1
|
Li G, Cao Y, Yang C, Li X, Yang Y, Yang L, Hao D, Li CSR. Sex differences in dorsolateral prefrontal cortical and superior colliculus activities support the impact of alcohol use severity and sleep deficiency on two-back memory. Quant Imaging Med Surg 2024; 14:4972-4986. [PMID: 39022273 PMCID: PMC11250293 DOI: 10.21037/qims-24-156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
Background Working memory refers to a process of temporary storage and manipulation of information to support planning, decision-making, and action. Frequently comorbid alcohol misuse and sleep deficiency have both been associated with working memory deficits. However, how alcohol misuse and sleep deficiency interact to impact working memory remains unclear. In this study, we aim to investigate the neural processes inter-relating alcohol misuse, sleep deficiency and working memory. Methods We curated the Human Connectome Project (HCP) dataset and investigated the neural correlation of working memory in link with alcohol use severity and sleep deficiency in 991 young adults (521 women). The two were indexed by the first principal component (PC1) of principal component analysis of all drinking metrics and Pittsburgh Sleep Quality Index (PSQI) score, respectively. We processed the imaging data with published routines and evaluated the results with a corrected threshold. We used path model to characterize the inter-relationship between the clinical, behavioral, and neural measures, and explored sex differences in the findings. Results In whole-brain regression, we identified β estimates of dorsolateral prefrontal cortex response (DLPFC β) to 2- vs. 0-back in correlation with PC1. The DLPFC showed higher activation in positive correlation with PC1 across men and women (r=0.16, P<0.001). Path analyses showed the model PC1 → DLPFC β → differences in reaction time (2- minus 0-back; RT2-0) of correct trials → differences in critical success index (2- minus 0-back; CSI2-0) with the best fit. In women alone, in addition to the DLPFC, a cluster in the superior colliculus (SC) showed a significant negative correlation with the PSQI score (r=-0.23, P<0.001), and the path model showed the inter-relationship of PC1, PSQI score, DLPFC and SC β's, and CSI2-0 in women. Conclusions Alcohol misuse may involve higher DLPFC activation in functional compensation, whereas, in women only, sleep deficiency affects 2-back memory by depressing SC activity. In women only, path model suggests inter-related impact of drinking severity and sleep deficiency on 2-back memory. These findings suggest potential sex differences in the impact of drinking and sleep problems on working memory that need to be further investigated.
Collapse
Affiliation(s)
- Guangfei Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing, China
| | - Yingjie Cao
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Chunlan Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing, China
| | - Xuwen Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Yimin Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Lin Yang
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing, China
| | - Dongmei Hao
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
- Beijing International Science and Technology Cooperation Base for Intelligent Physiological Measurement and Clinical Transformation, Beijing, China
| | - Chiang-Shan R. Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| |
Collapse
|
2
|
Farzan F. Transcranial Magnetic Stimulation-Electroencephalography for Biomarker Discovery in Psychiatry. Biol Psychiatry 2024; 95:564-580. [PMID: 38142721 DOI: 10.1016/j.biopsych.2023.12.018] [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: 06/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Current diagnosis and treatment of psychiatric illnesses are still based on behavioral observations and self-reports, commonly leading to prolonged untreated illness. Biological markers (biomarkers) may offer an opportunity to revolutionize clinical psychiatry practice by helping provide faster and potentially more effective therapies. Transcranial magnetic stimulation concurrent with electroencephalography (TMS-EEG) is a noninvasive brain mapping methodology that can assess the functions and dynamics of specific brain circuitries in awake humans and aid in biomarker discovery. This article provides an overview of TMS-EEG-based biomarkers that may hold potential in psychiatry. The methodological readiness of the TMS-EEG approach and steps in the validation of TMS-EEG biomarkers for clinical utility are discussed. Biomarker discovery with TMS-EEG is in the early stages, and several validation steps are still required before clinical implementations are realized. Thus far, TMS-EEG predictors of response to magnetic brain stimulation treatments in particular have shown promise for translation to clinical practice. Larger-scale studies can confirm validation followed by biomarker-informed trials to assess added value compared to existing practice.
Collapse
Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| |
Collapse
|
3
|
Tang VM, Ibrahim C, Rodak T, Goud R, Blumberger DM, Voineskos D, Le Foll B. Managing substance use in patients receiving therapeutic repetitive transcranial magnetic stimulation: A scoping review. Neurosci Biobehav Rev 2023; 155:105477. [PMID: 38007879 DOI: 10.1016/j.neubiorev.2023.105477] [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: 09/25/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) is an invaluable treatment option for neuropsychiatric disorders. Co-occurring recreational and nonmedical substance use can be common in those presenting for rTMS treatment, and it is unknown how it may affect the safety and efficacy of rTMS for the treatment of currently approved neuropsychiatric indications. This scoping review aimed to map the literature on humans receiving rTMS and had a history of any type of substance use. The search identified 274 articles providing information on inclusion/exclusion criteria, withdrawal criteria, safety protocols, type of rTMS and treatment parameters, adverse events and effect on primary outcomes that related to substance use. There are neurophysiological effects of substance use on cortical excitability, although the relevance to clinical rTMS practice is unknown. The current literature supports the safety and feasibility of delivering rTMS to those who have co-occurring neuropsychiatric disorder and substance use. However, specific details on how varying degrees of substance use alters the safety, efficacy, and mechanisms of rTMS remains poorly described.
Collapse
Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada.
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Terri Rodak
- CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Daphne Voineskos
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
| |
Collapse
|
4
|
Event-related potentials during mental rotation of body-related stimuli in spinal cord injury population. Neuropsychologia 2023; 179:108447. [PMID: 36521630 DOI: 10.1016/j.neuropsychologia.2022.108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/13/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Mental rotations of body-related stimuli are known to engage the motor system and activate body schema. Sensorimotor deficits following spinal cord injury (SCI) alter the representation of the body with a negative impact on the performance during motor-related tasks, such as mental rotation of body parts. Here we investigated the relationship between event-related potentials in SCI participants and the difficulty in mentally rotating a body-part. Participants with SCI and healthy control subjects performed a laterality judgment task, in which left or right images of hands, feet or animals (as a control stimulus) were presented in two different orientation angles (75° and 150°), and participants reported the laterality of the stimulus. We found that reaction times of participants with SCI were slower for the rotation of body-related stimuli compared to non-body-related stimuli and healthy controls. At the brain level, we found that relative to healthy controls SCI participants show: 1) reduced amplitudes of the posterior P100 and anterior N100 and larger amplitudes of the anterior P200 for overall stimuli; 2) an absence of the modulation of the rotation related negativity by stimulus type and rotation angles. Our results show that body representation changes after SCI affecting both components of early stimulus processing and late components that process high-order cognitive aspects of body-representation and task complexity.
Collapse
|
5
|
Hamel R, Demers O, Boileau C, Roy ML, Théoret H, Bernier PM, Lepage JF. The neurobiological markers of acute alcohol's subjective effects in humans. Neuropsychopharmacology 2022; 47:2101-2110. [PMID: 35701548 PMCID: PMC9556716 DOI: 10.1038/s41386-022-01354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 12/21/2022]
Abstract
The ingestion of alcohol yields acute biphasic subjective effects: stimulation before sedation. Despite their predictive relevance to the development of alcohol use disorders (AUD), the neurobiological markers accounting for the biphasic effects of alcohol remain poorly understood in humans. Informed by converging lines of evidence, this study tested the hypothesis that alcohol ingestion acutely increases gamma-aminobutyric acid (GABA)-mediated inhibition, which would positively and negatively predict the feeling of stimulation and sedation, respectively. To do so, healthy participants (n = 20) ingested a single dose of 94% ABV alcohol (males: 1.0 ml/kg; females: 0.85 ml/kg) in a randomized placebo-controlled cross-over design. The alcohol's biphasic effects were assessed with the Brief-Biphasic Alcohol Effects Scale, and non-invasive neurobiological markers were measured with transcranial magnetic stimulation, before and every 30 min (up to 120 min) after the complete ingestion of the beverage. Results showed that acute alcohol ingestion selectively increased the duration of the cortical silent period (CSP) as compared to placebo, suggesting that alcohol increases non-specific GABAergic inhibition. Importantly, CSP duration positively and negatively predicted increases in the feeling of stimulation and sedation, respectively, suggesting that stimulation emerges as GABAergic inhibition increases and that sedation emerges as GABAergic inhibition returns to baseline values. Overall, these results suggest that modulations of GABAergic inhibition are central to the acute biphasic subjective effects of alcohol, providing a potential preventive target to curb the progression of at-risk individuals to AUD.
Collapse
Affiliation(s)
- Raphael Hamel
- Département de kinanthropologie, Faculté des sciences de l'activité physique, Université de Sherbrooke, Sherbrooke, QC, Canada
- Département de pédiatrie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Olivier Demers
- Département de pédiatrie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Camille Boileau
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Laurence Roy
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Hugo Théoret
- Département de psychologie, Faculté des arts et sciences, Université de Montréal, Montreal, QC, Canada
| | - Pierre-Michel Bernier
- Département de kinanthropologie, Faculté des sciences de l'activité physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Francois Lepage
- Département de pédiatrie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
| |
Collapse
|
6
|
Pokorny L, Besting L, Roebruck F, Jarczok TA, Bender S. Fearful facial expressions reduce inhibition levels in the dorsolateral prefrontal cortex in subjects with specific phobia. Depress Anxiety 2022; 39:26-36. [PMID: 34617644 DOI: 10.1002/da.23217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/01/2021] [Accepted: 09/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Specific phobias have the highest prevalence among anxiety disorders. Cognitive control involving the dorsolateral prefrontal cortex (DLPFC) is crucial for coping abilities in anxiety disorders. However, there is little research on the DLPFC in specific phobia. METHODS Using transcranial magnetic stimulation (TMS), we investigated the TMS-evoked potential component N100 in the DLPFC at rest and while watching emotional expressions. The TMS-evoked N100 provides a parameter for gamma-aminobutyric acid (GABA)-B-mediated cortical inhibition. Twenty-two drug-free subjects with specific phobia (21 females and 1 male) were compared with 26 control subjects (23 females and 3 males) regarding N100 in the DLPFC at rest and during an emotional 1-back task with fearful, angry, and neutral facial expressions. RESULTS At rest, we found reduced N100 amplitudes in the specific phobia compared with the control group. Furthermore, the specific phobia group showed a further reduction in N100 amplitude when memorizing fearful compared with neutral facial expressions. CONCLUSION There appears to be a decrease in GABA-B-mediated inhibition in the DLPFC in subjects with a specific phobia at rest. This decrease was more pronounced under emotional activation by exposure to fearful facial expressions, pointing towards additional state effects of emotional processing on inhibitory function in the DLPFC.
Collapse
Affiliation(s)
- Lena Pokorny
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Besting
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Friederike Roebruck
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tomasz Antoni Jarczok
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
7
|
Pokorny L, Jarczok TA, Bender S. Topography and lateralization of long-latency trigeminal somatosensory evoked potentials. Clin Neurophysiol 2021; 135:37-50. [PMID: 35026539 DOI: 10.1016/j.clinph.2021.11.073] [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: 04/23/2021] [Revised: 09/20/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Long-latency trigeminal somatosensory evoked potentials (SSEPs) have not been sufficiently studied regarding their topography and lateralization. SSEPs are hypothesized to contribute to the evoked potentials after transcranial magnetic stimulation (TMS). This study focused on trigeminal SSEPs with latencies > 100 ms, potentially overlapping with TMS-evoked N100. METHODS In 14 healthy subjects, the trigeminus was electrically stimulated on the left and right forehead, and time-course, topography, and lateralization of trigeminal SSEPs were examined in 64-channel electroencephalogram (EEG). SSEPs were then compared to TMS-evoked potentials when TMS was applied to the left and right dorsolateral prefrontal cortex. RESULTS Trigeminal stimulation produced a somatosensory N140 with topographic maximum over centroparietal electrodes with larger amplitudes contra- than ipsilaterally to the stimulation. Contralateral potentials after TMS were partly comparable in their topography but differed in latencies. CONCLUSIONS SSEPs generated by electrical stimulation of the trigeminus occurred over somatosensory areas with a contralateral lateralization. Therefore, contralateral potentials after TMS should be interpreted with caution, as they may include somatosensory components. SIGNIFICANCE The topography and lateralization of long-latency trigeminal SSEPs should be considered in future TMS-EEG designs.
Collapse
Affiliation(s)
- Lena Pokorny
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany.
| | - Tomasz Antoni Jarczok
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Frankfurt, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, KJF Klinik Josefinum, Kapellenstrasse 30, 86154, Augsburg, Germany.
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany.
| |
Collapse
|
8
|
Turco CV, Arsalan SO, Nelson AJ. The Influence of Recreational Substance Use in TMS Research. Brain Sci 2020; 10:E751. [PMID: 33080965 PMCID: PMC7603156 DOI: 10.3390/brainsci10100751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Transcranial magnetic stimulation (TMS) approaches are widely used to study cortical and corticospinal function. However, responses to TMS are subject to significant intra-and inter-individual variability. Acute and chronic exposure to recreational substances alters the excitability of the sensorimotor system and may contribute to the variability in TMS outcome measures. The increasing prevalence of recreational substance use poses a significant challenge for executing TMS studies, but there is a lack of clarity regarding the influence of these substances on sensorimotor function. (2) Methods: The literature investigating the influence of alcohol, nicotine, caffeine and cannabis on TMS outcome measures of corticospinal, intracortical and interhemispheric excitability was reviewed. (3) Results: Both acute and chronic use of recreational substances modulates TMS measures of excitability. Despite the abundance of research in this field, we identify knowledge gaps that should be addressed in future studies to better understand the influence of these substances on TMS outcomes. (4) Conclusions: This review highlights the need for TMS studies to take into consideration the history of participant substance use and to control for acute substance use prior to testing.
Collapse
Affiliation(s)
| | | | - Aimee J. Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4L8, Canada; (C.V.T.); (S.O.A.)
| |
Collapse
|
9
|
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: 20] [Impact Index Per Article: 5.0] [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.
Collapse
Affiliation(s)
- Yoshihiro Noda
- Multidisciplinary Translational Research Lab, Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
10
|
Hadas I, Sun Y, Lioumis P, Zomorrodi R, Jones B, Voineskos D, Downar J, Fitzgerald PB, Blumberger DM, Daskalakis ZJ. Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2019; 2:e195578. [PMID: 31167023 PMCID: PMC6551850 DOI: 10.1001/jamanetworkopen.2019.5578] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/25/2019] [Indexed: 12/21/2022] Open
Abstract
Importance Hyperactivity in the subgenual cingulate cortex (SGC) is associated with major depressive disorder (MDD) and anticorrelated with activity in the dorsolateral prefrontal cortex (DLPFC). This association was found to be predictive of responsiveness to repetitive transcranial magnetic stimulation (rTMS) treatment. Such findings suggest that DLPFC-SGC connectivity is important for understanding both the therapeutic mechanism of rTMS in patients with MDD and the underlying pathophysiology of MDD. Objective To evaluate SGC hyperactivity in patients with MDD before and after rTMS treatment. Design, Setting, and Participants In this diagnostic study, among participants recruited from the adult and geriatric mood and anxiety services at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, who had participated in a randomized clinical trial, baseline SGC activity of patients with MDD was compared with healthy controls. In patients with MDD, SGC activity was compared before and after active or sham high-frequency rTMS treatment. Data collection started in July 2008 and concluded in March 2012. Neurophysiological data analysis started in January 2017 and ended in May 2018. Main Outcomes and Measures Hyperactivity in the SGC before and after rTMS treatment was measured. Subgenual cingulate cortex hyperactivity activity was quantified using significant current density (SCD), and effective connectivity between the left DLPFC and SGC was computed using significant current scattering (SCS). Both measures were computed around TMS evoked potentials standard peak latencies prior to rTMS and after rTMS treatment, comparing patients with MMD treated with active and sham rTMS. Patients with MDD were assessed with the 17-item Hamilton Rating Scale for Depression. Results Of 121 patients with MDD in the initial trial, 30 (15 [50.0%] women) were compared with 30 healthy controls (15 [50.0%] women) at rTMS treatment baseline. The mean (SD) age of the cohort with MDD was 39.1 (10.9) years, and the mean (SD) age of healthy controls was 37.0 (11.0) years. Following rTMS treatment, 26 patients with MDD who had active rTMS treatment (21.5%) were compared with 17 patients with MDD who had sham treatment (14.0%). At baseline, the SGC mean (SD) SCD and mean (SD) SCS at 200 milliseconds after TMS pulse were higher in participants with MDD compared with healthy controls (SCD: 1.04 × 10-6 [1.41 × 10-6] μA/mm2 vs 3.8 × 10-7 [7.8 × 10-7] μA/mm2; z = -2.95; P = .004; SCS: 0.87 [0.86] mm vs 0.54 [0.87] mm; z = -2.27; P = .02). Baseline source current density was able to classify MDD with 77% accuracy. Scores on the 17-item Hamilton Rating Scale for Depression were correlated with current density at the SGC (ρ = 0.41; P = .03). After rTMS treatment, SGC mean (SD) SCD and mean (SD) SCS at 200 milliseconds after rTMS pulse were attenuated to approximately the standard TMS-evoked potential latencies in the active rTMS group compared with the sham rTMS group (SCD: 1.57 × 10-7 [3.67 × 10-7] μA/mm2 vs 7.00 × 10-7 [7.51 × 10-7] μA/mm2; z = -2.91; P = .004; SCS: 0.20 [0.44] mm vs 0.74 [0.73] mm; z = -2.78; P = .006). Additionally, the SGC SCS change was correlated with symptom improvement on the 17-item Hamilton Rating Scale for Depression in the active rTMS group (ρ = 0.58; P = .047). Conclusions and Relevance The findings of this study further implicate left DLPFC-SGC effective connectivity and SGC excitability in the pathophysiology of MDD and treatment with rTMS. These findings suggest that DLPFC-SGC connectivity may be a marker of rTMS treatment responsiveness. Trial Registration ClinicalTrials.gov identifier: NCT01515215.
Collapse
Affiliation(s)
- Itay Hadas
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Yinming Sun
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Pantelis Lioumis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Brett Jones
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Paul B. Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, Victoria, Australia
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|