity, such as electromagnetic neural stimulation, may be desirable to improve outcomes. To date, few, small clinical trials have assessed the effects of invasive and noninvasive nervous system stimulation on pain after SCI. OBJECTIVE We aimed to review initial efficacy, safety and potential predictors of response by assessing the effects of neural stimulation techniques to treat SCI pain. SEARCH STRATEGY A literature search was performed using the PubMed database including studies using the following targeted stimulation strategies: transcranial Direct Current Stimulation (tDCS), High Definition tDCS (HD-tDCS), repetitive Transcranial Magnetical Stimulation (rTMS), Cranial Electrotherapy Stimulation (CES), Transcutaneous Electrical Nerve Stimulation (TENS), Spinal Cord Stimulation (SCS) and Motor Cortex Stimulation (MCS), published prior to June of 2012. We included studies from 1998 to 2012. RESULTS Eight clinical trials and one naturalistic observational study (nine studies in total) met the inclusion criteria. Among the clinical trials, three studies assessed the effects of tDCS, two of CES, two of rTMS and one of TENS. The naturalistic study investigated the analgesic effects of SCS. No clinical trials for epidural motor cortex stimulation (MCS) or HD-tDCS were found. Parameters of stimulation and also clinical characteristics varied significantly across studies. Three out of eight studies showed larger effects sizes (0.73, 0.88 and 1.86 respectively) for pain reduction. Classical neuropathic pain symptoms such as dysesthesia (defined as an unpleasant burning sensation in response to touch), allodynia (pain due to a non-painful stimulus), pain in paroxysms, location of SCI in thoracic and lumbar segments and pain in the lower limbs seem to be associated with a positive response to neural stimulation. No significant adverse effects were reported in these studies. CONCLUSIONS Chronic pain in SCI is disabling and resistant to common pharmacologic approaches. Electrical and magnetic neural stimulation techniques have been developed to offer a potential tool in the management of these patients. Although some of these techniques are associated with large standardized mean differences to reduce pain, we found an important variability in these results across studies. There is a clear need for the development of methods to decrease treatment variability and increase response to neural stimulation for pain treatment. We discuss potential methods such as neuroimaging or EEG-guided neural stimulation and the development of better surrogate markers of response such as TMS-indexed cortical plasticity.
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Affiliation(s)
- Ingrid Moreno-Duarte
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, USA; Spaulding-Harvard Spinal Cord Injury Model System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Brain structural and psychometric alterations in chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1958-64. [PMID: 23392554 DOI: 10.1007/s00586-013-2692-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/25/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Chronic low back pain (CLBP) is one of the most important pain disorders with increasing social and economic implications. Given that CLBP is a multidimensional process associated with comorbidities such as anxiety and depression, treatment of chronic low back pain is still a challenge. Advancement of in vivo brain imaging technologies has revealed increasing insights into the etiology and pathogenesis of chronic pain; however, the exact mechanisms of chronification of LBP remain still unclear. The purpose of the present study was to analyse the neurostructural alterations in CLBP and to evaluate the role of comorbidities and their neurostructural underpinnings. METHODS In the present study we investigated a well-characterized group of 14 patients with CLBP and 14 healthy controls applying structural MRI and psychometric measures. Using an improved algorithm for brain normalization (DARTEL) we performed a voxel-based morphometry (VBM) approach. Correlation analyses were performed to evaluate the role of anxiety and depression in neurostructural alterations observed in CLBP. RESULTS The psychometric measures revealed significantly higher scores on depression and anxiety in the patient population. VBM analysis showed significant decreases in grey matter density in areas associated with pain processing and modulation, i.e. the dorsolateral prefrontal cortex, the thalamus and the middle cingulate cortex. With respect to anxiety and depression scores, we did not observe any correlations to the structural data. CONCLUSIONS In the present study we found compelling evidence for alterations of grey matter architecture in CLBP in brain regions playing a major role in pain modulation and control. Our results fit the hypothesis of a "brain signature" in chronic pain conditions. The results of the psychometric assessment underline the importance of an interdisciplinary therapeutic approach including orthopedic, neurological and psychological evaluation and treatment.
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Dumas R, Padovani R, Richieri R, Lançon C. Stimulation magnétique transcrânienne répétée dans la prise en charge des épisodes dépressifs majeurs : facteurs prédictifs de réponse thérapeutique. Encephale 2012; 38:360-8. [DOI: 10.1016/j.encep.2011.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 05/13/2011] [Indexed: 01/18/2023]
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Rochas V, Gelmini L, Krolak-Salmon P, Poulet E, Saoud M, Brunelin J, Bediou B. Disrupting Pre-SMA Activity Impairs Facial Happiness Recognition: An Event-Related TMS Study. Cereb Cortex 2012; 23:1517-25. [DOI: 10.1093/cercor/bhs133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Jaafari N, Rachid F, Rotge JY, Polosan M, El-Hage W, Belin D, Vibert N, Pelissolo A. Safety and efficacy of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder: a review. World J Biol Psychiatry 2012; 13:164-77. [PMID: 21623668 DOI: 10.3109/15622975.2011.575177] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) is a chronic, often severe, neuropsychiatric disorder leading to a dramatic impairment in interpersonal and occupational functions. rTMS has been tried out in several studies in patients with OCD with different characteristics. In this paper, we review the safety and efficacy of rTMS in the treatment of mostly severe resistant OCD. METHODS A review of the English literature from 1966 to 2010 pertaining to rTMS in the treatment of OCD was conducted using MEDLINE by selectively entering the search terms "transcranial magnetic stimulation", "repetitive transcranial magnetic stimulation", "obsessive-compulsive disorder" and "OCD". Twelve studies including open and randomized, sham-controlled trials were included in this review. RESULTS Although available data about the use of rTMS in OCD treatment are quite heterogeneous in terms of sample size, study design, stimulus parameters used and stimulation areas targeted, promising findings regarding rTMS efficacy appeared for two structures based on recent controlled studies: the supplementary motor area and the orbitofrontal cortex. On the other hand, rTMS of the dorsolateral prefrontal cortex is not significantly effective when compared to sham rTMS. CONCLUSIONS Three target areas have already been selected of which the supplementary motor area in particular and the orbitofrontal cortex seem to be the most promising in terms of potential efficacy and could more accurately be targeted with the help of neuronavigational techniques. Larger randomized controlled trials should be conducted in order to better clarify the therapeutic role of rTMS in OCD.
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Affiliation(s)
- Nematollah Jaafari
- Unité de recherche clinique intersectorielle en psychiatrie, Centre Hospitalier Henri Laborit , INSERM CIC-P 0802, CHU et faculté de médecine de Poitiers, Poitiers, France.
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Eche J, Mondino M, Haesebaert F, Saoud M, Poulet E, Brunelin J. Low- vs High-Frequency Repetitive Transcranial Magnetic Stimulation as an Add-On Treatment for Refractory Depression. Front Psychiatry 2012; 3:13. [PMID: 22408627 PMCID: PMC3296064 DOI: 10.3389/fpsyt.2012.00013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/12/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) seems to be effective as an antidepressant, however, some confusion remains about the best parameters to apply and the efficacy of its association with pharmacological antidepressant treatments. METHOD In a single blind randomized study 14 patients with unipolar resistant depression to one antidepressant treatment were enrolled to receive, in combination with venlafaxine (150 mg), either 20 sessions of 10 Hz rTMS (2000 pulses per session) applied over the left dorsolateral prefrontal cortex (DLPFC) or 20 sessions of 1 Hz rTMS (120 stimulations per sessions) applied over the right DLPFC. RESULTS A similar antidepressant effect was observed in both groups with a comparable antidepressant delay of action (2 weeks) and a comparable number of responders (MADRS < 15) after 4 weeks of daily rTMS sessions (66 vs 50%). CONCLUSION Low- and high- frequency rTMS seems to be effective as an add-on treatment to venlafaxine as monotherapy in pharmacological refractory major depression (stage 1). Due to its short duration (one session of 1 Hz rTMS lasts 4 min vs 16 for 10 Hz rTMS) and its safety, low frequency rTMS may be a useful alternative treatment for patients with refractory depression.
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McDonald WM, Durkalski V, Ball ER, Holtzheimer PE, Pavlicova M, Lisanby SH, Avery D, Anderson BS, Nahas Z, Zarkowski P, Sackeim HA, George MS. Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety 2011; 28:973-80. [PMID: 21898711 PMCID: PMC4413508 DOI: 10.1002/da.20885] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/05/2011] [Accepted: 07/10/2011] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To assess the efficacy of increasing the number of fast left repetitive transcranial magnetic stimulations (rTMS) (10 Hz @ 120% of motor threshold (MT) over the left dorsolateral prefrontal cortex (DLPFC)) needed to achieve remission in treatment-resistant depression (TRD). And, to determine if patients who do not remit to fast left will remit using slow right rTMS (1 Hz @ 120% MT over the right DLPFC). METHOD Patients were part of a multicenter sham-controlled trial investigating the efficacy of fast left rTMS. Patients who failed to meet minimal response criteria in the sham-controlled study could enroll in this open fast left rTMS study for an additional 3-6 weeks. Patients who failed to remit to fast left could switch to slow right rTMS for up to 4 additional weeks. The final outcome measure was remission, defined as a HAM-D score of <3 or 2 consecutive HAM-D scores less than 10. RESULTS Forty-three of 141 (30.5%) patients who enrolled in the open phase study eventually met criteria for remission. Patients who remitted during fast left treatment received a mean of 26 active treatments (90,000 pulses). Twenty-six percent of patients who failed fast left remitted during slow right treatment. CONCLUSION The total number of rTMS stimulations needed to achieve remission in TRD may be higher than is used in most studies. TRD patients who do not respond to fast left rTMS may remit to slow right rTMS or additional rTMS stimulations.
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Affiliation(s)
| | - Valerie Durkalski
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston
| | - Edward R. Ball
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston
| | | | - Martina Pavlicova
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York
| | | | - David Avery
- Department of Psychiatry, University of Washington, Seattle
| | - Berry S. Anderson
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Ziad Nahas
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Paul Zarkowski
- Department of Psychiatry, University of Washington, Seattle
| | - Harold A. Sackeim
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston,Ralph H. Johnson Veterans Affairs Medical Center, Charleston
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Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci 2011; 31:7540-50. [PMID: 21593339 DOI: 10.1523/jneurosci.5280-10.2011] [Citation(s) in RCA: 427] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic pain is associated with reduced brain gray matter and impaired cognitive ability. In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes. We acquired MRI scans from chronic low back pain (CLBP) patients before (n = 18) and 6 months after (spine surgery or facet joint injections; n = 14) treatment. In addition, we scanned 16 healthy controls, 10 of which returned 6 months after the first visit. We performed cortical thickness analysis on structural MRI scans, and subjects performed a cognitive task during the functional MRI. We compared patients and controls, as well as patients before versus after treatment. After treatment, patients had increased cortical thickness in the left dorsolateral prefrontal cortex (DLPFC), which was thinner before treatment compared with controls. Increased DLPFC thickness correlated with the reduction of both pain and physical disability. Additionally, increased thickness in primary motor cortex was associated specifically with reduced physical disability, and right anterior insula was associated specifically with reduced pain. Left DLPFC activity during an attention-demanding cognitive task was abnormal before treatment, but normalized following treatment. These data indicate that functional and structural brain abnormalities-specifically in the left DLPFC-are reversible, suggesting that treating chronic pain can restore normal brain function in humans.
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Richieri R, Boyer L, Farisse J, Colavolpe C, Mundler O, Lancon C, Guedj E. Predictive value of brain perfusion SPECT for rTMS response in pharmacoresistant depression. Eur J Nucl Med Mol Imaging 2011; 38:1715-22. [PMID: 21647787 DOI: 10.1007/s00259-011-1850-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/16/2011] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to determine the predictive value of whole-brain voxel-based regional cerebral blood flow (rCBF) for repetitive transcranial magnetic stimulation (rTMS) response in patients with pharmacoresistant depression. METHODS Thirty-three right-handed patients who met DSM-IV criteria for major depressive disorder (unipolar or bipolar depression) were included before rTMS. rTMS response was defined as at least 50% reduction in the baseline Beck Depression Inventory scores. The predictive value of (99m)Tc-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) for rTMS response was studied before treatment by comparing rTMS responders to non-responders at voxel level using Statistical Parametric Mapping (SPM) (p < 0.001, uncorrected). RESULTS Of the patients, 18 (54.5%) were responders to rTMS and 15 were non-responders (45.5%). There were no statistically significant differences in demographic and clinical characteristics (p > 0.10). In comparison to responders, non-responders showed significant hypoperfusions (p < 0.001, uncorrected) in the left medial and bilateral superior frontal cortices (BA10), the left uncus/parahippocampal cortex (BA20/BA35) and the right thalamus. The area under the curve for the combination of SPECT clusters to predict rTMS response was 0.89 (p < 0.001). Sensitivity, specificity, positive predictive value and negative predictive value for the combination of clusters were: 94, 73, 81 and 92%, respectively. CONCLUSION This study shows that, in pharmacoresistant depression, pretreatment rCBF of specific brain regions is a strong predictor for response to rTMS in patients with homogeneous demographic/clinical features.
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Affiliation(s)
- Raphaelle Richieri
- Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France
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Richieri R, Adida M, Dumas R, Fakra E, Azorin JM, Pringuey D, Lancon C. Troubles affectifs et stimulation magnétique transcrânienne répétée : innovations thérapeutiques. Encephale 2010; 36 Suppl 6:S197-201. [DOI: 10.1016/s0013-7006(10)70057-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li CT, Wang SJ, Hirvonen J, Hsieh JC, Bai YM, Hong CJ, Liou YJ, Su TP. Antidepressant mechanism of add-on repetitive transcranial magnetic stimulation in medication-resistant depression using cerebral glucose metabolism. J Affect Disord 2010; 127:219-29. [PMID: 20598753 DOI: 10.1016/j.jad.2010.05.028] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/24/2010] [Accepted: 05/29/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Add-on repetitive transcranial magnetic stimulation (rTMS) is effective in treating medication-resistant depression (MRD), but little is known about the rTMS antidepressant mechanism and pathophysiology underlying MRD. METHODS Twenty MRD patients received 2 weeks of navigated add-on rTMS to the left dorsolateral prefrontal cortex (DLPFC). Treatment response was defined as a ≥50% decrease in HDRS after treatment. Cerebral glucose metabolism was measured from all MRD patients twice, before and 3 months after rTMS, and from 20 healthy controls once at baseline. RESULTS At baseline, MRD subjects presented significant hypometabolism at the bilateral DLPFC and anterior cingulum, as well as hypermetabolism at several limbic and subcortical regions compared to the controls. Higher metabolism at the medial PFC and rostral anterior cingulum, and lower metabolism at the limbic structures, including the left parahippocampus and fusiform gyrus, predicted a response to rTMS. After successful rTMS treatment, the abnormally elevated metabolism in the left middle temporal cortex and fusiform gyrus decreased significantly, suggesting a reversal of metabolic imbalances. However, the overall metabolic pattern was still abnormal, even after their depression was under control. In contrast, the non-responders showed a worsening pattern of increased metabolism in the bilateral temporal cortex and fusiform gyrus. CONCLUSIONS The antidepressant mechanism of add-on rTMS may be reflected as suppression of hyperactivity in the left temporal cortex and fusiform gyrus, perhaps through enhancing the function of the medial prefrontal cortex and anterior cingulum. The limbic-cortical dysregulation of glucose metabolism might be a trait of an underlying mechanism of MRD.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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Brunelin J, Maklouf WB, Nicolas A, Saoud M, Poulet E. Successful switch to maintenance rTMS after maintenance ECT in refractory bipolar disorder. Brain Stimul 2010; 3:238-9. [DOI: 10.1016/j.brs.2010.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022] Open
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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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Brunelin J, Poulet E, Bor J, Rivet A, Eche J, d’Amato T, Saoud M. Stimulation magnétique transcrânienne répétée (rTMS) et symptômes négatifs de la schizophrénie. ANNALES MEDICO-PSYCHOLOGIQUES 2010. [DOI: 10.1016/j.amp.2010.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jalenques I, Legrand G, Vaille-Perret E, Tourtauchaux R, Galland F. Efficacité et tolérance de la stimulation magnétique transcrânienne (SMTr) dans le traitement des dépressions chez le sujet âgé : revue de la littérature. Encephale 2010; 36 Suppl 2:D105-18. [DOI: 10.1016/j.encep.2009.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
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Liang X, Liu K, Guo L. Repetitive transcranial magnetic stimulation (rTMS): A possible novel therapeutic approach to dementia with Lewy bodies. Med Hypotheses 2010; 74:877-9. [DOI: 10.1016/j.mehy.2009.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/18/2009] [Indexed: 11/16/2022]
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Trojak B, Leclercq S, Bonin B, Gisselmann A. The growing enthusiasm for transcranial magnetic stimulation (TMS). Presse Med 2010; 39:411-2. [DOI: 10.1016/j.lpm.2010.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/30/2009] [Accepted: 01/06/2010] [Indexed: 11/30/2022] Open
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Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) during capsaicin-induced pain: modulatory effects on motor cortex excitability. Exp Brain Res 2010; 203:31-8. [PMID: 20232062 DOI: 10.1007/s00221-010-2206-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 02/21/2010] [Indexed: 01/26/2023]
Abstract
Evidence by functional imaging studies suggests the role of left DLPFC in the inhibitory control of nociceptive transmission system. Pain exerts an inhibitory modulation on motor cortex, reducing MEP amplitude, while the effect of pain on motor intracortical excitability has not been studied so far. In the present study, we explored in healthy subjects the effect of capsaicin-induced pain and the modulatory influences of left DLPFC stimulation on motor corticospinal and intracortical excitability. Capsaicin was applied on the dorsal surface of the right hand, and measures of motor corticospinal excitability (test-MEP) and short intracortical inhibition (SICI) and facilitation (ICF) were obtained by paired-pulse TMS on left motor cortex. Evaluations were made before and at different times after capsaicin application in two separate sessions: without and with high-frequency rTMS of left DLPF cortex, delivered 10 min. after capsaicin application. We performed also two control experiments to explore: 1: the effects of Left DLPFC rTMS on capsaicin-induced pain; 2: the modulatory influence of left DLPFC rTMS on motor cortex without capsaicin application. Capsaicin-induced pain significantly reduced test MEP amplitude and decreased SICI leaving ICF unchanged. Left DLPFC rTMS, together with the analgesic effect, was able to revert the effects of capsaicin-induced pain on motor cortex restoring normal MEP and SICI levels. These data support the notion that that tonic pain exerts modulatory influence on motor intracortical excitability; the activation of left DLPFC by hf rTMS could have analgesic effects, reverting also the motor cortex excitability changes induced by pain stimulation.
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Cho SS, Strafella AP. rTMS of the left dorsolateral prefrontal cortex modulates dopamine release in the ipsilateral anterior cingulate cortex and orbitofrontal cortex. PLoS One 2009; 4:e6725. [PMID: 19696930 PMCID: PMC2725302 DOI: 10.1371/journal.pone.0006725] [Citation(s) in RCA: 300] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 07/21/2009] [Indexed: 11/27/2022] Open
Abstract
Background Brain dopamine is implicated in the regulation of movement, attention, reward and learning and plays an important role in Parkinson's disease, schizophrenia and drug addiction. Animal experiments have demonstrated that brain stimulation is able to induce significant dopaminergic changes in extrastriatal areas. Given the up-growing interest of non-invasive brain stimulation as potential tool for treatment of neurological and psychiatric disorders, it would be critical to investigate dopaminergic functional interactions in the prefrontal cortex and more in particular the effect of dorsolateral prefrontal cortex (DLPFC) (areas 9/46) stimulation on prefrontal dopamine (DA). Methodology/Principal Findings Healthy volunteers were studied with a high-affinity DA D2-receptor radioligand, [11C]FLB 457-PET following 10 Hz repetitive transcranial magnetic stimulation (rTMS) of the left and right DLPFC. rTMS on the left DLPFC induced a significant reduction in [11C]FLB 457 binding potential (BP) in the ipsilateral subgenual anterior cingulate cortex (ACC) (BA 25/12), pregenual ACC (BA 32) and medial orbitofrontal cortex (BA 11). There were no significant changes in [11C]FLB 457 BP following right DLPFC rTMS. Conclusions/Significance To our knowledge, this is the first study to provide evidence of extrastriatal DA modulation following acute rTMS of DLPFC with its effect limited to the specific areas of medial prefrontal cortex. [11C]FLB 457-PET combined with rTMS may allow to explore the neurochemical functions of specific cortical neural networks and help to identify the neurobiological effects of TMS for the treatment of different neurological and psychiatric diseases.
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Affiliation(s)
- Sang Soo Cho
- Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Canada
- PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | - Antonio P. Strafella
- Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Canada
- PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
- * E-mail:
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