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Kabir A, Dhami P, Dussault Gomez MA, Blumberger DM, Daskalakis ZJ, Moreno S, Farzan F. Influence of Large-Scale Brain State Dynamics on the Evoked Response to Brain Stimulation. J Neurosci 2024; 44:e0782242024. [PMID: 39164105 PMCID: PMC11426374 DOI: 10.1523/jneurosci.0782-24.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 08/22/2024] Open
Abstract
Understanding how spontaneous brain activity influences the response to neurostimulation is crucial for the development of neurotherapeutics and brain-computer interfaces. Localized brain activity is suggested to influence the response to neurostimulation, but whether fast-fluctuating (i.e., tens of milliseconds) large-scale brain dynamics also have any such influence is unknown. By stimulating the prefrontal cortex using combined transcranial magnetic stimulation (TMS) and electroencephalography, we examined how dynamic global brain state patterns, as defined by microstates, influence the magnitude of the evoked brain response. TMS applied during what resembled the canonical Microstate C was found to induce a greater evoked response for up to 80 ms compared with other microstates. This effect was found in a repeated experimental session, was absent during sham stimulation, and was replicated in an independent dataset. Ultimately, ongoing and fast-fluctuating global brain states, as probed by microstates, may be associated with intrinsic fluctuations in connectivity and excitation-inhibition balance and influence the neurostimulation outcome. We suggest that the fast-fluctuating global brain states be considered when developing any related paradigms.
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Affiliation(s)
- Amin Kabir
- Centre for Engineering-Led Brain Research, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia V3T 0A3, Canada
| | - Prabhjot Dhami
- Centre for Engineering-Led Brain Research, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia V3T 0A3, Canada
| | - Marie-Anne Dussault Gomez
- Centre for Engineering-Led Brain Research, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia V3T 0A3, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, La Jolla, California 92093
| | - Sylvain Moreno
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, British Columbia V3T 0A3, Canada
- Circle Innovation, Vancouver, British Columbia V6B 4N6, Canada
| | - Faranak Farzan
- Centre for Engineering-Led Brain Research, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia V3T 0A3, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada
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Mijancos-Martínez G, Bachiller A, Fernández-Linsenbarth I, Romero S, Serna LY, Molina V, Mañanas MÁ. Individualized time windows enhance TMS-EEG signal characterization and improve assessment of cortical function in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01859-z. [PMID: 38969752 DOI: 10.1007/s00406-024-01859-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/20/2024] [Indexed: 07/07/2024]
Abstract
Transcranial magnetic stimulation and electroencephalography (TMS-EEG) recordings are crucial to directly assess cortical excitability and inhibition in a non-invasive and task-free manner. TMS-EEG signals are characterized by TMS-evoked potentials (TEPs), which are employed to evaluate cortical function. Nonetheless, different time windows (TW) have been used to compute them over the years. Moreover, these TWs tend to be the same for all participants omitting the intersubject variability. Therefore, the objective of this study is to assess the effect of using different TWs to compute the TEPs, moving from a common fixed TW to more adaptive individualized TWs. Twenty-nine healthy (HC) controls and twenty schizophrenia patients (SCZ) underwent single-pulse (SP) TMS-EEG protocol. Firstly, only the HC were considered to evaluate the TEPs for three different TWs in terms of amplitude and topographical distribution. Secondly, the SCZ patients were included to determine which TW is better to characterize the brain alterations of SCZ. The results indicate that a more individualized TW provides a better characterization of the SP TMS-EEG signals, although all of them show the same tendency. Regarding the comparison between groups, the individualized TW is the one that provides a better differentiation between populations. They also provide further support to the possible imbalance of cortical excitability/inhibition in the SCZ population due to its reduced activity in the N45 TEP and greater amplitude values in the N100. Results also suggest that the SCZ brain has a baseline hyperactive state since the TEPs of the SCZ appear earlier than those of the HC.
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Affiliation(s)
- Gema Mijancos-Martínez
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Barcelona, Spain.
- Institute of Research Sant Joan de Déu, Barcelona, Spain.
| | - Alejandro Bachiller
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
| | | | - Sergio Romero
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Leidy Y Serna
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Vicente Molina
- Psychiatry Department, School of Medicine, University of Valladolid, Valladolid, Spain
- Psychiatry Service, Clinical Hospital of Valladolid, Valladolid, Spain
- Neurosciences Institute of Castilla y Léon (INCYL), University of Salamanca, Salamanca, Spain
| | - Miguel Ángel Mañanas
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Universitat Politècnica de Catalunya - BarcelonaTech (UPC), Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
- CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Li D, Li X, Li J, Liu J, Luo R, Li Y, Wang D, Zhou D, Zhang XY. Neurophysiological markers of disease severity and cognitive dysfunction in major depressive disorder: A TMS-EEG study. Int J Clin Health Psychol 2024; 24:100495. [PMID: 39282218 PMCID: PMC11402404 DOI: 10.1016/j.ijchp.2024.100495] [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: 03/22/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Background Transcranial magnetic stimulation-electroencephalography (TMS-EEG) is a powerful technique to study the neuropathology and biomarkers of major depressive disorder (MDD). This study investigated cortical activity and its relationship with clinical symptoms and cognitive dysfunction in MDD patients by indexing TMS-EEG biomarkers in the dorsolateral prefrontal cortex (DLPFC). Methods 133 patients with MDD and 76 healthy individuals participated in this study. Single-pulse TMS was performed on the left DLPFC to obtain TMS-evoked potential (TEP) indices. TMS-EEG waveforms and components were determined by global mean field amplitude. We used the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to measure participants' cognitive function. Results Patients with MDD had a lower excitatory P180 index compared to healthy controls, and P180 amplitude was negatively correlated with the severity of depressive and anxiety symptoms in patients with MDD. In the MDD group, P30 amplitude was negatively associated with RBANS Visuospatial/ Constructional index and total score. Conclusions TMS-EEG findings suggest that abnormal cortical excitation and inhibition induced by TMS on the DLPFC are associated with the severity of clinical symptoms and cognitive dysfunction in patients with MDD. P180 and P30 have the potential to serve as neurophysiological biomarkers of clinical symptoms and cognitive dysfunction in MDD patients, respectively.
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Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xingxing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, Zhejiang, China
- Department of psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Jiaxin Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Junyao Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruichenxi Luo
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanli Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongsheng Zhou
- Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, Zhejiang, China
- Department of psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Fernández-Linsenbarth I, Mijancos-Martínez G, Bachiller A, Núñez P, Rodríguez-González V, Beño-Ruiz-de-la-Sierra RM, Roig-Herrero A, Arjona-Valladares A, Poza J, Mañanas MÁ, Molina V. Relation between task-related activity modulation and cortical inhibitory function in schizophrenia and healthy controls: a TMS-EEG study. Eur Arch Psychiatry Clin Neurosci 2024; 274:837-847. [PMID: 38243018 PMCID: PMC11127880 DOI: 10.1007/s00406-023-01745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024]
Abstract
Schizophrenia has been associated with a reduced task-related modulation of cortical activity assessed through electroencephalography (EEG). However, to the best of our knowledge, no study so far has assessed the underpinnings of this decreased EEG modulation in schizophrenia. A possible substrate of these findings could be a decreased inhibitory function, a replicated finding in the field. In this pilot study, our aim was to explore the association between EEG modulation during a cognitive task and the inhibitory system function in vivo in a sample including healthy controls and patients with schizophrenia. We hypothesized that the replicated decreased task-related activity modulation during a cognitive task in schizophrenia would be related to a hypofunction of the inhibitory system. For this purpose, 27 healthy controls and 22 patients with schizophrenia (including 13 first episodes) performed a 3-condition auditory oddball task from which the spectral entropy modulation was calculated. In addition, cortical reactivity-as an index of the inhibitory function-was assessed by the administration of 75 monophasic transcranial magnetic stimulation single pulses over the left dorsolateral prefrontal cortex. Our results replicated the task-related cortical activity modulation deficit in schizophrenia patients. Moreover, schizophrenia patients showed higher cortical reactivity following transcranial magnetic stimulation single pulses over the left dorsolateral prefrontal cortex compared to healthy controls. Cortical reactivity was inversely associated with EEG modulation, supporting the idea that a hypofunction of the inhibitory system could hamper the task-related modulation of EEG activity.
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Affiliation(s)
- Inés Fernández-Linsenbarth
- Psychiatry Department, School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - Gema Mijancos-Martínez
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Polytechnic University of Catalonia, Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
| | - Alejandro Bachiller
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Polytechnic University of Catalonia, Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
| | - Pablo Núñez
- Coma Science Group, CIGA-Consciousness, University of Liège, Liège, Belgium
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Biomaterials and Nanomedicine (BICER-BBN), CIBER of Bioengineering, Madrid, Spain
| | - Víctor Rodríguez-González
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Biomaterials and Nanomedicine (BICER-BBN), CIBER of Bioengineering, Madrid, Spain
| | | | - Alejandro Roig-Herrero
- Psychiatry Department, School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
- Imaging Processing Laboratory, University of Valladolid, Valladolid, Spain
| | - Antonio Arjona-Valladares
- Psychiatry Department, School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - Jesús Poza
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- Biomaterials and Nanomedicine (BICER-BBN), CIBER of Bioengineering, Madrid, Spain
- Instituto de Investigación en Matemáticas (IMUCA), University of Valladolid, Valladolid, Spain
| | - Miguel Ángel Mañanas
- Biomedical Engineering Research Centre (CREB), Department of Automatic Control (ESAII), Polytechnic University of Catalonia, Barcelona, Spain
- Institute of Research Sant Joan de Déu, Barcelona, Spain
- Biomaterials and Nanomedicine (BICER-BBN), CIBER of Bioengineering, Madrid, Spain
| | - Vicente Molina
- Psychiatry Department, School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain.
- Psychiatry Service, Clinical Hospital of Valladolid, Valladolid, Spain.
- Neurosciences Institute of Castilla y Léon (INCYL), University of Salamanca, Salamanca, Spain.
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Guo Y, Lu R, Ou Y, Huang Y, Li J, Cui Y, Li D, Zheng Y, Liang X, Qiu S, Liu Y. A study on the association between prefrontal functional connectivity and non-suicidal self-injury in adolescents with depression. Front Neurol 2024; 15:1382136. [PMID: 38711563 PMCID: PMC11070463 DOI: 10.3389/fneur.2024.1382136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Objective Among adolescents with depression, the occurrence of non-suicidal self-injury (NSSI) behavior is prevalent, constituting a high-risk factor for suicide. However, there has been limited research on the neuroimaging mechanisms underlying adolescent depression and NSSI behavior, and the potential association between the two remains unclear. Therefore, this study aims to investigate the alterations in functional connectivity (FC) of the regions in the prefrontal cortex with the whole brain, and elucidates the relationship between these alterations and NSSI behavior in adolescents with depression. Methods A total of 68 participants were included in this study, including 35 adolescents with depression and 33 healthy controls. All participants underwent assessments using the 17-item Hamilton Depression Rating Scale (17-HAMD) and the Ottawa Self-Harm Inventory. In addition, functional magnetic resonance imaging (fMRI) data of the participants' brains were collected. Subsequently, the FCs of the regions in the prefrontal cortex with the whole brain was calculated. The FCs showing significant differences were then subjected to correlation analyses with 17-HAMD scores and NSSI behavior scores. Result Compared to the healthy control group, the adolescent depression group exhibited decreased FCs in several regions, including the right frontal eye field, left dorsolateral prefrontal cortex, right orbitofrontal cortex, left insula and right anterior cingulate coetex. The 17-HAMD score was positively correlated with the frequency of NSSI behavior within 1 year (rs = 0.461, p = 0.005). The FC between the right anterior cingulate cortex and the right precuneus showed a negative correlation with the 17-HAMD scores (rs = -0.401, p = 0.023). Additionally, the FC between the right orbitofrontal cortex and the right insula, demonstrated a negative correlation with the frequency of NSSI behavior within 1 year (rs = -0.438, p = 0.012, respectively). Conclusion Adolescents with depression showed decreased FCs of the prefrontal cortex with multiple brain regions, and some of these FCs were associated with the NSSI frequency within 1 year. This study provided neuroimaging evidence for the neurophysiological mechanisms underlying adolescent depression and its comorbidity with NSSI behavior.
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Affiliation(s)
- Yan Guo
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Army Medical Center (Daping Hospital), Army Medical University, Chongqing, China
| | - Ruoxi Lu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Yiwen Ou
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuxin Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianyu Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Cui
- Cerebropathy Center, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Danian Li
- Cerebropathy Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanting Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinyu Liang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - Shijun Qiu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Traditional Chinese Medicine Syndrome, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yujie Liu
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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She X, Nix KC, Cline CC, Qi W, Tugin S, He Z, Baumer FM. Stability of transcranial magnetic stimulation electroencephalogram evoked potentials in pediatric epilepsy. Sci Rep 2024; 14:9045. [PMID: 38641629 PMCID: PMC11031596 DOI: 10.1038/s41598-024-59468-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Transcranial magnetic stimulation paired with electroencephalography (TMS-EEG) can measure local excitability and functional connectivity. To address trial-to-trial variability, responses to multiple TMS pulses are recorded to obtain an average TMS evoked potential (TEP). Balancing adequate data acquisition to establish stable TEPs with feasible experimental duration is critical when applying TMS-EEG to clinical populations. Here we aim to investigate the minimum number of pulses (MNP) required to achieve stable TEPs in children with epilepsy. Eighteen children with Self-Limited Epilepsy with Centrotemporal Spikes, a common epilepsy arising from the motor cortices, underwent multiple 100-pulse blocks of TMS to both motor cortices over two days. TMS was applied at 120% of resting motor threshold (rMT) up to a maximum of 100% maximum stimulator output. The average of all 100 pulses was used as a "gold-standard" TEP to which we compared "candidate" TEPs obtained by averaging subsets of pulses. We defined TEP stability as the MNP needed to achieve a concordance correlation coefficient of 80% between the candidate and "gold-standard" TEP. We additionally assessed whether experimental or clinical factors affected TEP stability. Results show that stable TEPs can be derived from fewer than 100 pulses, a number typically used for designing TMS-EEG experiments. The early segment (15-80 ms) of the TEP was less stable than the later segment (80-350 ms). Global mean field amplitude derived from all channels was less stable than local TEP derived from channels overlying the stimulated site. TEP stability did not differ depending on stimulated hemisphere, block order, or antiseizure medication use, but was greater in older children. Stimulation administered with an intensity above the rMT yielded more stable local TEPs. Studies of TMS-EEG in pediatrics have been limited by the complexity of experimental set-up and time course. This study serves as a critical starting point, demonstrating the feasibility of designing efficient TMS-EEG studies that use a relatively small number of pulses to study pediatric epilepsy and potentially other pediatric groups.
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Affiliation(s)
- Xiwei She
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Kerry C Nix
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Wendy Qi
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Sergei Tugin
- Department of Neurology, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Zihuai He
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Fiona M Baumer
- Department of Neurology, Stanford University, Stanford, CA, USA.
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Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
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Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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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: 4] [Impact Index Per Article: 4.0] [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.
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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.
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9
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He Y, Zhao B, Liu Z, Li Z, Han M, Geng X, Wu J. Bilateral theta burst stimulation modulates dorsolateral prefrontal cortex functional connectivity for emotion regulation in young adults: A randomized controlled trial. Brain Stimul 2024; 17:205-207. [PMID: 38373519 DOI: 10.1016/j.brs.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- Youze He
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China; The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Baoru Zhao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhihan Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhaoying Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Mengyu Han
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiujuan Geng
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hongkong, China; Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
| | - Jingsong Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China; The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
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10
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Dhami P, Moreno S, Croarkin PE, Blumberger DM, Daskalakis ZJ, Farzan F. Baseline markers of cortical excitation and inhibition predict response to theta burst stimulation treatment for youth depression. Sci Rep 2023; 13:19115. [PMID: 37925557 PMCID: PMC10625527 DOI: 10.1038/s41598-023-45107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
Theta burst stimulation (TBS), a specific form of repetitive transcranial magnetic stimulation (TMS), is a promising treatment for youth with Major Depressive Disorder (MDD) who do not respond to conventional therapies. However, given the variable response to TBS, a greater understanding of how baseline features relate to clinical response is needed to identify which patients are most likely to benefit from this treatment. In the current study, we sought to determine if baseline neurophysiology, specifically cortical excitation and/or inhibition, is associated with antidepressant response to TBS. In two independent open-label clinical trials, youth (aged 16-24 years old) with MDD underwent bilateral dorsolateral prefrontal cortex (DLPFC) TBS treatment. Clinical trial one and two consisted of 10 and 20 daily sessions of bilateral DLPFC TBS, respectively. At baseline, single-pulse TMS combined with electroencephalography was used to assess the neurophysiology of 4 cortical sites: bilateral DLPFC and inferior parietal lobule. Measures of cortical excitation and inhibition were indexed by TMS-evoked potentials (i.e., P30, N45, P60, N100, and P200). Depression severity was measured before, during and after treatment completion using the Hamilton Rating Scale for Depression-17. In both clinical trials, the baseline left DLPFC N45 and P60, which are believed to reflect inhibitory and excitatory mechanisms respectively, were predictors of clinical response. Specifically, greater (i.e., more negative) N45 and smaller P60 baseline values were associated with greater treatment response to TBS. Accordingly, cortical excitation and inhibition circuitry of the left DLPFC may have value as a TBS treatment response biomarker for youth with MDD.Clinical trial 1 registration number: NCT02472470 (June 15, 2015).Clinical trial 2 registration number: NCT03708172 (October 17, 2018).
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Affiliation(s)
- Prabhjot Dhami
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sylvain Moreno
- School of Interactive Arts and Technology, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada
- Circle Innovation, 1200-555 W. Hastings Street, Vancouver, BC, V6B 4N6, Canada
| | - Paul E Croarkin
- College of Medicine and Science, Mayo Clinic, Rochester, MN, 55905, USA
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada.
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
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11
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Krile L, Ensafi E, Cole J, Noor M, Protzner AB, McGirr A. A dose-response characterization of transcranial magnetic stimulation intensity and evoked potential amplitude in the dorsolateral prefrontal cortex. Sci Rep 2023; 13:18650. [PMID: 37903906 PMCID: PMC10616119 DOI: 10.1038/s41598-023-45730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
By combining transcranial magnetic stimulation (TMS) with electroencephalography, human cortical circuits can be directly interrogated. The resulting electrical trace contains TMS-evoked potential (TEP) components, and it is not known whether the amplitudes of these components are stimulus intensity dependent. We examined this in the left dorsolateral prefrontal cortex in nineteen healthy adult participants and extracted TEP amplitudes for the N40, P60, N120, and P200 components at 110%, 120%, and 130% of resting motor threshold (RMT). To probe plasticity of putative stimulus intensity dose-response relationships, this was repeated after participants received intermittent theta burst stimulation (iTBS; 600 pulses, 80% RMT). The amplitude of the N120 and P200 components exhibited a stimulus intensity dose-response relationship, however the N40 and P60 components did not. After iTBS, the N40 and P60 components continued to exhibit a lack of stimulus intensity dose-dependency, and the P200 dose-response was unchanged. In the N120 component, however, we saw evidence of change within the stimulus intensity dose-dependent relationship characterized by a decrease in absolute peak amplitudes at lower stimulus intensities. These data suggest that TEP components have heterogeneous dose-response relationships, with implications for standardizing and harmonizing methods across experiments. Moreover, the selective modification of the N120 dose-response relationship may provide a novel marker for iTBS plasticity in health and disease.
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Affiliation(s)
- Louisa Krile
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Elnaz Ensafi
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Jaeden Cole
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Mah Noor
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Andrea B Protzner
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, TRW-4D68, Calgary, AB, T2N 4Z6, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
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12
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Poorganji M, Zomorrodi R, Hawco C, Hill AT, Hadas I, Zrenner C, Rajji TK, Chen R, Voineskos D, Blumberger DM, Daskalakis ZJ. Isolating sensory artifacts in the suprathreshold TMS-EEG signal over DLPFC. Sci Rep 2023; 13:6796. [PMID: 37100795 PMCID: PMC10130812 DOI: 10.1038/s41598-023-29920-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/13/2023] [Indexed: 04/28/2023] Open
Abstract
Combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) is an effective way to evaluate neurophysiological processes at the level of the cortex. To further characterize the TMS-evoked potential (TEP) generated with TMS-EEG, beyond the motor cortex, we aimed to distinguish between cortical reactivity to TMS versus non-specific somatosensory and auditory co-activations using both single-pulse and paired-pulse protocols at suprathreshold stimulation intensities over the left dorsolateral prefrontal cortex (DLPFC). Fifteen right-handed healthy participants received six blocks of stimulation including single and paired TMS delivered as active-masked (i.e., TMS-EEG with auditory masking and foam spacing), active-unmasked (TMS-EEG without auditory masking and foam spacing) and sham (sham TMS coil). We evaluated cortical excitability following single-pulse TMS, and cortical inhibition following a paired-pulse paradigm (long-interval cortical inhibition (LICI)). Repeated measure ANOVAs revealed significant differences in mean cortical evoked activity (CEA) of active-masked, active-unmasked, and sham conditions for both the single-pulse (F(1.76, 24.63) = 21.88, p < 0.001, η2 = 0.61) and LICI (F(1.68, 23.49) = 10.09, p < 0.001, η2 = 0.42) protocols. Furthermore, global mean field amplitude (GMFA) differed significantly across the three conditions for both single-pulse (F(1.85, 25.89) = 24.68, p < 0.001, η2 = 0.64) and LICI (F(1.8, 25.16) = 14.29, p < 0.001, η2 = 0.5). Finally, only active LICI protocols but not sham stimulation ([active-masked (0.78 ± 0.16, P < 0.0001)], [active-unmasked (0.83 ± 0.25, P < 0.01)]) resulted in significant signal inhibition. While previous findings of a significant somatosensory and auditory contribution to the evoked EEG signal are replicated by our study, an artifact attenuated cortical reactivity can reliably be measured in the TMS-EEG signal with suprathreshold stimulation of DLPFC. Artifact attenuation can be accomplished using standard procedures, and even when masked, the level of cortical reactivity is still far above what is produced by sham stimulation. Our study illustrates that TMS-EEG of DLPFC remains a valid investigational tool.
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Affiliation(s)
- Mohsen Poorganji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Colin Hawco
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aron T Hill
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Itay Hadas
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Christoph Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Robert Chen
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA.
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13
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Poorganji M, Zomorrodi R, Zrenner C, Bansal A, Hawco C, Hill AT, Hadas I, Rajji TK, Chen R, Zrenner B, Voineskos D, Blumberger DM, Daskalakis ZJ. Pre-Stimulus Power but Not Phase Predicts Prefrontal Cortical Excitability in TMS-EEG. BIOSENSORS 2023; 13:220. [PMID: 36831986 PMCID: PMC9953459 DOI: 10.3390/bios13020220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The cortical response to transcranial magnetic stimulation (TMS) has notable inter-trial variability. One source of this variability can be the influence of the phase and power of pre-stimulus neuronal oscillations on single-trial TMS responses. Here, we investigate the effect of brain oscillatory activity on TMS response in 49 distinct healthy participants (64 datasets) who had received single-pulse TMS over the left dorsolateral prefrontal cortex. Across all frequency bands of theta (4-7 Hz), alpha (8-13 Hz), and beta (14-30 Hz), there was no significant effect of pre-TMS phase on single-trial cortical evoked activity. After high-powered oscillations, whether followed by a TMS pulse or not, the subsequent activity was larger than after low-powered oscillations. We further defined a measure, corrected_effect, to enable us to investigate brain responses to the TMS pulse disentangled from the power of ongoing (spontaneous) oscillations. The corrected_effect was significantly different from zero (meaningful added effect of TMS) only in theta and beta bands. Our results suggest that brain state prior to stimulation might play some role in shaping the subsequent TMS-EEG response. Specifically, our findings indicate that the power of ongoing oscillatory activity, but not phase, can influence brain responses to TMS. Aligning the TMS pulse with specific power thresholds of an EEG signal might therefore reduce variability in neurophysiological measurements and also has the potential to facilitate more robust therapeutic effects of stimulation.
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Affiliation(s)
- Mohsen Poorganji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Christoph Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Aiyush Bansal
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Colin Hawco
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Aron T. Hill
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC 3125, Australia
| | - Itay Hadas
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA 92093-0603, USA
| | - Tarek K. Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Robert Chen
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada
| | - Brigitte Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA 92093-0603, USA
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14
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Neurophysiological Impact of Theta Burst Stimulation Followed by Cognitive Exercise in Treatment of Youth Depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142:104867. [PMID: 36122739 DOI: 10.1016/j.neubiorev.2022.104867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.
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16
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Changes in the TMS-evoked potential N100 in the dorsolateral prefrontal cortex as a function of depression severity in adolescents. J Neural Transm (Vienna) 2022; 129:1339-1352. [PMID: 36029418 PMCID: PMC9550695 DOI: 10.1007/s00702-022-02539-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022]
Abstract
Studies using transcranial magnetic stimulation with simultaneous electroencephalography (TMS-EEG) revealed an imbalance between cortical excitation and inhibition (E/I) in the dorsolateral prefrontal cortex (DLPFC) in depression. As adolescence is a developmental period with an increase in depression prevalence and profound neural changes, it is crucial to study the relationship between depression and cortical excitability in adolescence. We aimed to investigate the cortical excitability of the DLPFC in adolescents with depression and a dependency of the TMS-evoked potential N100 on the depression severity. 36 clinical patients (12–18 years of age; 21 females) with a major depressive episode were assessed twice in a longitudinal design: shortly after admission (T0) and after six weeks of intervention (T1). GABA-B-mediated cortical inhibition in the left and right DLPFC, as assessed by the N100, was recorded with EEG. Significantly higher depression scores were reported at T0 compared to T1 (p < 0.001). N100 amplitudes were significantly increased (i.e., more negative) at T0 compared to T1 (p = 0.03). No significant hemispheric difference was found in the N100 component. The correlation between the difference in depression severity and the difference in N100 amplitudes (T0–T1) obtained during stimulation of the left DLPFC did not remain significant after correction for testing in both hemispheres. Higher N100 amplitudes during a state of greater depression severity are suggestive of an E/I imbalance in the DLPFC in adolescents with an acute depressive episode. The N100 reduction potentially reflects a normalization of DLPFC over inhibition in association with decreased depressive symptomatology, indicating severity dependency.
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17
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Farzan F, Bortoletto M. Identification and verification of a 'true' TMS evoked potential in TMS-EEG. J Neurosci Methods 2022; 378:109651. [PMID: 35714721 DOI: 10.1016/j.jneumeth.2022.109651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/05/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The concurrent combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) can unveil functional neural mechanisms with applications in basic and clinical research. In particular, TMS-evoked potentials (TEPs) potentially allow studying excitability and connectivity of the cortex in a causal manner that is not easily or non-invasively attainable with other neuroimaging techniques. The TEP waveform is obtained by isolating the EEG responses phase-locked to the time of TMS application. The intended component in a TEP waveform is the cortical activation by the TMS-induced electric current, free of instrumental and physiological artifact sources. This artifact-free cortical activation can be referred to as 'true' TEP. However, due to many unwanted auxiliary effects of TMS, the interpretation of 'true' TEPs has not been free of controversy. This paper reviews the most recent understandings of 'true' TEPs and their application. In the first part of the paper, TEP components are defined according to recommended methodologies. In the second part, the verification of 'true' TEP is discussed along with its sensitivity to brain-state, age, and disease. The various proposed origins of TEP components are then presented in the context of existing literature. Throughout the paper, lessons learned from the past TMS-EEG studies are highlighted to guide the identification and interpretation of 'true' TEPs in future studies.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Marta Bortoletto
- Neurophysiology lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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18
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Langenecker SA, Westlund Schreiner M, Thomas LR, Bessette KL, DelDonno SR, Jenkins LM, Easter RE, Stange JP, Pocius SL, Dillahunt A, Love TM, Phan KL, Koppelmans V, Paulus M, Lindquist MA, Caffo B, Mickey BJ, Welsh RC. Using Network Parcels and Resting-State Networks to Estimate Correlates of Mood Disorder and Related Research Domain Criteria Constructs of Reward Responsiveness and Inhibitory Control. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:76-84. [PMID: 34271215 PMCID: PMC8748287 DOI: 10.1016/j.bpsc.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/14/2021] [Accepted: 06/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Resting-state graph-based network edges can be powerful tools for identification of mood disorders. We address whether these edges can be integrated with Research Domain Criteria (RDoC) constructs for accurate identification of mood disorder-related markers, while minimizing active symptoms of disease. METHODS We compared 132 individuals with currently remitted or euthymic mood disorder with 65 healthy comparison participants, ages 18-30 years. Subsets of smaller brain parcels, combined into three prominent networks and one network of parcels overlapping across these networks, were used to compare edge differences between groups. Consistent with the RDoC framework, we evaluated individual differences with performance measure regressors of inhibitory control and reward responsivity. Within an omnibus regression model, we predicted edges related to diagnostic group membership, performance within both RDoC domains, and relevant interactions. RESULTS There were several edges of mood disorder group, predominantly of greater connectivity across networks, different than those related to individual differences in inhibitory control and reward responsivity. Edges related to diagnosis and inhibitory control did not align well with prior literature, whereas edges in relation to reward responsivity constructs showed greater alignment with prior literature. Those edges in interaction between RDoC constructs and diagnosis showed a divergence for inhibitory control (negative interactions in default mode) relative to reward (positive interactions with salience and emotion network). CONCLUSIONS In conclusion, there is evidence that prior simple network models of mood disorders are currently of insufficient biological or diagnostic clarity or that parcel-based edges may be insufficiently sensitive for these purposes.
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Affiliation(s)
| | | | - Leah R Thomas
- Department of Psychiatry, University of Utah, Salt Lake City, Utah; Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Katie L Bessette
- Department of Psychiatry, University of Utah, Salt Lake City, Utah; Department of Psychiatry & Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Sophia R DelDonno
- Department of Psychiatry & Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Lisanne M Jenkins
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - Rebecca E Easter
- Department of Psychiatry & Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Jonathan P Stange
- Department of Psychiatry & Psychology, University of Illinois at Chicago, Chicago, Illinois; Department of Psychology, University of Southern California, Los Angeles, California
| | | | - Alina Dillahunt
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Tiffany M Love
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio
| | | | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Brian Caffo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian J Mickey
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
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19
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Lau EYY, Wong ML, Lam YC, Lau KNT, Chung KF, Rusak B. Sleep and Inhibitory Control Over Mood-Congruent Information in Emerging Adults With Depressive Disorder. Psychosom Med 2021; 83:1004-1012. [PMID: 34419999 DOI: 10.1097/psy.0000000000000996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Accumulating evidence has suggested bidirectionality between sleep problems and depression, but the underlying mechanism is unclear. We assessed the role of sleep in inhibitory control ability with emotional stimuli, which has been shown to be suboptimal among individuals with depression and proposed to perpetuate depressive symptoms. METHODS Emerging adults (aged 18-25 years, 64.6% female) were screened for depressive and other mental disorders by structured clinical interview and questionnaire. Individuals with depressive disorders were assigned to have a polysomnography-monitored daytime sleep opportunity (Sleep-Dep, n = 20), whereas nondepressed individuals were randomized to either have daytime sleep (Sleep-Ctrl, n = 27) or stay awake (Wake-Ctrl, n = 18). Participants completed the Affective Go/No-Go Task two times, separated by experimental conditions. RESULTS A factorial model with a between-subject factor (Sleep-Dep/Sleep-Ctrl/Wake-Ctrl) and a within-subject factor (test 1/test 2) was used to assess if the groups differed in inhibitory control across test sessions, as inferred by changes in d-prime and false alarm rates (FA). Results from mixed factorial models showed a significant interaction effect between time and group on FA in the block with neutral faces as the target and happy faces as the nontarget (F(2,61) = 5.15, pfdr = .045). Although Sleep-Dep had decreased FA after sleep (t(19) = 2.94, pfdr = .050), Sleep-Ctrl and Wake-Ctrl had no significant between-session changes (p values > .05). Postsleep improvement in FA in Sleep-Dep correlated with longer stage 2 sleep (r(20) = 0.788, pfdr < .001) and stage 2 fast spindle number at O1 (r(18) = 0.692, pfdr = .015). CONCLUSIONS Sleep gain, particularly stage 2 sleep and related physiology, potentially enhances inhibitory control ability responding to emotional information among individuals with depressive disorders.
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Affiliation(s)
- Esther Yuet Ying Lau
- From the Department of Psychology (E. Lau, Lam), Centre for Psychosocial Health (E. Lau, Lam), and Centre for Religious and Spirituality Education (E. Lau), The Education University of Hong Kong, Hong Kong; Department of Psychology (Wong), University of Exeter, Devon, United Kingdom; Clinical Psychological Services (K. Lau), Hong Kong Children & Youth Services; Department of Psychiatry (Chung, E. Lau), Queen Mary Hospital, The University of Hong Kong, Hong Kong; Departments of Psychiatry (Rusak) and Psychology and Neuroscience (Rusak), Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Altered neural activity in the reward-related circuit and executive control network associated with amelioration of anhedonia in major depressive disorder by electroconvulsive therapy. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110193. [PMID: 33285263 DOI: 10.1016/j.pnpbp.2020.110193] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023]
Abstract
Anhedonia is a core characteristic of depression, the amelioration of which accounts for depressive symptom improvement. Electroconvulsive therapy (ECT) has been shown remarkable antidepressive effect, however, less is known about the effect of ECT on anhedonia and its underlying neural mechanism. Herein, we investigated local and global intrinsic brain functional alterations during the resting state in 46 patients with pre- and post-ECT major depressive disorder using the amplitude of low-frequency fluctuations (ALFF) and degree centrality (DC) approach. Functional connectivity (FC) was also calculated between nodes with significant local and global intrinsic brain functional alterations. The severity of anhedonia and depression was assessed with the Temporal Experience of Pleasure Scale and Hamilton Depression Rating Scale, respectively. The relationship between the change in anhedonia and depressive symptoms and brain functional alterations was determined. Increased ALFF and DC were observed in the bilateral dorsal medial prefrontal cortex (dmPFC), right dorsal lateral prefrontal cortex (dlPFC), left orbitofrontal cortex, and right orbitofrontal cortex (ROFC) after ECT. Correlational analysis between the change in anhedonia and ALFF had positive results in the dmPFC. Similarly, there was a positive correlation between the change in anhedonia and change in DC in the dmPFC, right dlPFC, ROFC, and middle frontal gyrus. Furthermore, there was a significant relationship between the change in anhedonia and altered dmPFC-dlPFC FC. These results revealed that amelioration of anhedonia may be associated with intrinsic neural activity alteration in the reward-related circuit and executive control network following ECT.
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21
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Wellan SA, Daniels A, Walter H. State Anhedonia in Young Healthy Adults: Psychometric Properties of the German Dimensional Anhedonia Rating Scale (DARS) and Effects of the COVID-19 Pandemic. Front Psychol 2021; 12:682824. [PMID: 34248783 PMCID: PMC8260844 DOI: 10.3389/fpsyg.2021.682824] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/25/2021] [Indexed: 01/18/2023] Open
Abstract
Healthy reward processing is a complex interplay of several components. Recent self-report measures of anhedonia, the decrease or loss of hedonic capacity, take this complexity into account. The Dimensional Anhedonia Rating Scale (DARS) measures interest, motivation, effort and consummatory pleasure across four domains: hobbies, food/drink, social activities and sensory experiences. In the present cross-sectional survey study, we validated the German version of the DARS in a sample of 557 young healthy adults. Factor structure as well as convergent and divergent validity were assessed. As a secondary aim, we examined the effects of the COVID-19 pandemic on state anhedonia and depression severity. Our results suggest good convergent and divergent validity and high internal consistency of the German DARS. The original differentiation of four factors mapping onto the four domains was confirmed and measurement invariance before and during the COVID-19 pandemic was established. We conclude that the DARS is a valid instrument to comprehensively assess state anhedonia in healthy German samples. Future studies should further assess the utility of the German DARS in clinical contexts. In line with many previous studies, participants during the pandemic reported significantly higher levels of depressive symptoms compared to participants in the months before. We found no indication that the COVID-19 pandemic affected state hedonic capacity.
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Affiliation(s)
- Sarah A. Wellan
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna Daniels
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Characterizing Cortical Oscillatory Responses in Major Depressive Disorder Before and After Convulsive Therapy: A TMS-EEG Study. J Affect Disord 2021; 287:78-88. [PMID: 33774319 DOI: 10.1016/j.jad.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) is emerging as a powerful technique for interrogating neural circuit dysfunction in psychiatric disorders. Here, we utilized time-frequency analyses to characterize differences in neural oscillatory dynamics between subjects with major depressive disorder (MDD) and healthy controls (HC). We further examined changes in TMS-related oscillatory power following convulsive therapy. METHODS Oscillatory power was examined following TMS over the dorsolateral prefrontal and motor cortices (DLPFC and M1) in 38 MDD subjects, and 22 HCs. We further investigated how these responses changed in the MDD group following an acute course of convulsive therapy (either magnetic seizure therapy [MST, n = 24] or electroconvulsive therapy [ECT, n = 14]). RESULTS Prior to treatment, MDD subjects exhibited increased oscillatory power within delta, theta, and alpha frequency bands with TMS-EEG over the DLPFC, but showed no differences to HCs with stimulation over M1. Following MST, DLPFC stimulation revealed attenuated baseline-normalized power in the delta and theta bands, with reductions in the delta, theta, and alpha power following ECT. TMS over M1 revealed reduced delta and theta power following ECT, with no changes observed following MST. An association was also observed between the treatment- induced change in alpha power and depression severity score. LIMITATIONS Limitations include the modest sample size, open-label MST and ECT treatment designs, and lack of a placebo condition. CONCLUSIONS These results provide evidence of alterations in TMS-related oscillatory activity in MDD, and further suggest modulation of oscillatory power following ECT and MST.
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23
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Ferrarelli F, Phillips M. Examining and Modulating Neural Circuits in Psychiatric Disorders With Transcranial Magnetic Stimulation and Electroencephalography: Present Practices and Future Developments. Am J Psychiatry 2021; 178:400-413. [PMID: 33653120 PMCID: PMC8119323 DOI: 10.1176/appi.ajp.2020.20071050] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique uniquely equipped to both examine and modulate neural systems and related cognitive and behavioral functions in humans. As an examination tool, TMS can be used in combination with EEG (TMS-EEG) to elucidate directly, objectively, and noninvasively the intrinsic properties of a specific cortical region, including excitation, inhibition, reactivity, and oscillatory activity, irrespective of the individual's conscious effort. Additionally, when applied in repetitive patterns, TMS has been shown to modulate brain networks in healthy individuals, as well as ameliorate symptoms in individuals with psychiatric disorders. The key role of TMS in assessing and modulating neural dysfunctions and associated clinical and cognitive deficits in psychiatric populations is therefore becoming increasingly evident. In this article, the authors review TMS-EEG studies in schizophrenia and mood disorders, as most TMS-EEG studies to date have focused on individuals with these disorders. The authors present the evidence on the efficacy of repetitive TMS (rTMS) and theta burst stimulation (TBS), when targeting specific cortical areas, in modulating neural circuits and ameliorating symptoms and abnormal behaviors in individuals with psychiatric disorders, especially when informed by resting-state and task-related neuroimaging measures. Examples of how the combination of TMS-EEG assessments and rTMS and TBS paradigms can be utilized to both characterize and modulate neural circuit alterations in individuals with psychiatric disorders are also provided. This approach, along with the evaluation of the behavioral effects of TMS-related neuromodulation, has the potential to lead to the development of more effective and personalized interventions for individuals with psychiatric disorders.
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Affiliation(s)
- Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Mary Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine
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24
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Cao KX, Ma ML, Wang CZ, Iqbal J, Si JJ, Xue YX, Yang JL. TMS-EEG: An emerging tool to study the neurophysiologic biomarkers of psychiatric disorders. Neuropharmacology 2021; 197:108574. [PMID: 33894219 DOI: 10.1016/j.neuropharm.2021.108574] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 01/02/2023]
Abstract
The etiology of psychiatric disorders remains largely unknown. The exploration of the neurobiological mechanisms of mental illness helps improve diagnostic efficacy and develop new therapies. This review focuses on the application of concurrent transcranial magnetic stimulation and electroencephalography (TMS-EEG) in various mental diseases, including major depressive disorder, bipolar disorder, schizophrenia, autism spectrum disorder, attention-deficit/hyperactivity disorder, substance use disorder, and insomnia. First, we summarize the commonly used protocols and output measures of TMS-EEG; then, we review the literature exploring the alterations in neural patterns, particularly cortical excitability, plasticity, and connectivity alterations, and studies that predict treatment responses and clinical states in mental disorders using TMS-EEG. Finally, we discuss the potential mechanisms underlying TMS-EEG in establishing biomarkers for psychiatric disorders and future research directions.
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Affiliation(s)
- Ke-Xin Cao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Mao-Liang Ma
- Department of Clinical Psychology, Tianjin Medical University General Hospital Airport Site, Tianjin, China
| | - Cheng-Zhan Wang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Javed Iqbal
- School of Psychology, Shaanxi Normal University and Key Laboratory for Behavior and Cognitive Neuroscience of Shaanxi Province, Xi'an, China
| | - Ji-Jian Si
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan-Xue Xue
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; Key Laboratory for Neuroscience of Ministry of Education and Neuroscience, National Health and Family Planning Commission, Peking University, Beijing, China.
| | - Jian-Li Yang
- Department of Clinical Psychology, Tianjin Medical University General Hospital, Tianjin, China.
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Shafi RMA, Nakonezny PA, Miller KA, Desai J, Almorsy AG, Ligezka AN, Morath BA, Romanowicz M, Croarkin PE. Altered markers of stress in depressed adolescents after acute social media use. J Psychiatr Res 2021; 136:149-156. [PMID: 33592386 PMCID: PMC8009842 DOI: 10.1016/j.jpsychires.2021.01.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/23/2020] [Accepted: 01/29/2021] [Indexed: 01/13/2023]
Abstract
Social media use (SMU) is an inherent element in the daily life and neurodevelopment of adolescents, but broad concerns exist regarding the untoward effects of social media on adolescents. We conducted a prospective, cross-sectional study that sought to examine the acute effects of SMU on clinical measures and biomarkers of stress in healthy and depressed adolescents. After at least 24 h of abstinence from social media, depressed adolescents (n = 30) and healthy control adolescents (n = 30) underwent baseline clinical assessment of their prior SMU, depressive symptom severity, self-esteem, and exposure to bullying. Participants provided salivary samples that were analyzed for α-amylase and cortisol levels. After 20 min of unsupervised SMU, saliva analyses and clinical assessments were repeated. After 20 min of SMU, salivary cortisol and α-amylase levels were significantly higher in adolescents with depression but not in healthy control adolescents. Furthermore, small but statistically significant changes in depressive symptom severity occurred in all participants. These changes in depressive symptoms were not clinically meaningful. SMU did not significantly change self-esteem measures among participants. Adolescents with depression appeared to have more physiological reactivity after SMU compared with healthy adolescents. Further research should characterize SMU as a clinical dimension and risk factor among adolescents with depression and other psychiatric disorders.
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Affiliation(s)
- Reem M A Shafi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Cairns and Hinterland Hospital and Health Service, QLD, Australia.
| | - Paul A Nakonezny
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith A Miller
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jinal Desai
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ammar G Almorsy
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Anna N Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Brooke A Morath
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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26
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Dhami P, Atluri S, Lee J, Knyahnytska Y, Croarkin PE, Blumberger DM, Daskalakis ZJ, Farzan F. Neurophysiological markers of response to theta burst stimulation in youth depression. Depress Anxiety 2021; 38:172-184. [PMID: 33001549 PMCID: PMC8143862 DOI: 10.1002/da.23100] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/04/2020] [Accepted: 09/10/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Theta burst stimulation (TBS) has recently been proposed as a novel treatment for youth depression. However, the impact of TBS on the youth brain and neurophysiological predictors of response to TBS in this population have not been investigated. METHODS Cortical reactivity was assessed at baseline and following 2 weeks of bilateral dorsolateral prefrontal cortex (DLPFC) TBS treatment in 16 youth with depression (aged 16-24 years old). In 16 age-matched health youths, cortical reactivity was assessed twice, 2 weeks apart. Transcranial magnetic stimulation (TMS) combined with electroencephalography was used to assess TMS-evoked potentials in bilateral DLPFC, motor cortices, and intraparietal lobules (IPL). Resting-state functional magnetic resonance imaging (fMRI) data was also collected at baseline. RESULTS Left DLPFC pretreatment cortical reactivity, specifically the negativity at 45 ms (i.e., N45), which is related to GABAA neurotransmission, was associated with changes in depressive symptoms. Furthermore, TBS treatment was found to alter the N45 in the right IPL, a site distal to the treatment sites. The magnitude of the right IPL N45 modulation was correlated with the baseline fMRI connectivity between the right IPL and right DLPFC. CONCLUSIONS TMS-probed cortical inhibition at the site of TBS application may have potential as a predictor of treatment response in youth depression. Furthermore, pre-treatment functional connectivity may predict the impact of TBS on the neurophysiology of regions distal to the stimulation site. Collectively, these results offer novel neurophysiological insights into the application of TBS for youth depression, which may facilitate its wider use in the youth population.
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Affiliation(s)
- Prabhjot Dhami
- eBrain Lab, School of Mechatronic Systems Engineering, Faculty of Applied Science, Simon Fraser University, Surrey, British Columbia, Canada
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sravya Atluri
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterial and Biomedical Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Lee
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Neuromodulation Division, Department of Psychiatry and Biobehavioral Sciences, TMS Clinical and Research Program, Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul E. Croarkin
- Mayo Clinic Depression Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Faculty of Applied Science, Simon Fraser University, Surrey, British Columbia, Canada
- Temerty Centre for Therapeutic Brain Intervention, General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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27
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Voineskos AN, Blumberger DM, Schifani C, Hawco C, Dickie EW, Rajji TK, Mulsant BH, Foussias G, Wang W, Daskalakis ZJ. Effects of Repetitive Transcranial Magnetic Stimulation on Working Memory Performance and Brain Structure in People With Schizophrenia Spectrum Disorders: A Double-Blind, Randomized, Sham-Controlled Trial. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:449-458. [PMID: 33551284 DOI: 10.1016/j.bpsc.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND There are currently no approved treatments for working memory deficits in schizophrenia spectrum disorders (SSDs). The objective of the present study was to assess whether repetitive transcranial magnetic stimulation (rTMS) to the bilateral dorsolateral prefrontal cortex (DLPFC) in people with SSDs 1) improves working memory deficits and 2) changes brain structure. METHODS We conducted a double-blind, parallel, randomized, sham-controlled study at the Centre for Addiction and Mental Health in Toronto, Canada. We randomized 83 participants with SSDs to receive either active 20 Hz rTMS applied to the bilateral DLPFC or sham rTMS for 4 weeks. The participants also completed pre/posttreatment magnetic resonance imaging. Clinical and cognitive assessments were performed at baseline, treatment end, and 1 month later. The primary outcome was change in verbal n-back working memory performance accuracy (d-prime). The secondary outcome measures were change in DLPFC thickness and fractional anisotropy of white matter tracts connecting to the DLPFC. Prespecified exploratory outcome measures were changes in general cognition; positive, negative, and depressive symptoms. RESULTS Compared with sham treatment, active rTMS did not lead to significant change in working memory performance; it was associated with an increase in right DLPFC thickness but not fractional anisotropy. Prespecified exploratory analysis showed a significant decrease in depressive symptoms in the active group; the decrease in depressive symptoms was correlated with an increase in right DLPFC thickness. CONCLUSIONS Although rTMS applied to the bilateral DLPFC was not efficacious in treating working memory deficits in SSDs, it did increase right DLPFC thickness and decrease depressive symptoms. These findings deserve further study given the lack of efficacy of antidepressant medications in SSDs.
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Affiliation(s)
- Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christin Schifani
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Colin Hawco
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erin W Dickie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California
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