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Chen J, Amdanee N, Zuo X, Wang Y, Gong M, Yang Y, Li H, Zhang X, Zhang C. Biomarkers of bipolar disorder based on metabolomics: A systematic review. J Affect Disord 2024; 350:492-503. [PMID: 38218254 DOI: 10.1016/j.jad.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
Bipolar disorder (BD) is a severe affective disorder characterized by recurrent episodes of depression or mania/hypomania, which significantly impair cognitive function, life skills, and social abilities of patients. There is little understanding of the neurobiological mechanisms of BD. The diagnosis of BD is primarily based on clinical assessment and psychiatric examination, highlighting the urgent need for objective markers to facilitate the diagnosis of BD. Metabolomics can be used as a diagnostic tool for disease identification and evaluation. This study summarized the altered metabolites in BD and analyzed aberrant metabolic pathways, which might contribute to the diagnosis of BD. Search of PubMed and Web of science for human BD studies related to metabolism to identify articles published up to November 19, 2022 yielded 987 articles. After screening and applying the inclusion and exclusion criteria, 16 untargeted and 11 targeted metabolomics studies were included. Pathway analysis of the potential differential biometabolic markers was performed using the Kyoto encyclopedia of genes and genomes (KEGG). There were 72 upregulated and 134 downregulated biomarkers in the untargeted metabolomics studies using blood samples. Untargeted metabolomics studies utilizing urine specimens revealed the presence of 78 upregulated and 54 downregulated metabolites. The targeted metabolomics studies revealed abnormalities in the metabolism of glutamate and tryptophan. Enrichment analysis revealed that the differential metabolic pathways were mainly involved in the metabolism of glucose, amino acid and fatty acid. These findings suggested that certain metabolic biomarkers or metabolic biomarker panels might serve as a reference for the diagnosis of BD.
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Affiliation(s)
- Jin Chen
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China; Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu,210000, China
| | - Nousayhah Amdanee
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu,210000, China
| | - Xiaowei Zuo
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China
| | - Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu,210000, China
| | - Muxin Gong
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China
| | - Yujing Yang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China
| | - Hao Li
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China
| | - Xiangrong Zhang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China; Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu,210000, China.
| | - Caiyi Zhang
- Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu,221004, China.
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Abstract
Major depressive disorder (MDD) is a leading cause of suicide in the world. Monoamine-based antidepressant drugs are a primary line of treatment for this mental disorder, although the delayed response and incomplete efficacy in some patients highlight the need for improved therapeutic approaches. Over the past two decades, ketamine has shown rapid onset with sustained (up to several days) antidepressant effects in patients whose MDD has not responded to conventional antidepressant drugs. Recent preclinical studies have started to elucidate the underlying mechanisms of ketamine's antidepressant properties. Herein, we describe and compare recent clinical and preclinical findings to provide a broad perspective of the relevant mechanisms for the antidepressant action of ketamine.
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Affiliation(s)
- Ji-Woon Kim
- Department of Pharmacology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA;
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation through Science, Kyung Hee University, Seoul, Republic of Korea
| | - Kanzo Suzuki
- Department of Pharmacology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA;
- Department of Biological Science and Technology, Faculty of Advanced Engineering, Tokyo University of Science, Katsushika-ku, Tokyo, Japan
| | - Ege T Kavalali
- Department of Pharmacology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA;
| | - Lisa M Monteggia
- Department of Pharmacology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA;
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3
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Bohnen JLB, Wigstrom TP, Griggs AM, Roytman S, Paalanen RR, Andrews HA, Bohnen NI, Franklin JJH, McInnis MG. Ketogenic-Mimicking Diet as a Therapeutic Modality for Bipolar Disorder: Biomechanistic Rationale and Protocol for a Pilot Clinical Trial. Nutrients 2023; 15:3068. [PMID: 37447394 PMCID: PMC10346691 DOI: 10.3390/nu15133068] [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: 06/07/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
There is growing interest in the investigation of ketogenic diets as a potential therapy for bipolar disorder. The overlapping pharmacotherapies utilized for both bipolar disorder and seizures suggest that a mechanistic overlap may exist between these conditions, with fasting and the ketogenic diet representing the most time-proven therapies for seizure control. Recently, preliminary evidence has begun to emerge supporting a potential role for ketogenic diets in treating bipolar disorder. Notably, some patients may struggle to initiate a strict diet in the midst of a mood episode or significant life stressors. The key question addressed by this pilot clinical trial protocol is if benefits can be achieved with a less restrictive diet, as this would allow such an intervention to be accessible for more patients. Recent development of so-called ketone esters, that once ingested is converted to natural ketone bodies, combined with low glycemic index dietary changes has the potential to mimic two foundational components of therapeutic ketosis: high levels of ketones and minimal spiking of glucose/insulin. This pilot clinical trial protocol thus aims to investigate the effect of a 'ketogenic-mimicking diet' (combining supplementation of ketone esters with a low glycemic index dietary intervention) on neural network stability, mood, and biomarker outcomes in the setting of bipolar disorder. Positive findings obtained via this pilot clinical trial protocol may support future target engagement studies of ketogenic-mimicking diets or related ketogenic interventions. A lack of positive findings, in contrast, may justify a focus on more strict dietary interventions for future research.
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Affiliation(s)
| | | | - Alexis M. Griggs
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Stiven Roytman
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | - Nicolaas I. Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
- Heinz C. Prechter Bipolar Research Program, University of Michigan, Ann Arbor, MI 48109, USA
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Onitsuka T, Tsuchimoto R, Oribe N, Spencer KM, Hirano Y. Neuronal imbalance of excitation and inhibition in schizophrenia: a scoping review of gamma-band ASSR findings. Psychiatry Clin Neurosci 2022; 76:610-619. [PMID: 36069299 DOI: 10.1111/pcn.13472] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022]
Abstract
Recent empirical findings suggest that altered neural synchronization, which is hypothesized to be associated with an imbalance of excitatory (E) and inhibitory (I) neuronal activities, may underlie a core pathophysiological mechanism in patients with schizophrenia. The auditory steady-state response (ASSR) examined by electroencephalography (EEG) and magnetoencephalography (MEG) has been proposed as a potential biomarker for evaluating altered neural synchronization in schizophrenia. For this review, we performed a comprehensive literature search for papers published between 1999 and 2021 examining ASSRs in patients with schizophrenia. Almost all EEG-ASSR studies reported gamma-band ASSR reductions, especially to 40-Hz stimuli both in power and/or phase synchronization in chronic and first-episode schizophrenia. In addition, similar to EEG-ASSR findings, MEG-ASSR deficits to 80-Hz stimuli (high gamma) have been reported in patients with schizophrenia. Moreover, the 40-Hz ASSR is likely to be a predictor of the onset of schizophrenia. Notably, increased spontaneous (or ongoing) broadband (30-100 Hz) gamma power has been reported during ASSR tasks, which resembles the increased spontaneous gamma activity reported in animal models of E/I imbalance. Further research on ASSRs and evoked and spontaneous gamma oscillations is expected to elucidate the pathophysiology of schizophrenia with translational implications.
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Affiliation(s)
- Toshiaki Onitsuka
- Department of Neuroimaging Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rikako Tsuchimoto
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Oribe
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Medical Center, Saga, Japan
| | - Kevin M Spencer
- Neural Dynamics Laboratory, Research Service, Veterans Affairs Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02130, USA.,Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Boston VA Healthcare System, Brockton Division and Harvard Medical School, Brockton, Massachusetts, USA
| | - Yoji Hirano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Neural Dynamics Laboratory, Research Service, Veterans Affairs Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, 02130, USA.,Clinical Neuroscience Division, Laboratory of Neuroscience, Department of Psychiatry, Boston VA Healthcare System, Brockton Division and Harvard Medical School, Brockton, Massachusetts, USA
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Sablaban IM, Sivananthan M. Attention-Deficit Hyperactivity Disorder-Associated Impulsive Aggression Treated With Lamotrigine. Am J Ther 2022; 29:e747-e748. [PMID: 32769396 DOI: 10.1097/mjt.0000000000001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ibrahim M Sablaban
- Department of Psychiatry, Henry Ford Hospital/Wayne State University, Detroit, MI
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Zavala-Tecuapetla C, Manjarrez-Marmolejo J, Ramírez-Jarquín JO, Rivera-Cerecedo CV. Eslicarbazepine, but Not Lamotrigine or Ranolazine, Shows Anticonvulsant Efficacy in Carbamazepine-Resistant Rats Developed by Window-Pentylenetetrazole Kindling. Brain Sci 2022; 12:brainsci12050629. [PMID: 35625015 PMCID: PMC9139658 DOI: 10.3390/brainsci12050629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 01/27/2023] Open
Abstract
Approximately 30% of epileptic patients develop Drug-Resistant Epilepsy. Based on evidence that shows a loss of efficacy in some sodium channel blocker antiseizure drugs in epilepsy, we focus our study on assessing the anticonvulsant efficacy of different sodium channel blockers on carbamazepine (CBZ)-resistant seizures generated using the window-pentylenetetrazole (PTZ) kindling model to verify whether one of these drugs presents some anticonvulsant effect that could have potential therapeutic use. Wistar rats were treated with a subthreshold dose of PTZ (35 mg/kg) three times/week. Fully kindled rats were then treated with a single dose of CBZ (40 mg/kg i.p.) at 2, 9 and 16 days after their last kindling stimulation to obtain CBZ-resistant rats. Right after, sodium channel blockers were tested for anticonvulsant action (lamotrigine, 30 mg/kg i.p.; eslicarbazepine, 150 or 300 mg/kg i.p.; ranolazine, 10, 20 or 40 mg/kg i.p.). Behavioral parameters included severity, latency or duration of convulsions. Our data showed for the first time directly that eslicarbazepine does have an anticonvulsant effect over CBZ-resistant seizures, while lamotrigine shows drug resistance and ranolazine demonstrates severe seizure worsening. It is of potential therapeutic relevance that eslicarbazepine could be useful to control seizures resistant to common sodium channel blockers such as CBZ.
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Affiliation(s)
- Cecilia Zavala-Tecuapetla
- Laboratory of Physiology of Reticular Formation, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, Mexico City 14269, Mexico;
- Correspondence:
| | - Joaquín Manjarrez-Marmolejo
- Laboratory of Physiology of Reticular Formation, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, La Fama, Mexico City 14269, Mexico;
| | - Josué Orlando Ramírez-Jarquín
- Department of Molecular Neuropathology, Institute of Cellular Physiology, National Autonomous University of Mexico, Circuito Exterior s/n, Ciudad Universitaria, Mexico City 04510, Mexico;
| | - Claudia Verónica Rivera-Cerecedo
- Bioterium Academic Unit, Institute of Cellular Physiology, National Autonomous University of Mexico, Circuito Exterior s/n, Ciudad Universitaria, Mexico City 04510, Mexico;
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Biondi A, Rocchi L, Santoro V, Rossini PG, Beatch GN, Richardson MP, Premoli I. Spontaneous and TMS-related EEG changes as new biomarkers to measure anti-epileptic drug effects. Sci Rep 2022; 12:1919. [PMID: 35121751 PMCID: PMC8817040 DOI: 10.1038/s41598-022-05179-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2022] [Indexed: 01/02/2023] Open
Abstract
Robust biomarkers for anti-epileptic drugs (AEDs) activity in the human brain are essential to increase the probability of successful drug development. The frequency analysis of electroencephalographic (EEG) activity, either spontaneous or evoked by transcranial magnetic stimulation (TMS-EEG) can provide cortical readouts for AEDs. However, a systematic evaluation of the effect of AEDs on spontaneous oscillations and TMS-related spectral perturbation (TRSP) has not yet been provided. We studied the effects of Lamotrigine, Levetiracetam, and of a novel potassium channel opener (XEN1101) in two groups of healthy volunteers. Levetiracetam suppressed TRSP theta, alpha and beta power, whereas Lamotrigine decreased delta and theta but increased the alpha power. Finally, XEN1101 decreased TRSP delta, theta, alpha and beta power. Resting-state EEG showed a decrease of theta band power after Lamotrigine intake. Levetiracetam increased theta, beta and gamma power, while XEN1101 produced an increase of delta, theta, beta and gamma power. Spontaneous and TMS-related cortical oscillations represent a powerful tool to characterize the effect of AEDs on in vivo brain activity. Spectral fingerprints of specific AEDs should be further investigated to provide robust and objective biomarkers of biological effect in human clinical trials.
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Affiliation(s)
- Andrea Biondi
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK.
| | - L Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - V Santoro
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - P G Rossini
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - G N Beatch
- Xenon Pharmaceuticals Inc., Burnaby, Canada
| | - M P Richardson
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
| | - I Premoli
- Division of Neuroscience, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Ground Floor (G.33.08), 5 Cutcombe Road, Camberwell, London, SE5 9RX, UK
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Rissardo JP, Fornari Caprara AL. Lamotrigine-Associated Movement Disorder: A Literature Review. Neurol India 2021; 69:1524-1538. [PMID: 34979637 DOI: 10.4103/0028-3886.333440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lamotrigine (LMT) is a phenyltriazine derivative that was originally described as an antiepileptic drug. OBJECTIVE This literature review aims to evaluate the clinical epidemiological profile, pathological mechanisms, and management of lamotrigine-associated movement disorders. METHODS Relevant reports in six databases were identified and assessed by two reviewers without language restriction. Reports that the individuals only developed tremor or ataxia after LMT use were not included. RESULTS In total 48 reports of 108 cases from 19 countries were assessed. The movement disorders associated with LMT found were 29 tics, 21 dyskinesias, 14 myoclonus, 13 parkinsonism, 10 dystonia, and 1 stuttering. The not clearly defined cases included 10 akathisia, 4 myoclonus, 4 cerebellar syndromes, 1 hypertonia, 1 dyskinesia, and an unknown number of dystonia cases. The mean reported age was 33.34 years (range: 1.574 years). The male was the predominant sex and the most common LMT indication was epilepsy. The mean LMT-dose at the movement disorder onset was 228 mg. The time from LMT start to the onset of movement disorder was within 6 months in 81%. The time from LMT withdrawal to complete recovery was within 1 month in 83%. The most common management was LMT withdrawal. CONCLUSIONS In the literature, the majority of the cases did not give a clear picture of the individual, and the times of movement disorder onset and recovery are not described. We believe that before withdrawal LMT, a dose adjustment based on the benefits and adverse events with careful evaluation case-by-case can be done.
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Affiliation(s)
- Jamir Pitton Rissardo
- Department of Neurology; Departments of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil
| | - Ana L Fornari Caprara
- Department of Neurology; Departments of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brasil
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Dean RL, Marquardt T, Hurducas C, Spyridi S, Barnes A, Smith R, Cowen PJ, McShane R, Hawton K, Malhi GS, Geddes J, Cipriani A. Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. Cochrane Database Syst Rev 2021; 10:CD011611. [PMID: 34623633 PMCID: PMC8499740 DOI: 10.1002/14651858.cd011611.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate receptor modulators for depression in bipolar disorder. OBJECTIVES 1. To assess the effects of ketamine and other glutamate receptor modulators in alleviating the acute symptoms of depression in people with bipolar disorder. 2. To review the acceptability of ketamine and other glutamate receptor modulators in people with bipolar disorder who are experiencing depressive symptoms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO all years to July 2020. We did not apply any restrictions to date, language or publication status. SELECTION CRITERIA RCTs comparing ketamine or other glutamate receptor modulators with other active psychotropic drugs or saline placebo in adults with bipolar depression. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. Primary outcomes were response rate and adverse events. Secondary outcomes included remission rate, depression severity change scores, suicidality, cognition, quality of life, and dropout rate. The GRADE framework was used to assess the certainty of the evidence. MAIN RESULTS Ten studies (647 participants) were included in this review (an additional five studies compared to the 2015 review). There were no additional studies added to the comparisons identified in the 2015 Cochrane review on ketamine, memantine and cytidine versus placebo. However, three new comparisons were found: ketamine versus midazolam, N-acetylcysteine versus placebo, and riluzole versus placebo. The glutamate receptor modulators studied were ketamine (three trials), memantine (two), cytidine (one), N-acetylcysteine (three), and riluzole (one). Eight of these studies were placebo-controlled and two-armed. In seven trials the glutamate receptor modulators had been used as add-on drugs to mood stabilisers. Only one trial compared ketamine with an active comparator, midazolam. The treatment period ranged from a single intravenous administration (all ketamine studies), to repeated administration for riluzole, memantine, cytidine, and N-acetylcysteine (with a follow-up of eight weeks, 8 to 12 weeks, 12 weeks, and 16 to 20 weeks, respectively). Six of the studies included sites in the USA, one in Taiwan, one in Denmark, one in Australia, and in one study the location was unclear. All participants had a primary diagnosis of bipolar disorder and were experiencing an acute bipolar depressive episode, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (IV) or fourth edition text revision (IV-TR). Among all glutamate receptor modulators included in this review, only ketamine appeared to be more efficacious than placebo 24 hours after infusion for response rate (odds ratio (OR) 11.61, 95% confidence interval (CI) 1.25 to 107.74; P = 0.03; participants = 33; studies = 2; I² = 0%, low-certainty evidence). Ketamine seemed to be more effective in reducing depression rating scale scores (MD -11.81, 95% CI -20.01 to -3.61; P = 0.005; participants = 32; studies = 2; I2 = 0%, very low-certainty evidence). There was no evidence of ketamine's efficacy in producing remission over placebo at 24 hours (OR 5.16, 95% CI 0.51 to 52.30; P = 0.72; participants = 33; studies = 2; I2 = 0%, very low-certainty evidence). Evidence on response, remission or depression rating scale scores between ketamine and midazolam was uncertain at 24 hours due to very low-certainty evidence (OR 3.20, 95% CI 0.23 to 45.19). In the one trial assessing ketamine and midazolam, there were no dropouts due to adverse effects or for any reason (very low-certainty evidence). Placebo may have been more effective than N-acetylcysteine in reducing depression rating scale scores at three months, although this was based on very low-certainty evidence (MD 1.28, 95% CI 0.24 to 2.31; participants = 58; studies = 2). Very uncertain evidence found no difference in response at three months (OR 0.82, 95% CI 0.32 to 2.14; participants = 69; studies = 2; very low-certainty evidence). No data were available for remission or acceptability. Extremely limited data were available for riluzole vs placebo, finding only very-low certainty evidence of no difference in dropout rates (OR 2.00, 95% CI 0.31 to 12.84; P = 0.46; participants = 19; studies = 1; I2 = 0%). AUTHORS' CONCLUSIONS It is difficult to draw reliable conclusions from this review due to the certainty of the evidence being low to very low, and the relatively small amount of data usable for analysis in bipolar disorder, which is considerably less than the information available for unipolar depression. Nevertheless, we found uncertain evidence in favour of a single intravenous dose of ketamine (as add-on therapy to mood stabilisers) over placebo in terms of response rate up to 24 hours, however ketamine did not show any better efficacy for remission in bipolar depression. Even though ketamine has the potential to have a rapid and transient antidepressant effect, the efficacy of a single intravenous dose may be limited. We did not find conclusive evidence on adverse events with ketamine, and there was insufficient evidence to draw meaningful conclusions for the remaining glutamate receptor modulators. However, ketamine's psychotomimetic effects (such as delusions or delirium) may have compromised study blinding in some studies, and so we cannot rule out the potential bias introduced by inadequate blinding procedures. To draw more robust conclusions, further methodologically sound RCTs (with adequate blinding) are needed to explore different modes of administration of ketamine, and to study different methods of sustaining antidepressant response, such as repeated administrations.
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Affiliation(s)
| | | | | | - Styliani Spyridi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus
| | | | | | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rupert McShane
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Gin S Malhi
- Discipline of Psychiatry, Northern Clinical School, University of Sydney, Sydney, Australia
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Kahveci FO, Kahveci R, Gokce EC, Gokce A, Kısa Ü, Sargon MF, Fesli R, Sarı MF, Gürer B. Biochemical, pathological and ultrastructural investigation of whether lamotrigine has neuroprotective efficacy against spinal cord ischemia reperfusion injury. Injury 2021; 52:2803-2812. [PMID: 34391576 DOI: 10.1016/j.injury.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lamotrigine, an anticonvulsant drug with inhibition properties of multi-ion channels, has been shown to be able to attenuates secondary neuronal damage by influencing different pathways. The aim of this study was to look into whether lamotrigine treatment could protect the spinal cord from experimental spinal cord ischemia-reperfusion injury. MATERIALS AND METHODS Thirty-two rats, eight rats per group, were randomly assigned to the sham group in which only laparotomy was performed, and to the ischemia, methylprednisolone and lamotrigine groups, where the infrarenal aorta was clamped for thirty minutes to induce spinal cord ischemia-reperfusion injury. Tissue samples belonging to spinal cords were harvested from sacrificed animals twenty-four hours after reperfusion. Tumor necrosis factor-alpha levels, interleukin-1 beta levels, nitric oxide levels, superoxide dismutase activity, catalase activity, glutathione peroxidase activity, malondialdehyde levels and caspase-3 activity were studied. Light and electron microscopic evaluations were also performed to reveal the pathological alterations. Basso, Beattie, and Bresnahan locomotor scale and the inclined-plane test was used to evaluate neurofunctional status at the beginning of the study and just before the animals were sacrificed. RESULTS Lamotrigine treatment provided significant improvement in the neurofunctional status by preventing the increase in cytokine expression, increased lipid peroxidation and oxidative stress, depletion of antioxidant enzymes activity and increased apoptosis, all of which contributing to spinal cord damage through different paths after ischemia reperfusion injury. Furthermore, lamotrigine treatment has shown improved results concerning the histopathological and ultrastructural scores and the functional tests. CONCLUSION These results proposed that lamotrigine may be a useful therapeutic agent to prevent the neuronal damage developing after spinal cord ischemia-reperfusion injury.
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Affiliation(s)
- Fatih Ozan Kahveci
- Department of Emergency Medicine, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - Ramazan Kahveci
- Department of Neurosurgery, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey
| | - Emre Cemal Gokce
- Department of Neurosurgery, Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Aysun Gokce
- Department of Pathology, Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Üçler Kısa
- Department of Biochemistry, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Mustafa Fevzi Sargon
- Department of Anatomy, Lokman Hekim University, Faculty of Medicine, Ankara, Turkey
| | - Ramazan Fesli
- Department of Neurosurgery, Mersin VM Medical Park Hospital, Mersin, Turkey
| | - Muhammed Fatih Sarı
- Department of Neurosurgery, Balıkesir University, Faculty of Medicine, Balıkesir, Turkey
| | - Bora Gürer
- Department of Neurosurgery, İstinye University, Faculty of Medicine, Istanbul, Turkey.
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11
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Vibholm AK, Dietz MJ, Beniczky S, Christensen J, Højlund A, Jacobsen J, Bender D, Møller A, Brooks DJ. Activated N-methyl-D-aspartate receptor ion channels detected in focal epilepsy with [ 18 F]GE-179 positron emission tomography. Epilepsia 2021; 62:2899-2908. [PMID: 34558066 DOI: 10.1111/epi.17074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Imaging activated glutamate N-methyl-D-aspartate receptor ion channels (NMDAR-ICs) using positron emission tomography (PET) has proved challenging due to low brain uptake, poor affinity and selectivity, and high metabolism and dissociation rates of candidate radioligands. The radioligand [18 F]GE-179 is a known use-dependent marker of NMDAR-ICs. We studied whether interictal [18 F]GE-179 PET would detect foci of abnormal NMDAR-IC activation in patients with refractory focal epilepsy. METHODS Ten patients with refractory focal epilepsy and 18 healthy controls had structural magnetic resonance imaging (MRI) followed by a 90-min dynamic [18 F]GE-179 PET scan with simultaneous electroencephalography (EEG). PET and EEG findings were compared with MRI and previous EEGs. Standard uptake value (SUV) images of [18 F]GE-179 were generated and global gray matter uptake was measured for each individual. To localize focal increases in uptake of [18 F]GE-179, the individual SUV images were interrogated with statistical parametric mapping in comparison to a normal database. Additionally, individual healthy control SUV images were compared with the rest of the control database to determine their prevalence of increased focal [18 F]GE-179 uptake. RESULTS Interictal [18 F]GE-179 PET detected clusters of significantly increased binding in eight of 10 patients with focal epilepsy but none of the controls. The number of clusters of raised [18 F]GE-179 uptake in the patients with epilepsy exceeded the focal abnormalities revealed by the simultaneously recorded EEG. Patients with extensive clusters of raised [18 F]GE-179 uptake showed the most abnormal EEGs. SIGNIFICANCE Detection of multiple foci of abnormal NMDAR-IC activation in 80% of our patients with refractory focal epilepsy using interictal [18 F]GE-179 PET could reflect enhanced neuronal excitability due to chronic seizure activity. This indicates that chronic epileptic activity is associated with abnormal NMDAR ion channel activation beyond the initial irritative zones. [18 F]GE-179 PET could be a candidate marker for identifying pathological brain areas in patients with treatment-resistant focal epilepsy.
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Affiliation(s)
- Ali K Vibholm
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Martin J Dietz
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center and Aarhus University, Dianalund, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,National Center for Register-Based Research, Department of Economics and Business Economics, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Andreas Højlund
- Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Jacobsen
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Dirk Bender
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark
| | - Arne Møller
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark.,Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David J Brooks
- Department of Nuclear Medicine and PET Center, Institute of Clinical Medicine, Aarhus University and University Hospital, Aarhus, Denmark.,Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
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12
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Abstract
Periodic catatonia is a rare form of catatonia, characterized by episodes occurring in a cyclic pattern with clinical features of combined stupor and excitement, with intervals of remission. Although periodic catatonia is not common, it is an urgent condition, requiring hospitalization for evaluation and treatment. The management of periodic catatonia is quite challenging, mainly because of the unknown pathophysiological mechanisms involved in the onset of this clinical entity, which are less clear than in other forms of catatonia. Although positive trials of several medications in the acute phase of periodic catatonia have been published, available literature concerning the prevention of recurrent catatonic episodes is scarce. Here, we present the case of a patient with periodic catatonia in which long-term treatment with lamotrigine appears to have acted prophylactically in reducing the occurrence and severity of new catatonic episodes. A better understanding of the mechanisms involved in the pathophysiology of periodic catatonia and increasing psychiatrists' and physicians' awareness of the presentation of this clinical entity could be of benefit in shedding light on the most appropriate treatment approach. However, further clinical studies are needed before any firm recommendations can be made.
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13
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Methaneethorn J, Leelakanok N. Sources of lamotrigine pharmacokinetic variability: A systematic review of population pharmacokinetic analyses. Seizure 2020; 82:133-147. [DOI: 10.1016/j.seizure.2020.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022] Open
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14
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Kumar S, Goel RK. Pharmacokinetic, pharmacodynamic, and neurochemical investigations of lamotrigine-pentylenetetrazole kindled mice to ascertain it as a reliable model for clinical drug-resistant epilepsy. Animal Model Exp Med 2020; 3:245-255. [PMID: 33024946 PMCID: PMC7529331 DOI: 10.1002/ame2.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pentylenetetrazole kindling has long been used for the screening of investigational antiseizure drugs. The presence of lamotrigine, at a very low dose, does not hamper kindling in mice; rather it modifies this epileptogenesis process into drug-resistant epilepsy. The lamotrigine-pentylenetetrazole kindled mice show resistance to lamotrigine, phenytoin, and carbamazepine. It may also be possible that other licensed antiseizure drugs, like the mentioned drugs, remain ineffective in this model; therefore, this was the subject of this study. METHODS Swiss albino mice were kindled with pentylenetetrazole for 35 days in the presence of either methylcellulose vehicle or lamotrigine (subtherapeutic dose, ie, 5 mg/kg). Vehicle vs lamotrigine-kindled mice were compared in terms of (a) resistance/response toward nine antiseizure drugs applied as monotherapies and two drug combinations; (b) lamotrigine bioavailability in blood and brain; (c) blood-brain barrier integrity; and (d) amino acids and monoamines in the cerebral cortex and hippocampus. RESULTS Lamotrigine vs vehicle-kindled mice are similar (or not significantly different P > .05 from each other) in terms of (a) response toward drug combinations; (b) lamotrigine bioavailability; and (c) blood-brain barrier integrity except for, significantly (P < .05) reduced taurine and increased glutamate in the cerebral cortex and hippocampus. Aside from these, lamotrigine-kindled mice show significant (P < .05) resistant to lamotrigine (15 mg/kg), levetiracetam (40 mg/kg); carbamazepine (40 mg/kg), zonisamide (100 mg/kg), gabapentin (224 mg/kg), pregabalin (30 mg/kg), phenytoin (35 mg/kg), and topiramate (300 mg/kg). CONCLUSION Lamotrigine-pentylenetetrazole kindling takes longer to develop (~5 weeks) in comparison to lamotrigine-amygdale (~4 weeks) and lamotrigine-corneal (~2 weeks) kindling models. However, drug screening through this model may yield superior drugs with novel antiseizure mechanisms.
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Affiliation(s)
- Sandeep Kumar
- Department of Pharmaceutical Sciences & Drug Research Punjabi University Patiala Punjab India
| | - Rajesh K Goel
- Department of Pharmaceutical Sciences & Drug Research Punjabi University Patiala Punjab India
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15
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Levenberg K, Edris W, Levine M, George DR. Considering a Potential Role of Linalool as a Mood Stabilizer for Bipolar Disorder. Curr Pharm Des 2020; 26:5128-5133. [PMID: 32713332 DOI: 10.2174/1381612826666200724160742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022]
Abstract
Epidemiologic studies suggest that the lifetime prevalence of bipolar spectrum disorders ranges from 2.8 to 6.5 percent of the population. To decrease morbidity and mortality associated with disease progression, pharmacologic intervention is indicated for the majority of these patients. While a number of effective treatment regimens exist, many conventional medications have significant side effect profiles that adversely impact patients' short and long-term well-being. It is thus important to continue advancing and improving therapeutic options available to patients. This paper reviews the limitations of current treatments and examines the chemical compound Linalool, an alcohol found in many plant species, that may serve as an effective mood stabilizer. While relatively little is known about Linalool and bipolar disorder, the compound has been shown to have antiepileptic, anti-inflammatory, anxiolytic, anti-depressive, and neurotrophic effects, with mechanisms that are comparable to current bipolar disorder treatment options.
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Affiliation(s)
- Kate Levenberg
- College of Medicine, Penn State University College of Medicine, State College, Hershey, United States
| | - Wade Edris
- Department of Medicine, Penn State University College of Medicine, State College, Hershey, United States
| | - Martha Levine
- Department of Pediatrics, Penn State University College of Medicine, Hershey, United States
| | - Daniel R George
- Department of Pediatrics, Penn State University College of Medicine, Hershey, United States
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16
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Webler RD, Hamady C, Molnar C, Johnson K, Bonilha L, Anderson BS, Bruin C, Bohning DE, George MS, Nahas Z. Decreased interhemispheric connectivity and increased cortical excitability in unmedicated schizophrenia: A prefrontal interleaved TMS fMRI study. Brain Stimul 2020; 13:1467-1475. [PMID: 32585355 DOI: 10.1016/j.brs.2020.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prefrontal abnormalities in schizophrenia have consistently emerged from resting state and cognitive neuroimaging studies. However, these correlative findings require causal verification via combined imaging/stimulation approaches. To date, no interleaved transcranial magnetic stimulation and functional magnetic resonance imaging study (TMS fMRI) has probed putative prefrontal cortex abnormalities in schizophrenia. OBJECTIVE /Hypothesis: We hypothesized that subjects with schizophrenia would show significant hyperexcitability at the site of stimulation (BA9) and decreased interhemispheric functional connectivity. METHODS We enrolled 19 unmedicated subjects with schizophrenia and 22 controls. All subjects underwent brain imaging using a 3T MRI scanner with a SENSE coil. They also underwent a single TMS fMRI session involving motor threshold (rMT) determination, structural imaging, and a parametric TMS fMRI protocol with 10 Hz triplet pulses at 0, 80, 100 and 120% rMT. Scanning involved a surface MR coil optimized for bilateral prefrontal cortex image acquisition. RESULTS Of the original 41 enrolled subjects, 8 subjects with schizophrenia and 11 controls met full criteria for final data analyses. At equal TMS intensity, subjects with schizophrenia showed hyperexcitability in left BA9 (p = 0.0157; max z-score = 4.7) and neighboring BA46 (p = 0.019; max z-score = 4.47). Controls showed more contralateral functional connectivity between left BA9 and right BA9 through increased activation in right BA9 (p = 0.02; max z-score = 3.4). GM density in subjects with schizophrenia positively correlated with normalized prefrontal to motor cortex ratio of the corresponding distance from skull to cortex ratio (S-BA9/S-MC) (r = 0.83, p = 0.004). CONCLUSIONS Subjects with schizophrenia showed hyperexcitability in left BA9 and impaired interhemispheric functional connectivity compared to controls. Interleaved TMS fMRI is a promising tool to investigate prefrontal dysfunction in schizophrenia.
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Affiliation(s)
- Ryan D Webler
- University of Minnesota, Department of Psychology, USA
| | - Carmen Hamady
- American University of Beirut, Department of Psychiatry, USA
| | - Chris Molnar
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA
| | | | | | | | - Claartje Bruin
- American University of Beirut, Department of Psychiatry, USA
| | - Daryl E Bohning
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA
| | - Mark S George
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Ziad Nahas
- American University of Beirut, Department of Psychiatry, USA; University of Minnesota, Department of Psychiatry, USA.
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17
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PharmGKB summary: lamotrigine pathway, pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics 2020; 30:81-90. [PMID: 32187155 DOI: 10.1097/fpc.0000000000000397] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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18
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Makki MST, Abdel-Rahman RM, Alharbi AS. Synthesis and Anti-Inflammatory Effect of Some More New Fluorinated 3-Substituted Amino/ 3,5-Diamino-1,2,4-Triazine Derivatives as Lamotrigine Analogs. Curr Org Synth 2020; 16:165-172. [PMID: 31965931 DOI: 10.2174/1570179415666181105142247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 11/22/2022]
Abstract
AIM AND OBJECTIVE It is known that the Lamotrigine drug has anti-inflammatory activity. So it was the goal to prepare similar compounds containing fluorine atoms (fluorine-substituted 3,5-diamino-6-aryl- 1,2,4-triazines) as Lamotrigine drug analogs to evaluate them as an anti-inflammatory. MATERIALS AND METHODS The novel fluorine substituted 3,5-diamino-6-aryl-1,2,4-triazines as new Lamotrigine analogs were prepared via aminolysis and/ or ammonolysis of the corresponding 3-thioxo-6-aryl-1,2,4-triazin- 5-ones in ethanolic media. RESULTS All the new targets were deduced upon their elemental analysis and spectral data as well as screened as anti-inflammatory agents, where we found that the fluorinated systems 15 and 9-11 exhibited high and more activity. CONCLUSION Simple routes to synthesize some more novel fluorinated Lamotrigine analogs have been reported. The new targets exhibited high and moderate anti-inflammatory probes. Presence of both amino and CF3 groups caused high biological activities of these compounds were studied.
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Affiliation(s)
- Mohammed S T Makki
- Department of Chemistry, Faculty of Science, King Abdul Aziz University, P.O. Box. 42805 Jeddah, 21551, Saudi Arabia
| | - Reda M Abdel-Rahman
- Department of Chemistry, Faculty of Science, King Abdul Aziz University, P.O. Box. 42805 Jeddah, 21551, Saudi Arabia
| | - Abdulrahman Salim Alharbi
- Department of Chemistry, Faculty of Science, King Abdul Aziz University, P.O. Box. 42805 Jeddah, 21551, Saudi Arabia
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19
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Noda Y. Toward the establishment of neurophysiological indicators for neuropsychiatric disorders using transcranial magnetic stimulation-evoked potentials: A systematic review. Psychiatry Clin Neurosci 2020; 74:12-34. [PMID: 31587446 DOI: 10.1111/pcn.12936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/14/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022]
Abstract
Transcranial magnetic stimulation (TMS) can depolarize the neurons directly under the coil when applied to the cerebral cortex, and modulate the neural circuit associated with the stimulation site, which makes it possible to measure the neurophysiological index to evaluate excitability and inhibitory functions. Concurrent TMS and electroencephalography (TMS-EEG) has been developed to assess the neurophysiological characteristics of cortical regions other than the motor cortical region noninvasively. The aim of this review is to comprehensively discuss TMS-EEG research in the healthy brain focused on excitability, inhibition, and plasticity following neuromodulatory TMS paradigms from a neurophysiological perspective. A search was conducted in PubMed to identify articles that examined humans and that were written in English and published by September 2018. The search terms were as follows: (TMS OR 'transcranial magnetic stimulation') AND (EEG OR electroencephalog*) NOT (rTMS OR 'repetitive transcranial magnetic stimulation' OR TBS OR 'theta burst stimulation') AND (healthy). The study presents an overview of TMS-EEG methodology and neurophysiological indices and reviews previous findings from TMS-EEG in healthy individuals. Furthermore, this review discusses the potential application of TMS-EEG neurophysiology in the clinical setting to study healthy and diseased brain conditions in the future. Combined TMS-EEG is a powerful tool to probe and map neural circuits in the human brain noninvasively and represents a promising approach for determining the underlying pathophysiology of neuropsychiatric disorders.
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Affiliation(s)
- Yoshihiro Noda
- Multidisciplinary Translational Research Lab, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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20
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Premoli I, Rossini PG, Goldberg PY, Posadas K, Green L, Yogo N, Pimstone S, Abela E, Beatch GN, Richardson MP. TMS as a pharmacodynamic indicator of cortical activity of a novel anti-epileptic drug, XEN1101. Ann Clin Transl Neurol 2019; 6:2164-2174. [PMID: 31568714 PMCID: PMC6856596 DOI: 10.1002/acn3.50896] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 08/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objective Transcranial magnetic stimulation (TMS) produces characteristic deflections in the EEG signal named TMS‐evoked EEG potentials (TEPs), which can be used to assess drug effects on cortical excitability. TMS can also be used to determine the resting motor threshold (RMT) for eliciting a minimal muscle response, as a biomarker of corticospinal excitability. XEN1101 is a novel potassium channel opener undergoing clinical development for treatment of epilepsy. We used TEPs and RMT to measure the effects of XEN1101 in the human brain, to provide evidence that XEN1101 alters cortical excitability at doses that might be used in future clinical trials. Methods TMS measurements were incorporated in this Phase I clinical trial to evaluate the extent to which XEN1101 modulates TMS parameters of cortical and corticospinal excitability. TEPs and RMT were collected before and at 2‐, 4‐, and 6‐hours post drug intake in a double‐blind, placebo‐controlled, randomized, two‐period crossover study of 20 healthy male volunteers. Results Consistent with previous TMS investigations of antiepileptic drugs (AEDs) targeting ion channels, the amplitude of TEPs occurring at early (15–55 msec after TMS) and at late (150–250 msec after TMS) latencies were significantly suppressed from baseline by 20 mg of XEN1101. Furthermore, the RMT showed a significant time‐dependent increase that correlated with the XEN1101 plasma concentration. Interpretation Changes from baseline in TMS measures provided evidence that 20 mg of XEN1101 suppressed cortical and corticospinal excitability, consistent with the effects of other AEDs. These results support the implementation of TMS as a tool to inform early‐stage clinical trials.
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Affiliation(s)
- Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pierre G Rossini
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Louise Green
- Clinical Research Facility, King's College Hospital, London, UK
| | - Noah Yogo
- Clinical Research Facility, King's College Hospital, London, UK
| | - Simon Pimstone
- Xenon Pharmaceuticals Inc., Burnaby, Canada.,Department of General Internal Medicine, University of British Columbia, Vancouver, Canada
| | - Eugenio Abela
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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21
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Kovács A, Farkas Z, Kelemen A, Juhos V, Szűcs A, Kamondi A. Lamotrigine Induces Tremor among Epilepsy Patients Probably via Cerebellar Pathways. TOHOKU J EXP MED 2019; 248:273-284. [PMID: 31447473 DOI: 10.1620/tjem.248.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lamotrigine, a frequently used antiepileptic drug, inhibits voltage-gated sodium-channels. By suppressing the release of glutamate and aspartate, lamotrigine acts as a membrane stabilizer, and it is also effective in bipolar disorder and migraine. However, lamotrigine is known to induce tremor among 4-10% of patients. We examined the lamotrigine-induced tremor in 28 epilepsy patients (age: 38.06 ± 13.56 years; 24 females and 4 males) receiving lamotrigine monotherapy and compared the data to 30 age- and sex-matched controls (age: 33.06 ± 10.71 years; 25 females and 5 males). Tremor was visually assessed by clinical tremor rating scales. Quantitative characteristics (intensity, center frequency and frequency dispersion) which are regularly used to differentiate various tremor syndromes were measured by validated, sensitive biaxial accelerometry in resting, postural and intentional positions. Regularity of repetitive finger and hand movements and reaction time were also determined. Data were statistically analyzed. Clinical tremor rating scales detected pathological tremor in three patients (10%), while accelerometry revealed tremor in seven patients (25%). Center frequency of patients with pathological tremor was similar to controls, but the frequency dispersion was significantly lower and tremor intensity was significantly higher in both postural and intentional positions. Rhythmic movements and reaction time were normal. Our results show that objective measurements detect pathological intention tremor in 25% of epilepsy patients receiving lamotrigine monotherapy. Quantitative characteristics suggest the involvement of the cerebellum in the pathomechanism of lamotrigine-induced tremor. Determining the parameters of drug-induced tremor syndromes might help to understand the complex action of tremor generator networks.
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Affiliation(s)
- Andrea Kovács
- Department of Neurology, National Institute of Clinical Neurosciences.,János Szentágothai Doctoral School of Neurosciences, Semmelweis University
| | | | - Anna Kelemen
- Department of Neurology, National Institute of Clinical Neurosciences
| | | | - Anna Szűcs
- Department of Neurology, National Institute of Clinical Neurosciences
| | - Anita Kamondi
- Department of Neurology, National Institute of Clinical Neurosciences.,Department of Neurology, Semmelweis University
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22
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Prados-Pardo Á, Martín-González E, Mora S, Merchán A, Flores P, Moreno M. Increased Fear Memory and Glutamatergic Modulation in Compulsive Drinker Rats Selected by Schedule-Induced Polydipsia. Front Behav Neurosci 2019; 13:100. [PMID: 31133835 PMCID: PMC6514533 DOI: 10.3389/fnbeh.2019.00100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
Compulsive behavior is observed in several neuropsychiatric disorders such as obsessive-compulsive disorder (OCD), anxiety, depression, phobia, and schizophrenia. Thus, compulsivity has been proposed as a transdiagnostic symptom with a highly variable pharmacological treatment. Recent evidence shows that glutamate pharmacotherapy may be of benefit in impaired inhibitory control. The purpose of the present study was: first, to test the comorbidity between compulsivity and other neuropsychiatric symptoms on different preclinical behavioral models; second, to assess the therapeutic potential of different glutamate modulators in a preclinical model of compulsivity. Long Evans rats were selected as either high (HD) or low (LD) drinkers corresponding with their water intake in schedule-induced polydipsia (SIP). We assessed compulsivity in LD and HD rats by marble burying test (MBT), depression by forced swimming test (FST), anxiety by elevated plus maze (EPM) and fear behavior by fear conditioning (FC) test. After that, we measured the effects of acute administration (i.p.) of glutamatergic drugs: N-Acetylcysteine (NAC; 25, 50, 100 and 200 mg/kg), memantine (3.1 and 6.2 mg/kg) and lamotrigine (15 and 30 mg/kg) on compulsive drinking on SIP. The results obtained showed a relation between high compulsive drinking on SIP and a higher number of marbles partially buried in MBT, as well as a higher percentage of freezing on the retrieval day of FC test. We did not detect any significant differences between LD and HD rats in FST, nor in EPM. The psychopharmacological study of glutamatergic drugs revealed that memantine and lamotrigine, at all doses tested, decreased compulsive water consumption in HD rats compared to LD rats on SIP. NAC did not produce any significant effect on SIP. These results indicate that the symptom clusters of different forms of compulsivity and phobia might be found in the compulsive phenotype of HD rats selected by SIP. The effects of memantine and lamotrigine in HD rats point towards a dysregulation in the glutamatergic signaling as a possible underlying mechanism in the vulnerability to compulsive behavior on SIP. Further studies on SIP, could help to elucidate the therapeutic role of glutamatergic drugs as a pharmacological strategy on compulsive spectrum disorders.
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Affiliation(s)
- Ángeles Prados-Pardo
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
| | - Elena Martín-González
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
| | - Santiago Mora
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
| | - Ana Merchán
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
| | - Pilar Flores
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
| | - Margarita Moreno
- Department of Psychology, Health Research Center, University of Almería, Campus de Excelencia Internacional Agroalimentario CeiA3, Almería, Spain
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23
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Lehnhoff J, Strauss U, Wierschke S, Grosser S, Pollali E, Schneider UC, Holtkamp M, Dehnicke C, Deisz RA. The anticonvulsant lamotrigine enhances Ih in layer 2/3 neocortical pyramidal neurons of patients with pharmacoresistant epilepsy. Neuropharmacology 2019; 144:58-69. [DOI: 10.1016/j.neuropharm.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022]
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24
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Miranda ASD, Miranda ASD, Teixeira AL. Lamotrigine as a mood stabilizer: insights from the pre-clinical evidence. Expert Opin Drug Discov 2018; 14:179-190. [PMID: 30523725 DOI: 10.1080/17460441.2019.1553951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Lamotrigine (LTG) is a well-established anticonvulsant that is also approved for the prevention of mood relapses in bipolar disorder. However, the mechanisms underlying LTG mood stabilizing effects remain unclear. Areas covered: Herein, the pre-clinical evidence concerning LTG's' mode of action in depression and mania is reviewed. Bottlenecks and future perspectives for this expanding and promising field are also discussed. Pre-clinical studies have indicated that neurotransmitter systems, especially serotoninergic, noradrenergic and glutamatergic, as well as non-neurotransmitter pathways such as inflammation and oxidative processes might play a role in LTG's antidepressant effects. The mechanisms underlying LTG's anti-manic properties remain to be fully explored, but the available pre-clinical evidence points out to the role of glutamatergic neurotransmission, possibly through AMPA-receptors. Expert opinion: A major limitation of current pre-clinical investigations is that there are no experimental models that recapitulate the complexity of bipolar disorder. Significant methodological differences concerning time and dose of LTG treatment, administration route, animal strains, and behavioral paradigms also hamper the reproducibility of the findings, leading to contradictory conclusions. Moreover, the role of other mechanisms (e.g. inositol phosphate and GSK3β pathways) implicated in the mode of action of different mood-stabilizers must also be consolidated with LTG.
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Affiliation(s)
- Aline Silva de Miranda
- a Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,b Laboratório de Neurobiologia, Departamento de Morfologia, Instituto de Ciências Biológicas , Universidade Federal de Minas Gerais , Belo Horizonte , Brasil
| | - Amanda Silva de Miranda
- c Departamento de Química , Instituto de Ciências Exatas, Universidade Federal de Minas Gerais , Belo Horizonte , Brasil
| | - Antônio Lúcio Teixeira
- a Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,d Neuropsychiatry Program & Immuno-Psychiatry Lab, Department of Psychiatry & Behavioral Sciences, McGovern Medical School , University of Texas Health Science Center at Houston , Houston , USA
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Coplan JD, Gupta NK, Flynn SK, Reiner WJ, Gaita D, Fulton SL, Rozenboym AV, Tang JE, Cooper TB, Mann JJ. Maternal Cerebrospinal Fluid Glutamate in Response to Variable Foraging Demand: Relationship to Cerebrospinal Fluid Serotonin Metabolites in Grown Offspring. ACTA ACUST UNITED AC 2018; 2. [PMID: 30246167 PMCID: PMC6145812 DOI: 10.1177/2470547018785625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Maternal response to allostatic overload during infant rearing may alter
neurobiological measures in grown offspring, potentially increasing
susceptibility to mood and anxiety disorders. We examined maternal
cerebrospinal fluid (CSF) glutamate response during exposure to variable
foraging demand (VFD), a bonnet macaque model of allostatic overload,
testing whether activation relative to baseline predicted concomitant CSF
elevations of the stress neuropeptide, corticotropin-releasing factor. We
investigated whether VFD-induced activation of maternal CSF glutamate
affects maternal–infant attachment patterns and offspring CSF
5-hydroxyindoleacetic acid concentrations. Methods Mother–infant dyads were exposed to the “VFD stressor,” a paradigm in which
mothers experience 16 weeks of foraging uncertainty while rearing their
infant offspring. Through staggering the infant age of VFD onset, both a
cross-sectional design and a longitudinal design were used. Maternal CSF
glutamate and glutamine concentrations post-VFD exposure were
cross-sectionally compared to maternal VFD naive controls. Proportional
change in concentrations of maternal glutamate (and glutamine), a
longitudinal measure, was evaluated in relation to VFD-induced elevations of
CSF corticotropin-releasing factor. The former measure was related to
maternal–infant proximity scores obtained during the final phases of VFD
exposure. Maternal glutamatergic response to VFD exposure was used as a
predictor variable for young adolescent offspring CSF metabolites of
serotonin, dopamine, and norepinephrine. Results Following VFD exposure, maternal CSF glutamate concentrations correlated
positively with maternal CSF CRF concentrations. Activation relative to
baseline of maternal CSF glutamate concentrations following VFD exposure
correlated directly with a) increased maternal-infant proximity during the
final phases of VFD and b) offspring CSF concentrations of monoamine
metabolites including 5-hydroxyindoleacetic acid, which was elevated
relative to controls. Conclusions Activation of maternal CSF glutamate in response to VFD-induced allostasis is
directly associated with elevations of maternal CSF corticotropin-releasing
factor. Maternal CSF glutamate alterations induced by VFD potentially
compromise serotonin neurotransmission in grown offspring, conceivably
modeling human vulnerability to treatment-resistant mood and anxiety
disorders.
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Affiliation(s)
- Jeremy D Coplan
- Department of Psychiatry and Behavioral Sciences, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Nishant K Gupta
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Sarah K Flynn
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Wade J Reiner
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - David Gaita
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Sasha L Fulton
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Anna V Rozenboym
- Department of Biological Sciences, Kingsborough Community College, City University of New York, Brooklyn, NY, USA
| | - Jean E Tang
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas B Cooper
- Department of Psychopharmacology, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY, USA
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Excitatory and inhibitory synaptic dysfunction in mania: an emerging hypothesis from animal model studies. Exp Mol Med 2018; 50:1-11. [PMID: 29628501 PMCID: PMC5938027 DOI: 10.1038/s12276-018-0028-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 12/26/2022] Open
Abstract
Bipolar disorder (BD) is a common psychiatric disorder characterized by recurrent mood swings between depression and mania, and is associated with high treatment costs. The existence of manic episodes is the defining feature of BD, during which period, patients experience extreme elevation in activity, energy, and mood, with changes in sleep patterns that together severely impair their ability to function in daily life. Despite some limitations in recapitulating the complex features of human disease, several rodent models of mania have been generated and characterized, which have provided important insights toward understanding its underlying pathogenic mechanisms. Among the mechanisms, neuronal excitatory and inhibitory (E/I) synaptic dysfunction in some brain regions, including the frontal cortex, hippocampus, and striatum, is an emerging hypothesis explaining mania. In this review, we highlight recent studies of rodent manic models having impairments in the E/I synaptic development and function. We also summarize the molecular and functional changes of E/I synapses by some mood stabilizers that may contribute to the therapeutic efficacy of drugs. Furthermore, we discuss potential future directions in the study of this emerging hypothesis to better connect the outcomes of basic research to the treatment of patients with this devastating mental illness. Studies in rodents offer insights into bipolar disorder that may help understanding and treatment of this common and debilitating condition. Kihoon Han and colleagues at Korea University in Seoul review research using mice and rats to model the episodes of mania in patients with bipolar disorder. The research supports an emerging hypothesis implicating specific problems with nervous transmission in the brain in the onset of mania. The hypothesis suggests that the transmission of signals between particular nerve cells whose normal function is either to excite or to inhibit other nerve cells may be involved. It also indicates regions of the brain most involved in manic episodes. Changes at the affected nerve junctions—called synapses—brought about by mood-stabilizing drugs are examined. The hypothesis suggests new approaches to treatment options for researchers to explore.
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Fasoli D, Cattani A, Panzeri S. Transitions between asynchronous and synchronous states: a theory of correlations in small neural circuits. J Comput Neurosci 2017; 44:25-43. [PMID: 29124505 PMCID: PMC5770155 DOI: 10.1007/s10827-017-0667-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/04/2017] [Accepted: 10/10/2017] [Indexed: 12/11/2022]
Abstract
The study of correlations in neural circuits of different size, from the small size of cortical microcolumns to the large-scale organization of distributed networks studied with functional imaging, is a topic of central importance to systems neuroscience. However, a theory that explains how the parameters of mesoscopic networks composed of a few tens of neurons affect the underlying correlation structure is still missing. Here we consider a theory that can be applied to networks of arbitrary size with multiple populations of homogeneous fully-connected neurons, and we focus its analysis to a case of two populations of small size. We combine the analysis of local bifurcations of the dynamics of these networks with the analytical calculation of their cross-correlations. We study the correlation structure in different regimes, showing that a variation of the external stimuli causes the network to switch from asynchronous states, characterized by weak correlation and low variability, to synchronous states characterized by strong correlations and wide temporal fluctuations. We show that asynchronous states are generated by strong stimuli, while synchronous states occur through critical slowing down when the stimulus moves the network close to a local bifurcation. In particular, strongly positive correlations occur at the saddle-node and Andronov-Hopf bifurcations of the network, while strongly negative correlations occur when the network undergoes a spontaneous symmetry-breaking at the branching-point bifurcations. These results show how the correlation structure of firing-rate network models is strongly modulated by the external stimuli, even keeping the anatomical connections fixed. These results also suggest an effective mechanism through which biological networks may dynamically modulate the encoding and integration of sensory information.
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Affiliation(s)
- Diego Fasoli
- Laboratory of Neural Computation, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, 38068, Rovereto, Italy.
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, 08002, Barcelona, Spain.
| | - Anna Cattani
- Laboratory of Neural Computation, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, 38068, Rovereto, Italy
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Stefano Panzeri
- Laboratory of Neural Computation, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, 38068, Rovereto, Italy
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Premoli I, Costantini A, Rivolta D, Biondi A, Richardson MP. The Effect of Lamotrigine and Levetiracetam on TMS-Evoked EEG Responses Depends on Stimulation Intensity. Front Neurosci 2017; 11:585. [PMID: 29104528 PMCID: PMC5655014 DOI: 10.3389/fnins.2017.00585] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/05/2017] [Indexed: 12/29/2022] Open
Abstract
The combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) has uncovered underlying mechanisms of two anti-epileptic medications: levetiracetam and lamotrigine. Despite their different mechanism of action, both drugs modulated TMS-evoked EEG potentials (TEPs) in a similar way. Since both medications increase resting motor threshold (RMT), the current aim was to examine the similarities and differences in post-drug TEPs, depending on whether stimulation intensity was adjusted to take account of post-drug RMT increase. The experiment followed a placebo controlled, double blind, crossover design, involving a single dose of either lamotrigine or levetiracetam. When a drug-induced increase of RMT occurred, post-drug measurements involved two blocks of stimulations, using unadjusted and adjusted stimulation intensity. A cluster based permutation analysis of differences in TEP amplitude between adjusted and unadjusted stimulation intensity showed that lamotrigine induced a stronger modulation of the N45 TEP component compared to levetiracetam. Results highlight the impact of adjusting stimulation intensity.
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Affiliation(s)
- Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alyssa Costantini
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Davide Rivolta
- School of Psychology, University of East London, London, United Kingdom.,Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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29
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Gonda X, Sarginson J, Eszlari N, Petschner P, Toth ZG, Baksa D, Hullam G, Anderson IM, Deakin JFW, Juhasz G, Bagdy G. A new stress sensor and risk factor for suicide: the T allele of the functional genetic variant in the GABRA6 gene. Sci Rep 2017; 7:12887. [PMID: 29018204 PMCID: PMC5635130 DOI: 10.1038/s41598-017-12776-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
Low GABA transmission has been reported in suicide, and GABRA6 rs3219151 T allele has been associated with greater physiological and endocrine stress response in previous studies. Although environmental stress also plays a role in suicide, the possible role of this allele has not been investigated in this respect. In our present study effect of rs3219151 of GABRA6 gene in interaction with recent negative life events on lifetime and current depression, current anxiety, as well as lifetime suicide were investigated using regression models in a white European general sample of 2283 subjects. Post hoc measures for phenotypes related to suicide risk were also tested for association with rs3219151 in interaction with environmental stress. No main effect of the GABRA6 rs3219151 was detected, but in those exposed to recent negative life events GABRA6 T allele increased current anxiety and depression as well as specific elements of suicide risk including suicidal and death-related thoughts, hopelessness, restlessness and agitation, insomnia and impulsiveness as measured by the STOP task. Our data indicate that stress-associated suicide risk is elevated in carriers of the GABRA6 rs3219151 T allele with several independent markers and predictors of suicidal behaviours converging to this increased risk.
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Affiliation(s)
- Xenia Gonda
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
- Department of Psychiatry and Psychotherapy, Kutvolgyi Clinical Centre, Semmelweis University, Budapest, Hungary.
- NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary.
| | - Jane Sarginson
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
- School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M15GD, UK
| | - Nora Eszlari
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
| | - Peter Petschner
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Zoltan G Toth
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Institute of Communication Engineering, Kando Kalman Faculty of Electrical Engineering, Obuda University, Budapest, Hungary
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Gabor Hullam
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ian M Anderson
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - J F William Deakin
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gabriella Juhasz
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
- MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- Neuroscience and Psychiatry Unit, Division of Neuroscience and Experimental Psychology, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Gyorgy Bagdy
- MTA-SE Neuropsychopharmacology and Neurochemistry Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- NAP-A-SE New Antidepressant Target Research Group, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
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Prefrontal Connectivity and Glutamate Transmission: Relevance to Depression Pathophysiology and Ketamine Treatment. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 2:566-574. [PMID: 29034354 DOI: 10.1016/j.bpsc.2017.04.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prefrontal global brain connectivity with global signal regression (GBCr) was proposed as a robust biomarker of depression, and was associated with ketamine's mechanism of action. Here, we investigated prefrontal GBCr in treatment-resistant depression (TRD) at baseline and following treatment. Then, we conducted a set of pharmacological challenges in healthy subjects to investigate the glutamate neurotransmission correlates of GBCr. METHODS In study A, we used functional magnetic resonance imaging (fMRI) to compare GBCr between 22 TRD and 29 healthy control. Then, we examined the effects of ketamine and midazolam on GBCr in TRD patients 24h post-treatment. In study B, we acquired repeated fMRI in 18 healthy subjects to determine the effects of lamotrigine (a glutamate release inhibitor), ketamine, and lamotrigine-by-ketamine interaction. RESULTS In study A, TRD patients showed significant reduction in dorsomedial and dorsolateral prefrontal GBCr compared to healthy control. In TRD patients, GBCr in the altered clusters significantly increased 24h following ketamine (effect size = 1.0 [0.3 1.8]), but not midazolam (effect size = 0.5 [-0.6 1.3]). In study B, oral lamotrigine reduced GBCr 2h post-administration, while ketamine increased medial prefrontal GBCr during infusion. Lamotrigine significantly reduced the ketamine-induced GBCr surge. Exploratory analyses showed elevated ventral prefrontal GBCr in TRD and significant reduction of ventral prefrontal GBCr during ketamine infusion in healthy subjects. CONCLUSIONS This study provides first replication of the ability of ketamine to normalize depression-related prefrontal dysconnectivity. It also provides indirect evidence that these effects may be triggered by the capacity of ketamine to enhance glutamate neurotransmission.
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Alda M, McKinnon M, Blagdon R, Garnham J, MacLellan S, O'Donovan C, Hajek T, Nair C, Dursun S, MacQueen G. Methylene blue treatment for residual symptoms of bipolar disorder: randomised crossover study. Br J Psychiatry 2017; 210:54-60. [PMID: 27284082 DOI: 10.1192/bjp.bp.115.173930] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/14/2015] [Accepted: 02/01/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Residual symptoms and cognitive impairment are among important sources of disability in patients with bipolar disorder. Methylene blue could improve such symptoms because of its potential neuroprotective effects. AIMS We conducted a double-blind crossover study of a low dose (15 mg, 'placebo') and an active dose (195 mg) of methylene blue in patients with bipolar disorder treated with lamotrigine. METHOD Thirty-seven participants were enrolled in a 6-month trial (trial registration: NCT00214877). The outcome measures included severity of depression, mania and anxiety, and cognitive functioning. RESULTS The active dose of methylene blue significantly improved symptoms of depression both on the Montgomery-Åsberg Depression Rating Scale and Hamilton Rating Scale for Depression (P = 0.02 and 0.05 in last-observation-carried-forward analysis). It also reduced the symptoms of anxiety measured by the Hamilton Rating Scale for Anxiety (P = 0.02). The symptoms of mania remained low and stable throughout the study. The effects of methylene blue on cognitive symptoms were not significant. The medication was well tolerated with transient and mild side-effects. CONCLUSIONS Methylene blue used as an adjunctive medication improved residual symptoms of depression and anxiety in patients with bipolar disorder.
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Affiliation(s)
- Martin Alda
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Margaret McKinnon
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Blagdon
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Julie Garnham
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Susan MacLellan
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Claire O'Donovan
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Tomas Hajek
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia Nair
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Serdar Dursun
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Glenda MacQueen
- Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Margaret McKinnon, PhD, Department of Psychiatry and Neuroscience, McMaster University, Hamilton, Mood Disorders Program, St Joseph's Healthcare, Hamilton and Homewood Research Institute, Guelph, Ontario; Ryan Blagdon, MSc, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; Julie Garnham, RN, BN, Susan MacLellan, RN, Capital District Health Authority, Halifax, Nova Scotia; Claire O'Donovan, MB, FRCPC, Tomas Hajek, MD, PhD, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; Cynthia Nair, MD, FRCPC, Associate Medical Clinic, Prince Albert, Saskatchewan; Serdar Dursun, MD, PhD, FRCPC, Department of Psychiatry, University of Alberta, Edmonton, Alberta; Glenda MacQueen, MD, PhD, FRCPC, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Premoli I, Biondi A, Carlesso S, Rivolta D, Richardson MP. Lamotrigine and levetiracetam exert a similar modulation of TMS-evoked EEG potentials. Epilepsia 2016; 58:42-50. [PMID: 27808418 PMCID: PMC5244669 DOI: 10.1111/epi.13599] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 12/23/2022]
Abstract
Objective Antiepileptic drug (AED) treatment failures may occur because there is insufficient drug in the brain or because of a lack of relevant therapeutic response. Until now it has not been possible to measure these factors. It has been recently shown that the combination of transcranial magnetic stimulation and electroencephalography (TMS‐EEG) can measure the effects of drugs in healthy volunteers. TMS‐evoked EEG potentials (TEPs) comprise a series of positive and negative deflections that can be specifically modulated by drugs with a well‐known mode of action targeting inhibitory neurotransmission. Therefore, we hypothesized that TMS‐EEG can detect effects of two widely used AEDs, lamotrigine and levetiracetam, in healthy volunteers. Methods Fifteen healthy subjects participated in a pseudo‐randomized, placebo‐controlled, double‐blind, crossover design, using a single oral dose of lamotrigine (300 mg) and levetiracetam (3,000 mg). TEPs were recorded before and 120 min after drug intake, and the effects of drugs on the amplitudes of TEP components were statistically evaluated. Results A nonparametric cluster‐based permutation analysis of TEP amplitudes showed that AEDs both increased the amplitude of the negative potential at 45 msec after stimulation (N45) and suppressed the positive peak at 180 msec (P180). This is the first demonstration of AED‐induced modulation of TMS‐EEG measures. Significance Despite the different mechanism of action that lamotrigine and levetiracetam exert at the molecular level, both AEDs impact the TMS‐EEG response in a similar way. These TMS‐EEG fingerprints observed in healthy subjects are candidate predictive markers of treatment response in patients on monotherapy with lamotrigine and levetiracetam.
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Affiliation(s)
- Isabella Premoli
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Andrea Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Sara Carlesso
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Davide Rivolta
- School of Psychology, University of East London (UEL), London, United Kingdom
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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Revisiting the Lamotrigine-Mediated Effect on Hippocampal GABAergic Transmission. Int J Mol Sci 2016; 17:ijms17071191. [PMID: 27455251 PMCID: PMC4964560 DOI: 10.3390/ijms17071191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/19/2016] [Indexed: 01/07/2023] Open
Abstract
Lamotrigine (LTG) is generally considered as a voltage-gated sodium (Nav) channel blocker. However, recent studies suggest that LTG can also serve as a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel enhancer and can increase the excitability of GABAergic interneurons (INs). Perisomatic inhibitory INs, predominantly fast-spiking basket cells (BCs), powerfully inhibit granule cells (GCs) in the hippocampal dentate gyrus. Notably, BCs express abundant Nav channels and HCN channels, both of which are able to support sustained action potential generation. Using whole-cell recording in rat hippocampal slices, we investigated the net LTG effect on BC output. We showed that bath application of LTG significantly decreased the amplitude of evoked compound inhibitory postsynaptic currents (IPSCs) in GCs. In contrast, simultaneous paired recordings from BCs to GCs showed that LTG had no effect on both the amplitude and the paired-pulse ratio of the unitary IPSCs, suggesting that LTG did not affect GABA release, though it suppressed cell excitability. In line with this, LTG decreased spontaneous IPSC (sIPSC) frequency, but not miniature IPSC frequency. When re-examining the LTG effect on GABAergic transmission in the cornus ammonis region 1 (CA1) area, we found that LTG markedly inhibits both the excitability of dendrite-targeting INs in the stratum oriens and the concurrent sIPSCs recorded on their targeting pyramidal cells (PCs) without significant hyperpolarization-activated current (Ih) enhancement. In summary, LTG has no effect on augmenting Ih in GABAergic INs and does not promote GABAergic inhibitory output. The antiepileptic effect of LTG is likely through Nav channel inhibition and the suppression of global neuronal network activity.
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Abstract
Weight gain is a side-effect commonly associated with drugs used for headache prophylaxis. Weight gain can adversely affect patient health, exacerbate comorbid metabolic disorders and encourage noncompliance. Few studies have been conducted specifically on the effect of headache medications on weight, and it is important for physicians to have accurate information about weight-gain side-effects when identifying appropriate pharmacological regimens. This review discusses the potential effects on weight of the more common headache medications.
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Affiliation(s)
- W B Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
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Pharmacological evidence for the involvement of the NMDA receptor and nitric oxide pathway in the antidepressant-like effect of lamotrigine in the mouse forced swimming test. Biomed Pharmacother 2016; 82:713-21. [PMID: 27470415 DOI: 10.1016/j.biopha.2016.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/23/2016] [Indexed: 01/14/2023] Open
Abstract
Lamotrigine is an anticonvulsant agent that shows clinical antidepressant properties. The aim of the present study was to investigate the involvement of N-methyl-d-aspartate (NMDA) receptors and nitric oxide-cyclic guanosine monophosphate (NO-cGMP) synthesis in possible antidepressant-like effect of lamotrigine in forced swimming test (FST) in mice. Intraperitoneal administration of lamotrigine (10mg/kg) decreased the immobility time in the FST (P<0.01) without any effect on locomotor activity in the open-field test (OFT), while higher dose of lamotrigine (30mg/kg) reduced the immobility time in the FST (P<0.001) as well as the number of crossings in the OFT. Pretreatment of animals with NMDA (75mg/kg), l-arginine (750mg/kg, a substrate for nitric oxide synthase [NOS]) or sildenafil (5mg/kg, a phosphodiesterase [PDE] 5 inhibitor) reversed the antidepressant-like effect of lamotrigine (10mg/kg) in the FST. Injection of l-nitroarginine methyl ester (l-NAME, 10mg/kg, a non-specific NOS inhibitor), 7-nitroindazole (30mg/kg, a neuronal NOS inhibitor), methylene blue (20mg/kg, an inhibitor of both NOS and soluble guanylate cyclase [sGC]), or MK-801 (0.05mg/kg), ketamine (1mg/kg), and magnesium sulfate (10mg/kg) as NMDA receptor antagonists in combination with a sub-effective dose of lamotrigine (5mg/kg) diminished the immobility time of animals in the FST compared with either drug alone. None of the drugs produced significant effects on the locomotor activity in the OFT. Based on our findings, it is suggested that the antidepressant-like effect of lamotrigine might mediated through inhibition of either NMDA receptors or NO-cGMP synthesis.
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36
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Sawyer NT, Helvig AW, Makinson CD, Decker MJ, Neigh GN, Escayg A. Scn1a dysfunction alters behavior but not the effect of stress on seizure response. GENES, BRAIN, AND BEHAVIOR 2016; 15:335-47. [PMID: 26694226 DOI: 10.1111/gbb.12281] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022]
Abstract
Mutations in the voltage-gated sodium channel gene SCN1A are responsible for a number of epilepsy disorders, including genetic epilepsy with febrile seizures plus (GEFS+) and Dravet syndrome. In addition, dysfunction in SCN1A is increasingly being linked to neuropsychiatric abnormalities, social deficits and cognitive disabilities. We have previously reported that mice heterozygous for the SCN1A R1648H mutation identified in a GEFS+ family have infrequent spontaneous seizures, increased susceptibility to chemically and hyperthermia-induced generalized seizures and sleep abnormalities. In this study, we characterized the behavior of heterozygous mice expressing the SCN1A R1648H mutation (Scn1a(RH/+)) and the effect of stress on spontaneous and induced seizures. We also examined the effect of the R1648H mutation on the hypothalamic-pituitary-adrenal (HPA) axis response. We confirmed our previous finding that Scn1a(RH/+) mutants are hyperactive, and also identified deficits in social behavior, spatial memory, cued fear conditioning, pre-pulse inhibition and risk assessment. Furthermore, while exposure to a stressor did increase seizure susceptibility, the effect seen in the Scn1a(RH/+) mutants was similar to that seen in wild-type littermates. In addition, Scn1a dysfunction does not appear to alter HPA axis function in adult animals. Our results suggest that the behavioral abnormalities associated with Scn1a dysfunction encompass a wider range of phenotypes than previously reported and factors such as stress exposure may alter disease severity in patients with SCN1A mutations.
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Affiliation(s)
- N T Sawyer
- Department of Human Genetics, Emory University, Atlanta, GA
- Department of Biology, Clayton State University, Morrow, GA
| | - A W Helvig
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, GA
| | - C D Makinson
- Department of Human Genetics, Emory University, Atlanta, GA
| | - M J Decker
- Departments of Physiology & Biophysics, Case Western Reserve University, Cleveland, OH
- Department of Neuroscience, School of Nursing, Case Western Reserve University, Cleveland, OH
| | - G N Neigh
- Department of Physiology, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - A Escayg
- Department of Human Genetics, Emory University, Atlanta, GA
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D'Souza MS. Glutamatergic transmission in drug reward: implications for drug addiction. Front Neurosci 2015; 9:404. [PMID: 26594139 PMCID: PMC4633516 DOI: 10.3389/fnins.2015.00404] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/12/2015] [Indexed: 12/12/2022] Open
Abstract
Individuals addicted to drugs of abuse such as alcohol, nicotine, cocaine, and heroin are a significant burden on healthcare systems all over the world. The positive reinforcing (rewarding) effects of the above mentioned drugs play a major role in the initiation and maintenance of the drug-taking habit. Thus, understanding the neurochemical mechanisms underlying the reinforcing effects of drugs of abuse is critical to reducing the burden of drug addiction in society. Over the last two decades, there has been an increasing focus on the role of the excitatory neurotransmitter glutamate in drug addiction. In this review, pharmacological and genetic evidence supporting the role of glutamate in mediating the rewarding effects of the above described drugs of abuse will be discussed. Further, the review will discuss the role of glutamate transmission in two complex heterogeneous brain regions, namely the nucleus accumbens (NAcc) and the ventral tegmental area (VTA), which mediate the rewarding effects of drugs of abuse. In addition, several medications approved by the Food and Drug Administration that act by blocking glutamate transmission will be discussed in the context of drug reward. Finally, this review will discuss future studies needed to address currently unanswered gaps in knowledge, which will further elucidate the role of glutamate in the rewarding effects of drugs of abuse.
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Affiliation(s)
- Manoranjan S D'Souza
- Pharmaceutical and Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University Ada, OH, USA
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Prabhavalkar KS, Poovanpallil NB, Bhatt LK. Management of bipolar depression with lamotrigine: an antiepileptic mood stabilizer. Front Pharmacol 2015; 6:242. [PMID: 26557090 PMCID: PMC4615936 DOI: 10.3389/fphar.2015.00242] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
The efficacy of lamotrigine in the treatment of focal epilepsies have already been reported in several case reports and open studies, which is thought to act by inhibiting glutamate release through voltage-sensitive sodium channels blockade and neuronal membrane stabilization. However, recent findings have also illustrated the importance of lamotrigine in alleviating the depressive symptoms of bipolar disorder, without causing mood destabilization or precipitating mania. Currently, no mood stabilizers are available having equal efficacy in the treatment of both mania and depression, two of which forms the extreme sides of the bipolar disorder. Lamotrigine, a well established anticonvulsant has received regulatory approval for the treatment and prevention of bipolar depression in more than 30 countries worldwide. Lamotrigine, acts through several molecular targets and overcomes the major limitation of other conventional antidepressants by stabilizing mood from “below baseline” thereby preventing switches to mania or episode acceleration, thus being effective for bipolar I disorder. Recent studies have also suggested that these observations could also be extended to patients with bipolar II disorder. Thus, lamotrigine may supposedly fulfill the unmet requirement for an effective depression mood stabilizer.
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Affiliation(s)
- Kedar S Prabhavalkar
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy , Mumbai, India
| | - Nimmy B Poovanpallil
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy , Mumbai, India
| | - Lokesh K Bhatt
- Department of Pharmacology, Dr. Bhanuben Nanavati College of Pharmacy , Mumbai, India
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Grados MA, Atkins EB, Kovacikova GI, McVicar E. A selective review of glutamate pharmacological therapy in obsessive-compulsive and related disorders. Psychol Res Behav Manag 2015; 8:115-31. [PMID: 25995654 PMCID: PMC4425334 DOI: 10.2147/prbm.s58601] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glutamate, an excitatory central nervous system neurotransmitter, is emerging as a potential alternative pharmacological treatment when compared to gamma-aminobutyric acid (GABA)-, dopamine-, and serotonin-modulating treatments for neuropsychiatric conditions. The pathophysiology, animal models, and clinical trials of glutamate modulation are explored in disorders with underlying inhibitory deficits (cognitive, motor, behavioral) including obsessive–compulsive disorder, attention deficit hyperactivity disorder, Tourette syndrome, trichotillomania, excoriation disorder, and nail biting. Obsessive–compulsive disorder, attention deficit hyperactivity disorder, and grooming disorders (trichotillomania and excoriation disorder) have emerging positive data, although only scarce controlled trials are available. The evidence is less supportive for the use of glutamate modulators in Tourette syndrome. Glutamate-modulating agents show promise in the treatment of disorders of inhibition.
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Affiliation(s)
- Marco A Grados
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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41
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Stenner MP, Litvak V, Rutledge RB, Zaehle T, Schmitt FC, Voges J, Heinze HJ, Dolan RJ. Cortical drive of low-frequency oscillations in the human nucleus accumbens during action selection. J Neurophysiol 2015; 114:29-39. [PMID: 25878159 PMCID: PMC4518721 DOI: 10.1152/jn.00988.2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/09/2015] [Indexed: 11/24/2022] Open
Abstract
The nucleus accumbens is thought to contribute to action selection by integrating behaviorally relevant information from multiple regions, including prefrontal cortex. Studies in rodents suggest that information flow to the nucleus accumbens may be regulated via task-dependent oscillatory coupling between regions. During instrumental behavior, local field potentials (LFP) in the rat nucleus accumbens and prefrontal cortex are coupled at delta frequencies (Gruber AJ, Hussain RJ, O'Donnell P. PLoS One 4: e5062, 2009), possibly mediating suppression of afferent input from other areas and thereby supporting cortical control (Calhoon GG, O'Donnell P. Neuron 78: 181–190, 2013). In this report, we demonstrate low-frequency cortico-accumbens coupling in humans, both at rest and during a decision-making task. We recorded LFP from the nucleus accumbens in six epilepsy patients who underwent implantation of deep brain stimulation electrodes. All patients showed significant coherence and phase-synchronization between LFP and surface EEG at delta and low theta frequencies. Although the direction of this coupling as indexed by Granger causality varied between subjects in the resting-state data, all patients showed a cortical drive of the nucleus accumbens during action selection in a decision-making task. In three patients this was accompanied by a significant coherence increase over baseline. Our results suggest that low-frequency cortico-accumbens coupling represents a highly conserved regulatory mechanism for action selection.
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Affiliation(s)
- Max-Philipp Stenner
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany;
| | - Vladimir Litvak
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom
| | - Robb B Rutledge
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Friedhelm C Schmitt
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany; and
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany; and
| | - Raymond J Dolan
- Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
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Miyamoto S, Jarskog LF, Fleischhacker WW. New therapeutic approaches for treatment-resistant schizophrenia: a look to the future. J Psychiatr Res 2014; 58:1-6. [PMID: 25070124 DOI: 10.1016/j.jpsychires.2014.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/18/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023]
Abstract
Schizophrenia for many patients is a lifelong mental disorder with significant consequences on most functional domains. One fifth to one third of patients with schizophrenia experience persistent psychotic symptoms despite adequate trials of antipsychotic treatment, and are considered to have treatment-resistant schizophrenia (TRS). Clozapine is the only medication to demonstrate efficacy for psychotic symptoms in such patients. However, clozapine is not effective in 40%-70% of patients with TRS and it has significant limitations in terms of potentially life-threatening side effects and the associated monitoring. Accordingly, a number of pharmacological and non-pharmacological biological approaches for clozapine-resistant TRS have emerged. This article provides a brief updated critical review of recent therapeutic strategies for TRS, particularly for clozapine-resistant TRS, which include pharmacotherapy, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation.
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Affiliation(s)
- Seiya Miyamoto
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - L Fredrik Jarskog
- North Carolina Psychiatric Research Center, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Mann JJ, Oquendo MA, Watson KT, Boldrini M, Malone KM, Ellis SP, Sullivan G, Cooper TB, Xie S, Currier D. Anxiety in major depression and cerebrospinal fluid free gamma-aminobutyric acid. Depress Anxiety 2014; 31:814-21. [PMID: 24865448 PMCID: PMC4797625 DOI: 10.1002/da.22278] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/22/2014] [Accepted: 04/18/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Low gamma-aminobutyric acid (GABA) is implicated in both anxiety and depression pathophysiology. They are often comorbid, but most clinical studies have not examined these relationships separately. We investigated the relationship of cerebrospinal fluid (CSF) free GABA to the anxiety and depression components of a major depressive episode (MDE) and to monoamine systems. METHODS AND MATERIALS Patients with a DSM-IV major depressive episode (N = 167: 130 major depressive disorder; 37 bipolar disorder) and healthy volunteers (N = 38) had CSF free GABA measured by gas chromatography mass spectroscopy. Monoamine metabolites were assayed by high performance liquid chromatography. Symptomatology was assessed by Hamilton depression rating scale. RESULTS Psychic anxiety severity increased with age and correlated with lower CSF free GABA, controlling for age. CSF free GABA declined with age but was not related to depression severity. Other monoamine metabolites correlated positively with CSF GABA but not with psychic anxiety or depression severity. CSF free GABA was lower in MDD compared with bipolar disorder and healthy volunteers. GABA levels did not differ based on a suicide attempt history in mood disorders. Recent exposure to benzodiazepines, but not alcohol or past alcoholism, was associated with a statistical trend for more severe anxiety and lower CSF GABA. CONCLUSIONS Lower CSF GABA may explain increasing severity of psychic anxiety in major depression with increasing age. This relationship is not seen with monoamine metabolites, suggesting treatments targeting the GABAergic system should be evaluated in treatment-resistant anxious major depression and in older patients.
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Affiliation(s)
- J. John Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York,Department of Radiology, Columbia University, 1051 Riverside Drive, New York, New York,Correspondence to: J. John Mann M.D., Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, NY 10032.
| | - Maria A. Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Kalycia Trishana Watson
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Maura Boldrini
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Kevin M. Malone
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Steven P. Ellis
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Gregory Sullivan
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, New York,Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, New York
| | - Thomas B. Cooper
- Department of Analytical Psychopharmacology, the Nathan Klein Institute, Columbia University, 1051 Riverside Drive, New York, New York
| | - Shan Xie
- Department of Analytical Psychopharmacology, the Nathan Klein Institute, Columbia University, 1051 Riverside Drive, New York, New York
| | - Dianne Currier
- The Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Song F, Li Q, Wan ZY, Zhao YJ, Huang F, Yang Q, Zhao WF, Zhang M, Chen YJ. Lamotrigine reverses masseter overactivity caused by stress maybe via Glu suppression. Physiol Behav 2014; 137:25-32. [PMID: 24955497 DOI: 10.1016/j.physbeh.2014.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/25/2014] [Accepted: 06/13/2014] [Indexed: 12/15/2022]
Abstract
Experimental and non-experimental stress significantly increase masseter muscle tone, which has been linked to the symptoms and pathogenesis of several stomatognathic system diseases. Until now, the mechanism underlying this phenomenon has remained unclear. The current study was performed to determine the mechanism of the stress-induced increase in masseter muscle tone and to investigate the effect of lamotrigine on this change. Animals challenged by repeated restraint stress received either saline as a vehicle or lamotrigine in doses of 20, 30 or 40 mg/kg body weight, whereas control animals received saline without stress treatment. Masseter muscle tone was assessed using electromyography. The activity of glutamate-related metabolic enzymes (glutaminase and glutamine synthetase) in the trigeminal motor nucleus was also investigated. Our results showed an interesting phenomenon: masseter muscle activity increased concurrently with the upregulation of the glutamate concentration after stress treatment. The activities of glutaminase and glutamine synthetase in the trigeminal motor nucleus were also upregulated and downregulated, respectively, when the rats were challenged by prolonged stress. The animals treated with lamotrigine at moderate and high doses had significantly decreased masseter muscle tone compared with stressed animals treated with vehicle. These results suggested that increased glutaminase activity and decreased glutamine synthetase activity increased glutamate production and decreased glutamate decomposition, causing an increase in glutamate levels in the trigeminal motor nucleus and eventually increasing masseter muscle tone. The administration of lamotrigine at doses of 30 or 40 mg/kg body weight effectively mitigated the adverse effects of stress on masseter muscle tone via inhibition of glutamate release.
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Affiliation(s)
- Fang Song
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China
| | - Qiang Li
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China
| | - Zhong-Yuan Wan
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China
| | - Ya-Juan Zhao
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China
| | - Fei Huang
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China; Department of Stomatology, PLA Navy General Hospital, Beijing 100048, PR China
| | - Qi Yang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China
| | - Wen-Feng Zhao
- Department of Stomatology, General Hospital of Beijing Military Command, Dongsishitiao Road South Gate Warehouse No. 5, Beijing 100700, PR China.
| | - Min Zhang
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China.
| | - Yong-Jin Chen
- State Key Laboratory of Military Stomatology, Department of General Dentistry & Emergency, School of Stomatology, Fourth Military Medical University, Xi'an 710032, Shaanxi, PR China.
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Haggag BS, Hasanin AH, Raafat MH, Abdel Kawy HS. Lamotrigine decreased hippocampal damage and improved vascular risk markers in a rat model of pentylenetetrazole induced kindling seizure. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2014; 18:269-78. [PMID: 24976768 PMCID: PMC4071181 DOI: 10.4196/kjpp.2014.18.3.269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/02/2014] [Accepted: 04/12/2014] [Indexed: 11/15/2022]
Abstract
Various antiepileptic drugs (AEDs) especially enzyme-inducing AEDs might be associated with increased vascular risk, through impairment of the endogenous antioxidative ability which may trigger oxygen-dependent tissue injury. Lamotrigine (LTG) a non-enzyme-inducing AED has scarce information regarding its effects on oxidative stress. The present study aimed to study the possible modulation of vascular risk factors of epileptogenesis by LTG, in a rat model of kindling seizure induced by pentylenetetrazole (PTZ). Four groups of male Wister rats were used; vehicle control group, PTZ group (alternate day PTZ, 30 mg/kg, i.p), LTG/PTZ group (LTG 20 mg/kg/day p.o and alternate day PTZ) and LTG group. The study period was 5 weeks. Lipoproteins and total homocysteine (tHcy), malondialdehyde (MDA) and reduced glutathione (GSH) were measured. Aortic endothelial function study and histopathological examination of the rats' brains, aortas and coronaries were conducted. Serum total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), tHcy, MDA, GSH levels were significantly higher in epileptic rats than normal controls rats. A decrease in HDL-cholesterol with high atherosclerotic index was also demonstrated. The administration of LTG improved the PTZ-kindled seizures. It produced a significant decrease in TC, TG and LDL-cholesterol, MDA, aortic GSH and increase in HDL-cholesterol with no significant effect on serum GSH and tHcy levels. LTG improved endothelium-dependent relaxation, decreased hippocampal neurodegenerative changes and atherosclerotic changes of aortas and coronaries. LTG decreased seizures severity, hippocampal damage and improved vascular risk markers in this rat model of kindling seizures.
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Affiliation(s)
- Basma S Haggag
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Amany H Hasanin
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Mona H Raafat
- Department of Histology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Hala S Abdel Kawy
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
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Singh E, Pillai KK, Mehndiratta M. Characterization of a Lamotrigine-Resistant Kindled Model of Epilepsy in Mice: Evaluation of Drug Resistance Mechanisms. Basic Clin Pharmacol Toxicol 2014; 115:373-8. [DOI: 10.1111/bcpt.12238] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/10/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Ekta Singh
- Department of Pharmacology; Faculty of Pharmacy; Jamia Hamdard (Hamdard University); New Delhi India
| | - Krishna K. Pillai
- Department of Pharmacology; Faculty of Pharmacy; Jamia Hamdard (Hamdard University); New Delhi India
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Mula M. Investigating psychotropic properties of antiepileptic drugs. Expert Rev Neurother 2014; 13:639-46. [DOI: 10.1586/ern.13.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ohnuma T, Takebayashi Y, Higashiyama R, Shibata N, Arai H. Low-dose lamotrigine augmentation therapy improves residual symptoms in treatment-resistant schizophrenia: a report of five cases. Asia Pac Psychiatry 2013; 5:336-43. [PMID: 24591092 DOI: 10.1111/j.1758-5872.2012.00225.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/07/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Treatment-resistant schizophrenia (TRS) refers to the approximately 20-30% of schizophrenia patients whose symptoms are resistant to any antipsychotic treatment. For the improvement of residual symptoms in TRS, augmentation therapy using anticonvulsants such as lamotrigine (LTG) has recently attracted attention. Randomized clinical trials (RCTs) have demonstrated robust evidence; however, the results have shown both positive and negative outcomes for the use of LTG. Although RCTs have merit, they also obscure informative clinical features present in each patient, such as the types of TRS that show the most significant effects from LTG. Thus, detailed case reports examining the efficacy of LTG may help to shed light on various treatments for complex, heterogeneous diseases such as schizophrenia. METHODS We present detailed reports on the clinical course and features of TRS in five patients suffering from severe positive symptoms who were treated with LTG augmentation therapy. RESULTS After the administration of LTG augmentation therapy, two patients did not show any improvement in their residual symptoms, while the remaining three patients did experience improvement. Remarkably, patients with more severe residual positive symptoms, especially those with auditory hallucinations, seemed to respond better to low-dose LTG (50 mg daily). Additional clinical variables, such as type and dose of ongoing antipsychotics, age of onset, duration of illness, duration of untreated psychosis, number of administration cycles, and genetic heritability, were not found to be related to the effectiveness of LTG augmentation. DISCUSSION Low-dose LTG augmentation therapy seems to improve residual symptoms in some cases of TRS. The glutamatergic properties of LTG may be the decisive factor in these symptoms, as other glutamatergic agents have also been shown to be effective based on previous glutamate hypotheses in schizophrenia.
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Affiliation(s)
- Tohru Ohnuma
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
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Perucca P, Mula M. Antiepileptic drug effects on mood and behavior: molecular targets. Epilepsy Behav 2013; 26:440-9. [PMID: 23092694 DOI: 10.1016/j.yebeh.2012.09.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 09/06/2012] [Indexed: 01/09/2023]
Abstract
With almost 100 years of clinical experience, antiepileptic drugs (AEDs) remain the mainstay of epilepsy treatment. They suppress epileptic seizures by acting on a variety of mechanisms and molecular targets involved in the regulation of neuronal excitability. These include inhibitory-GABAergic and excitatory-glutamatergic neurotransmission, as well as ion (sodium and calcium) conductance through voltage-gated channels. On the other hand, accruing evidence indicates that these mechanisms and targets are also implicated in the regulation of mood and behavior, which may explain why each AED is associated with specific psychotropic effects. These effects, however, cannot be explained solely on the basis of the known mode of action of each AED, and other mechanisms or targets are likely to be implicated. In this article, we review positive and negative effects of AEDs on mood and behavior, discuss putative underlying mechanisms, and highlight knowledge gaps which should be addressed in future studies.
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Affiliation(s)
- Piero Perucca
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
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Egashira N, Abe M, Shirakawa A, Niki T, Mishima K, Iwasaki K, Oishi R, Fujiwara M. Effects of mood stabilizers on marble-burying behavior in mice: involvement of GABAergic system. Psychopharmacology (Berl) 2013; 226:295-305. [PMID: 23086022 DOI: 10.1007/s00213-012-2904-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 10/09/2012] [Indexed: 01/23/2023]
Abstract
RATIONALE Obsessive-compulsive disorder (OCD) is characterized by recurrent unwanted thoughts (obsessions), usually accompanied by repetitive behaviors (compulsions) intended to alleviate anxiety. Marble-burying behavior is a pharmacological model for study of OCD. OBJECTIVES In the present study, we examined the effects of mood stabilizers on marble-burying behavior in mice, as well as the role of GABA receptors in this behavior. METHODS The effects of treatment with valproate, carbamazepine, lithium carbonate, lamotrigine, muscimol and baclofen on marble-burying behavior in mice were evaluated. RESULTS Valproate (10, 30 and 100 mg/kg, i.p.) and carbamazepine (30 and 100 mg/kg, p.o.) significantly reduced marble-burying behavior without affecting total locomotor activity in ICR mice. Lamotrigine (30 mg/kg, i.p.) also significantly reduced marble-burying behavior in ddY mice. On the other hand, lithium carbonate (10, 30 and 100 mg/kg, i.p.) reduced total locomotor activity without affecting marble-burying behavior in ddY mice. The selective GABA(A) receptor agonist muscimol (1 mg/kg) significantly reduced marble-burying behavior without affecting total locomotor activity, whereas the selective GABA(B) receptor agonist baclofen (3 mg/kg) reduced total locomotor activity without affecting marble-burying behavior. Moreover, the selective GABA(A) receptor antagonist bicuculline (3 mg/kg) significantly counteracted the decrease in marble-burying induced by the administration of muscimol (1 mg/kg) and valproate (100 mg/kg). CONCLUSIONS These results suggest that GABAergic mechanism is involved in marble-burying behavior, and that valproate, carbamazepine and lamotrigine reduce marble-burying behavior. Moreover, valproate reduces marble-burying behavior via a GABA(A) receptor-dependent mechanism.
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Affiliation(s)
- Nobuaki Egashira
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan.
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